Everyone's experience of menopause is different – some will have hot flushes and night sweats, others will feel the toll mentally, while a lucky few will sail through, barely noticing.
Menopause is a natural event that usually happens between the ages of 45 and 55, though it can happen earlier. The whole process can last for just a few years, or for much longer, depending on the person.
Medication like hormone replacement therapy (HRT), for example, can be a lifeline for some, while others might prefer not to take anything unless their symptoms are severe. Meanwhile, aside from the possible difficulties many go through, it can also offer women positives like freedom from pregnancy and contraception.
With so much varied information out there, here are some vital things to know about the menopause from leading experts...
Menopause can cause weight gain
Scientifically, menopause can affect weight for some people.
"Menopause causes weight gain in a lot of women, and one of the main reasons for this is that declining oestrogen is linked to reduced insulin sensitivity," says Alli Godbold, nutritionist and hormonal health expert and spokesperson for Eostre. "Reduced insulin sensitivity results in more glucose from your diet being converted to fat and this fat tends to be laid down around the middle of the body as abdominal fat."
But, it's important to remember that age can also play a part.
"As we age, we also lose skeletal muscle mass resulting in fewer calories being burnt. This means that the diet you ate in your 30s is likely to result in weight gain in your 50s."
HRT can help with weight gain from menopause, as it replaces hormones that are at a lower level. Meanwhile, exercise and physical activity are, of course, the best ways to help your body burn calories.
Menopause can affect sleep
With your hormones out of kilter, it's natural that your body might feel the effects, making it harder to sleep through the night.
"Menopause is often associated with poor sleep," says Godbold. "A drop in the hormone progesterone (that starts in early perimenopause) is a major cause of disturbed sleep."
Symptoms like night sweats can especially cause difficulty sleeping, and make you feel tired and irritable the next day.
"Magnesium glycinate, taken at night, is helpful for improving sleep," Godbold recommends.
"It's also crucial to follow 'sleep hygiene' tips: cool room, total darkness, no screens before bed, finish eating at least two hours before bed, and no caffeine after lunch."
Perimenopause occurs before menopause
Technically speaking, perimenopause is when you have symptoms before your periods have stopped, as your ovaries gradually slow down over a period of time.
"Perimenopause marks the period of time before menopause occurs (menopause officially occurs 12 months after the last menstrual bleed). During this time oestrogen and progesterone gradually decline but oestrogen tends to be in a chaotic flux – this time is often associated with debilitating symptoms," says Godbold.
And menopause itself refers to the very day you haven't had a period for the year, though symptoms can continue afterwards. However, it's normal for the term to be used broadly to describe the whole process.
The perimenopause can last for up to 10 years, according to Godbold.
Menopause can affect your mood
Menopause symptoms aren't always just physical.
"Menopause can certainly affect mood. In early perimenopause, as soon as progesterone starts its decline, mood changes are often experienced," says Godbold.
"During the early perimenopause years, oestrogen is also often relatively high and can cause irritability and anxiety."
She suggests the plant supplements ashwagandha, rhodiola and saffron as they can help with stress and anxiety, as well as magnesium as it's thought to be calming.
Cognitive behavioural therapy (CBT) is also a type of talking therapy that can help with low mood while HRT can also improve mood swings for some (both can also help with some physical symptoms).
Lifestyle factors can improve some symptoms
There are some things you can do yourself to help with menopause and perimenopause, which can also keep you well generally and in the future.
"Lifestyle changes can definitely improve menopause symptoms," says Godbold.
Her top tips include:
Getting a good night's sleep is important for mood, energy and anxiety levels.
Exercise supports muscle mass which helps with body composition, weight maintenance and bone health.
Meditation, mindfulness practice, yoga and breathing exercises are all helpful for reducing anxiety and stress.
Switching to a real food diet (avoid anything refined, processed or sugary) helps with all symptoms and reducing caffeine and sugar can sometimes be helpful for reducing hot flushes.
Menopause can affect your skin
A common physical symptom of the menopause is skin changes.
"When it comes to skin, menopause causes oestrogen levels to dip, resulting in the skin becoming thinner and more dry," says Dr Miriam Adebibe, cosmetic doctor and co-founder of Victor & Garth skin clinic.
"Collagen production also decreases as you age (oestrogen stimulates the formation of collagen, which helps with skin smoothing and hydration) and as a result, this can become more apparent at this time too."
Self-help for skin problems during menopause may also include lifestyle factors like wearing suncream regardless of the weather, avoiding extremely hot showers and baths (stick to warm, instead), drinking plenty of water, using gentle soaps, exfoliating regularly, reducing alcohol consumption and giving up smoking.
There may be a link between menopause and dementia
Research suggests there's a connection between menopause and dementia. For example, "Early menopause (i.e. menopause occurring between 40-45 years of age) and surgical menopause before 45 is associated with an increased risk of dementia," says Erin Wolff, reproductive endocrinology and infertility physician.
In one study, surgical menopause at any age was associated with a faster decline in verbal memory, semantic memory (long-term), and processing speed, while early surgical menopause was further associated with faster global cognitive decline.
Among the women undergoing surgical menopause, a younger age at surgery was linked to faster decline in global cognition, semantic and episodic memory (everyday events), worse performance in verbal fluency and executive function (which helps with planning and juggling tasks), and developing signs of Alzheimer’s in the brain.
However, more positively, Wolff adds, "We also know that women who take oestrogen have a lower chance of developing dementia."
Menopause can affect memory
It's widely known that the menopause has also been linked with more general memory loss too.
"Menopause is associated with many changes that can adversely impact memory, including poor sleep, anxiety and depression," says Wolff.
"Separately from these indirect effects, there also appears to be a subtle decline in cognitive testing," she adds. "During studies, most research participants get better at taking the same cognitive tests each year, but women in the perimenopause don't show this improvement over time, and their scores remain the same despite having taken the test before."
Problems with memory can affect people's day-to-day lives. "Frequent complaints during the menopausal transition are forgetfulness and brain fog. In fact, a recent survey by women's reproductive health company Mira revealed that one in 10 women even consider leaving their jobs because they struggle with brain fog and fatigue, which makes it difficult to focus on their tasks and responsibilities," points out Wolff.
One respondent said: "It’s slowing me down due to the fact that I’m tired and can’t focus. I sometimes have to redo things because I didn’t do them right the first time."
Family history can determine timing of menopause
When exactly you go through menopause is different for everyone, but there is something that can help predict when you'll enter yours. "The age of menopause of family members is associated with the age of menopause for a patient," says Wolff.
Looking to your family history, it's likely you'll experience it at a similar age to when your mother or older sisters started theirs. It can also start due to certain surgeries or cancer treatments.
Getting pregnant is possible during menopause
"It is possible to carry a pregnancy after menopause, although the risks of pregnancy increase with older age," explains Wolff.
"While some patients with premature ovarian insufficiency (when the ovaries stop functioning how they should, normally before 40) get pregnant spontaneously, the highest pregnancy rates occur in patients who are donor egg recipients."
With risks and complications to consider, speak to your doctor and a fertility expert.
Menopause can affect your sight
One slightly lesser-known point is that menopause and vision quality can be linked.
"Menopause can affect sight in a number of ways," says Nicola Alexander-Cross, optometrist and co-founder of eyecare brand, Peep Club.
"Age alone is a risk factor for many sight changes (for example, most of us over the age of 40 will start to need reading glasses), but there are two that we know are closely linked with menopause in particular; dry eyes and cataracts."
The most common vision complaint is dry eyes, apparently. "At least 61% of women experience dry eyes as one of the symptoms of menopause," says Alexander-Cross. "It is also often one of the first symptoms, even experienced in perimenopause. Dry eyes encompasses everything from a low level discomfort, redness, itching and over-watering of the eyes especially in windy or bright conditions, but can certainly include blurred vision and even loss of vision if left untreated."
Cataracts are when the middle lens of the eye becomes cloudy. "This is usually through age-related changes, but has been found to be accelerated in menopausal women compared to men. Cataracts are very treatable but can cause vision deterioration, blurring, glare around lights, colour vision changes and reduced night vision," Alexander-Cross explains.
But, she adds, "Luckily, both dry eyes and cataracts can be treated in most cases – especially if they're identified early on."
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Watch: Five exercises to help alleviate menopause symptoms
Speak to your GP, nurse or pharmacist for advice and help with your symptoms, find your nearest NHS or private menopause specialist on the British Menopause Society website, or find an NHS psychological therapies service.