The menopause: everything you need to know, from hot flushes to HRT

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  • The menopause is something you can’t ignore. It’s unavoidable. It’s inevitable. And it can be daunting.

    We recently spoke with three women who are trying to encourage a bigger conversation around the menopause, so that those going through it don’t feel as isolated, feel that they can chat openly and have access to as much information as possible. Sara Matthews is a consultant gynaecologist, Dr Jan Toledano specialises in women’s hormones at the London Hormone Clinic and Jackie McCusker is a registered Nutritional Therapist.

    It’s almost as if the menopause is a taboo subject, despite the fact that every single woman in the world will go through it. It’s no surprise really, it’s reflective of the way women speak about their periods too. You rarely hear a woman walk up to a big group and ask as bold as brass whether anyone has a spare tampon; rather it’s posed in a hushed whisper.

    We hope that this will be a reliable and useful source of information about ‘the change’.

    What is the menopause

    ‘It is the age at which a woman has her last period,’ explains Sara Matthews. ‘Which for UK women is around 51. At which point there are no functioning eggs left in her ovaries.’ So technically, when a woman has been without a period for twelve months it can be referred to as the menopause. But not before that point. ‘In the Western world one year after your last period is when we’re officially diagnosed as going through the menopause, but up until that point we’re in the peri-menopause and that’s the stage when our oestrogen and progesterone levels are beginning to drop,’ adds Jackie McClusker, who experienced early menopause in her 30s. This is the point at which when women start to experience symptoms, like hot flushes (more on that below). Matthews goes on, ‘the perimenopause can pre-date the menopause by up to 10 years when periods are still regular and hormone levels are normal. The ability to conceive was also lost approximately two years prior to the last period.’

    What are the menopause symptoms?

    You start to experience symptoms in the perimenopausal stage, which as mentioned above can occur at different times for each individual and it’s all down to the changes in your hormones. ‘Progesterone will have already been depleted over the previous decade, so many women will have already gone through heavier periods and worse PMS,’ explains Dr Jan Toledano. ‘Then the ovaries stop producing oestrogen – the hormone that controls many functions of a woman’s body – and that’s when women experience things like hot flushes, low mood, vaginal dryness, poor memory and headaches. On top of that, testosterone also declines, which causes poor energy, lower libido and less muscle strength and lower confidence.’


    There are a whole host of symptoms that occur when you’re at this point, some more common than others. According to Matthews, around 88% of women in the perimenopausal stage will experience hot flushes.

    • skin dryness
    • vaginal dryness
    • hot flushes
    • forgetfulness
    • depression
    • low moods
    • night sweats
    • irregular periods
    • anxiety
    • heart palpatations
    • panic attacks
    • decreased libido
    • joint paints
    • brain fog
    • skin rashes
    • allergic reactions
    • weight gain
    • acne
    • hair loss
    • brittle nails
    • needing to go to the loo more often
    • increased urine leakage
    • migraines
    • breast tenderness
    • difficulty coping at work
    • relationship difficulties
    • sleep deprivation
    • exhaustion

    ‘We have completely individual biochemistries,’ explains McCusker. ‘So, one person’s menopause isn’t going to be the same as another person’s menopause. It’s genetics, diet, the amount of stress we’ve had in our lives, cultural differences, etc.’ Dr Toledano agrees, ‘All women experience the change in hormones differently. Some are debilitated and feel unable to function properly, while others barely notice this change at all.’

    ‘There is an idea that women must carry on through menopause with little complaining,’ says Dr Taledano. ‘These changes however can be devastating and often happen at a time of life when there are other changes too such as children growing up and leaving home. It’s important to know that all the symptoms are preventable and physical changes reversible.’

    Should you see a doctor to confirm you are going through the menopause?

    Matthews recommends that you do, ‘It is always useful to consult your GP about any symptoms that could relate to the menopause, no matter what age you are. A blood test to check your hormones will indicate whether you are 1-2 years from your last period, but you can still have symptoms long before that. If your hormones levels are fine and your periods regular, and your GP has ruled out other causes for your symptoms, then it would be useful at that stage to see a menopause specialist.’
    How long does the menopause last?

    This is not a straight-forward question to answer, because the menopause is defined by the day 12 months after your last period. However, the length of time a woman experiences the perimenopause, or symptoms of the menopause will vary considerably. There is nothing set in stone. ‘There is no test that can indicate how long,’ says Matthews. ‘Women can start symptoms up to 10 years before the periods stop, but recent research suggests that symptoms after the last period last an average time of 7.4 years.’

    What’s the best menopause treatment?

    ‘All perimenopausal symptoms will improve with hormone replacement therapy (HRT),’ says Matthews. ‘About 10 years ago, HRT received bad press after a study suggested it significantly increased the risk of blood clots and breast cancer. The findings have now been refuted and safer HRT regimes have been developed.’ Dr Toledo agrees with HRT as a treatment,’Topping up the hormones that are low is the best option. The fear instilled by those studies and subsequent press frenzy still causes confusion for women. There are no increased risk of disease, and in fact there’s a lower risk of many diseases with certain HRT.’


    Ideally you would get a top up of both oestrogen and progesterone, as they balance each other out. By replacing oestrogen you are protected against heart disease, strokes, high cholesterol, diabetes and osteoporosis. It also helps to relieve hot flushes. There’s also the option of vaginal oestrogen, which prevents and treats vaginal dryness and urinary symptoms. Matthews recommends it to all of her patients from the menopause onwards, apart from breast cancer patients. Replacing progesterone can stop skin being and feeling as dry and helps with cognition and sleep.

    Changes to your lifestyle can also help you manage your symptoms. ‘A heathy diet and exercise, good sleep and doing things that make you happy all have a positive impact,’ says Matthews. ‘Moderating alcohol intake, stopping smoking, taking control of your health will bring massive benefits. Cognitive behaviour therapy can help along with meditation.’ Dr Toledano couldn’t agree more: ‘Make healthy lifestyle choices, like a better diet, more exercise (especially weight bearing exercise to keep your bones healthy), stop smoking, lose excess weight and cut down on alcohol. Meditation or cognitive behaviour therapy can also be really useful.’

    Is there a recommended menopause diet?

    As a nutritional therapist, McCusker works closely with women to help them rethink their diets to help with the symptoms. ‘The female Asian population tend to have a better experience of menopause than us in the western world, and one of the main things is their diet. They have had a very nutritiously dense diet of whole foods, legumes, and traditional fermented soy, which contain phyto-oestrogens. These are natural plant oestrogens and can emit a mildly oestrogenic effect, when when our oestrogen levels are dropping severely during the perimenopause.

    So have a look at your diet, look at the composition of your plate and make vegetables your hero. 50% of your plate should be vegetables. There should be good quality fat, no low fat anything and good quality protein. Things like legumes are really great, tofu, and fermented soy products. Eggs and dairy are great sources of calcium and protein.’

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    A lil spring salad for lunch today using last nights left over organic steak. Really tasty, packed full of antioxidants from the green leaves, avocados, pumpkin seeds and beetroot. The organic steak is a brilliant source of high biological value protein (meaning it contains all essential amino acids, which are readily absorbed!) I don’t have red meat often but occasionally my body craves it and it’s usually because I am tired and low in iron. The pumpkin seeds are a brilliant source of the minerals, (magnesium, Zinc, potassium), vitamin E, protein and healthy fats (essential fatty acids). They also provide crunch and texture to make the salad interesting. Took 5 mins to put together, that’s my idea of fast food!! 😁

    A post shared by Nutrijack (@jackiemccusker) on

    The things to avoid are enviromental oestrogens, a.k.a zeno-oestrogens or endocrine disrupting chemicals. These disrupt your internal hormone system. These come from things like plastic bottles, plastic wrapping and parabens in skincare. McCusker recommends buying organic where possible, ‘Any live stock or animals products, like eggs, because they’re being pumped full of zeno-oestrogen hormones. It’s about making small steps to lower your toxic load. For example, you could change your washing liquids to more natural ones.’

    Is there anything you want our readers to know about the menopause?

    ‘Do not blame yourself for how you feel,’ says Dr Toledano. ‘Get help from your doctor to give you the hormones you need to top up what you are not making and do not use oestrogen if you still have periods (unless this is supervised by a gynaecologist), only use progesterone at this stage.

    ‘Be aware of the symptoms that can arise, seek medical help from your GP and if necessary, a menopause specialist,’ Matthews adds. ‘Don’t suffer in silence! Take a little time out to think about what is happening and how you can adapt your lifestyle to help. Little practical things like layering clothes and having a fan and some water in your handbag, cotton sheets and a cool bedroom can make all the difference.’

    ‘Find a bit of joy everyday,’ recommends McCusker. ‘Although life can be really crap and terrible, find time to laugh, find something that makes your heart sing, that lifts you a little bit. Even in the darkest moments.’

    Thankfully, we live in a world where there are brands that aim to help women during this tough time. Scroll down, for the products that might make your menopausal journey a little bit easier…

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