MENOPAUSE
Updated: Oct 5
Can’t sleep? Menopause.
Forgot a name? Menopause.
Feeling anxious? Menopause.
Lost your libido? Menopause.
Gained weight? Menopause.
Yes, I know. Menopause has terrible PR.
In fact, one of its worst marketing campaigns is the word menopause itself.
Officially, menopause is one day: the day you’ve gone 12 consecutive months without a period.
Unofficially, it has become an expiration label attached to women the day their ovaries supposedly shut the factory down.
And in real life? Neither option is really real. Menopause isn’t a day. And it’s definitely not the end of the story.
Most women don’t wake up one morning and think, I’m in menopause.
They think they’re tired. Or stressed. Or suddenly very hot. Or just getting older.
Menopause is a gradual hormonal transition that can begin years before your final period and continues long after it.
That’s why many women start experiencing symptoms long before they ever think of themselves as “menopausal.”
Yes, hormones are not new to us. And let’s be honest, for most of our lives, they have always been the prime suspect for almost everything.
Puberty. PMS. Periods. Pregnancy. Periods again. And then, just when we finally start to make peace with all of it, our body says, "Let’s do hormones again - but turn the volume up.” And here comes menopause.
For decades, menopause was barely discussed. There was little research, little medical training, and a lot of misinformation. Women were largely expected to figure it out themselves — and suffer through it quietly.
Today, things are starting to change.
Menopause is everywhere. Open a website, listen to a podcast, or scroll through social media, and you might start believing menopause is responsible for almost everything that’s gone wrong with your life.
Somewhere along the way, we got lost between knowing almost nothing about menopause and blaming it for almost everything.
Working with women from different cultures, I’ve noticed that even the way we name menopause can tell a different story.
In English, and in many Latin languages, it sounds like an ending — the end of monthly periods. In Germany and China, it’s described more as a time of change. In Thailand, it can be called the “Golden Age.” In traditional Arabic, it has been called the “Age of Despair.”
Same biology. Different stories.
So, what is actually the story?
This post isn't meant to give medical solutions or replace advice from a doctor. But I think it's helpful to have a bit of insight into what's going on inside our bodies and minds. Even if it doesn't fix everything, it might make things a little less confusing. I also hope it encourages you to start asking questions, looking for answers, and making choices based on facts, not fear.
I promise to keep the long story short, so stay with me.
First, let’s break the story down into three stages:
PERIMENOPAUSE - MENOPAUSE - POSTMENOPAUSE
Think of menopause as crossing a river from one bank to the other.
PERIMENOPAUSE is the crossing.
MENOPAUSE is reaching the other side.
POSTMENOPAUSE is life on the other bank.
Crossing the river isn’t a choice. Every woman who lives long enough will go through it. We just don’t cross it the same way — or at the same time.
Some women will play Jesus and walk on water. Others will feel like they’re barely keeping their head above it. For some, the crossing takes years. For others, much less.
So, when does all this happen?
Perimenopause is the transition before your periods stop. It’s when your hormones and periods start breaking the routine. It often begins several years before the final period, usually in your 40s, although it can start earlier.
Menopause is actually just one point in time: the day you reach 12 consecutive months without a period. The average age is around 51–52.
And then you’re officially on the other side.
Postmenopause is everything after that day. It’s your new hormonal home for the rest of your life.
Sorry. No way back:)
WHAT’S HAPPENING INSIDE OUR BODIES?
Menopause is really a story about the conversation between your brain and your ovaries. And for most of your reproductive life, they have a pretty good working relationship.
Simple, right?
Well, mostly.
Every woman is born with all the eggs she is ever going to have — around one to two million. Each immature egg lives inside a tiny sac called a follicle in the ovary.
Think of follicles as tiny hormone factories.
Every month, the brain sends signals to the ovaries, telling a group of follicles to grow.
As they grow, they produce hormones, including estrogen and small amounts of testosterone.
The brain is basically keeping an eye on the estrogen levels. When estrogen rises high enough, it means one follicle is ready. The brain gets the message and sends another signal to the ovary, triggering ovulation — the release of the egg.
Once the egg is released, the empty follicle changes jobs. It becomes the corpus luteum, a temporary hormone factory that produces progesterone, preparing the lining of the uterus for a possible pregnancy.
If pregnancy doesn’t happen, estrogen and progesterone levels fall. The lining of the uterus sheds, and you get your period.
Then the whole cycle starts again.
Month after month.
Year after year.
For decades.
SO, WHAT CHANGES?
The follicles don’t last forever. As the years go by, their numbers gradually decline. Fewer follicles mean fewer eggs available for ovulation, and eventually, the follicles that remain don’t always respond to the brain’s signals the way they used to. When the brain senses that something is off, it does what any good manager would do: It turns up the volume.
Sometimes the ovaries respond. Sometimes they don’t. The hormone factory starts to be unpredictable.
Estrogen doesn’t simply go down. It can swing high, drop low, then climb again. Up, down, up, down… feel familiar?
Ovulation becomes less predictable too. And when ovulation doesn’t happen, progesterone production is much lower. Periods start doing their own thing—shorter, longer, lighter, heavier, early, late, or sometimes missing altogether.
WHAT DOES IT ACTUALLY FEEL LIKE?
This is where all that biology starts to become personal.
There is no single menopause experience. Most of the time, you slowly start to notice that things aren’t quite the way they used to be.
Maybe you suddenly can’t sleep. You feel more anxious, irritable, or emotional than usual. Your periods become unpredictable. Even your relationship with your body, and sometimes with sex, may change. You get hot flashes or wake up drenched in sweat.
Maybe your brain feels like it has gone on strike. You forget names, lose your train of thought, or walk into a room and have no idea why you’re there. Your body may start changing too. Your weight becomes harder to manage, your muscles feel different, your joints may ache, and you may feel more tired than usual.
SO HOW DO I KNOW?
Perimenopause is usually recognized by looking at your symptoms, your age, your menstrual history, and the overall pattern of changes. And yes, many of these symptoms can have other causes too. So no, not every forgotten name is menopause.
But when several changes start showing up together, especially when you’re in your 40s, changing hormones may be part of the picture.
You don’t need to pee on a stick. You don’t need a blood test. There’s no single test that can tell you if you’re perimenopausal.
And there’s a reason for that. During perimenopause, your hormone levels don’t simply go down in a straight line. They can go up and down like crazy. One blood test is just a snapshot of what’s happening on that particular day.
Instead, we look at the bigger picture.
You know when the changes started.
You know what feels different.
And you know who knows those changes best? You.
You’re not collecting points. You’re just connecting them.
Why Estrogen Matters?
Because estrogen isn’t just about periods and reproduction. Estrogen may be produced in your ovaries, but it doesn’t just belong to your ovaries.
Think of estrogen as a key. The surprising part is how many locks it opens—not just in the ovaries, but in the brain, bones, heart, skin, bladder, and even the urinary system.
Not everything that happens in midlife is caused by estrogen, of course. But there’s something strangely liberating about knowing that we are hormonal beings. That this is completely normal. That we haven’t gone crazy.
And once you understand what’s going on, the next question is:
WHAT CAN YOU DO ABOUT IT?
For some women, the changes will be manageable. They may need a few lifestyle changes, some good sleep, exercise, nutrition — and time. They cross this river, get to the other side, and life settles down again.
But for many women, that isn’t enough.
And then we come to the treatment that has probably caused more confusion than anything else in menopause:
HRT — Hormone Replacement Therapy.
For decades, estrogen was used to treat menopausal symptoms. It helped with hot flashes, night sweats, vaginal symptoms, and bone loss.
Then came 2002, when the Women’s Health Initiative study was published — and everything changed.
The headlines were frightening. HRT became associated with breast cancer, heart disease, and other serious risks. Women stopped taking it. Doctors became more cautious about prescribing it. And a whole generation of women grew up with the idea that hormones were dangerous.
But the story turned out to be more complicated.
The women in the WHI were between 50 and 79, and many were older than women typically starting HRT for menopausal symptoms. The study also looked at specific hormone formulations, not every form of HRT we use today. In other words, 50 is not 70. And HRT is not one single treatment.
Age, timing, type, and route of hormone therapy matter.
Today, hormone therapy is considered the most effective treatment for hot flashes and night sweats. For healthy women younger than 60 or within about 10 years of menopause, who have no contraindications, the benefits often outweigh the risks when treatment is used for bothersome symptoms. It can also help prevent bone loss
But this doesn’t mean HRT is right for everyone. The risks are still there, and what makes sense for one woman may not make sense for another.
So I wouldn’t jump from one headline to the next—or follow every new trend, influencer, or “magic formula” that comes along.
Perhaps the biggest lesson from the HRT story isn’t “take hormones” or “don’t take hormones.”
It’s this:
Don’t make a medical decision based on fear—or on a headline from 20 years ago.
Science has moved on. And so should we.
Ask questions. Look at the evidence. And then look at you.
Which hormones do I need?
The heart of HRT is estrogen. It does most of the heavy lifting — helping with hot flashes and night sweats, vaginal dryness, and bone health.
If you still have a uterus, estrogen is usually combined with progesterone or another progestogen to protect the lining of the uterus. If you don’t have a uterus, you generally don’t need progesterone.
And then there’s testosterone. We’ll come back to that when we talk about sex and menopause.
You may also hear about “bioidentical” and “non-bioidentical” hormones. This is where the language can get confusing. Bioidentical means the hormone has the same chemical structure as the hormone made by your body. Non-bioidentical hormones have a different chemical structure but can have similar effects. And despite what the names might suggest, both are made in a laboratory.
So don’t get too caught up in which one sounds more natural. The better question is: which hormone is right for you, and why?
And bioidentical doesn’t mean compounded. Compounded hormones are made individually by a pharmacy and aren’t FDA-approved. They can have a place when an approved treatment doesn’t meet a woman’s specific needs, but there’s no good evidence that they are safer or more effective than approved hormone treatments.
Then there’s how the hormone is taken.
A pill? A patch? A gel? A spray?
With a pill, estrogen goes through your digestive system and then the liver before it reaches the rest of your body. Estrogen through the skin — like a patch, gel, or spray — takes a different route and bypasses the liver’s first pass. This is generally associated with a lower risk of blood clots than oral estrogen.
And vaginal estrogen is different again. It works locally, mainly where it’s needed, and yes, many women really do need it. Because sex doesn’t age — but our vaginas do.
MENO-PAUSE IS NOT MENO-STOP
Sex during Menopause
Right, Sex doesn’t age. But it changes throughout our lives.
Expecting it to stay the same may be part of the problem.
So relax. Whatever you feel is not working anymore the way it used to, you are probably not the only one.
But it doesn’t mean you have to suffer or feel uncomfortable, and it definitely doesn’t mean the game is over.
If I had to sum up the two concerns I hear most often from women about their sex lives after menopause, I’d say: a drier vagina and, sometimes, a drier desire.
The good news? You’re not in the desert. There are plenty of things you can do to keep your landscape green and vivid.
Let’s start with the physical level.
When sex starts to hurt
As estrogen levels fall during menopause, the tissues of the vulva and vagina can change. They can become thinner, drier, and less elastic, and natural lubrication may decrease.
This can mean burning, irritation, dryness, pain with penetration, or simply that sex doesn’t feel the way it used to.
These changes are very common. They are a normal part of menopause, and doctors call the collection of these symptoms genitourinary syndrome of menopause (GSM).
And GSM isn’t only about sex. The urinary tract is affected too. Some women notice urgency, needing to pee more often, burning when they pee, or more frequent urinary tract infections.
Normal doesn’t mean you have to suffer.
Lubricants and vaginal moisturizers can make sex more comfortable.
One of the most effective treatments for GSM is low-dose vaginal estrogen.
It is applied locally to the vagina, so only a small amount enters the bloodstream. It has been used for many years and is considered safe for most women who need it.
And this is important: vaginal estrogen is not the same as systemic HRT.
Also, testosterone often gets ignored in these discussions—it's not just for guys. Yes, women have testosterone too. It doesn't just vanish when menopause hits. It usually decreases slowly as you age, and for some women, testosterone therapy can make orgasms easier or more satisfying, plus it can help with low sexual desire.
But desire is a bit more interesting than that. It is never just a hormone story.
There is the body.
There is the brain.
There is your heart and relationship.
There is stress, sleep, medication, body image, confidence, and everything else going on in your life.
And sometimes the biggest change isn’t the loss of libido or interest in sex. Sometimes it’s that the sex we used to have—or used to want—doesn’t work for us anymore.
Maybe the answer isn’t to change yourself so you want sex again. Maybe it’s to change the sex so you want sex again.
Ask yourself: what does sex really mean to you now—not what you think it should mean?
Do you actually miss sex, or do you miss wanting sex?
Or maybe you don’t miss either of them at all. And that’s okay too.
Maybe you’re tired of following the same script.
Maybe penetration isn’t the main event anymore.
Maybe you want more touch. More intimacy. More time.
Maybe you miss feeling sexy, being desired.
And maybe you felt all of it before. You just did not let yourself say it. And now you do.
For years, sexuality can become tied up with being desired, being attractive, being young, being feminine, feeling sexually valuable, finding love, keeping a relationship alive, meeting social expectations, pleasing other people, or simply escaping loneliness.
Then, somewhere around menopause, the world may stop expecting you to be endlessly desirable.
That can hurt more than we admit.
But it can also be a release.
If you no longer have to perform being sexy—like a porn star, a good wife, or a younger version of yourself—you may finally get to ask:
What do I actually want?
Maybe menopause doesn’t simply take something away.
Maybe it asks us to reconsider what we want to keep.
And what we want to leave behind.
And sometimes, when you stop worrying quite so much about how you are supposed to look, behave, or be desirable, something interesting happens.
You become more yourself. There can be freedom in that.
Society often tells women they’re becoming invisible. Ironically, many women find that this is the first time they truly become visible to themselves.
