Menopause symptoms explained. You are not going mad.

Let’s start with the most important thing.

You are not imagining it.

You are not weak.

And you are definitely not going mad.

If you are struggling with menopause or perimenopause symptoms and would like personalised support, you can find out more about working with me here.

Menopause and perimenopause are not just about hot flushes or periods stopping. They are a whole-body transition that often falls right into the busiest, most demanding decade of a woman’s life.

Careers are peaking. Families still need you. Parents may be ageing. Stress levels are high. And just as life ramps up, hormones start doing their own thing.

Understanding what is happening in your body can be hugely reassuring. It also explains why symptoms can feel so intense, wide-ranging, and at times completely overwhelming.

Menopause is not a single moment

Perimenopause can begin in the late 30s or early 40s and can last many years. Hormones do not gently decline in a neat, predictable line. Instead, they fluctuate, spike, crash, and behave unpredictably.

This is why many women say they feel “not themselves” long before periods stop.

•             Progesterone is usually the first hormone to fall. It is calming, so its loss can drive anxiety, poor sleep, and emotional reactivity

•             Oestrogen fluctuates wildly before settling low. This affects mood, memory, temperature control, joints, skin, and confidence

•             Cortisol becomes more reactive. Life stress hits harder than it used to

•             Insulin resistance increases, making weight management and blood sugar harder

•             Thyroid function can wobble, affecting energy, focus, and temperature regulation

•             Testosterone declines from our late 30s, impacting muscle, motivation, mood, and libido

Sometimes lifestyle changes are enough. But when symptoms persist, understanding what is happening beneath the surface can be a game-changer.

This is also why blood tests alone often fail to tell the full story in midlife. Hormones do not simply run low or high during perimenopause. They fluctuate hour by hour and day by day. This is why I often use comprehensive hormone testing such as DUTCH testing. It looks at hormone patterns, metabolism, cortisol rhythms, and how oestrogen is being broken down and cleared. It helps explain why two women with similar symptoms can have very different underlying drivers, and why treatment needs to be personalised rather than based on guesswork.

For some women, understanding their hormones or gut health in more detail can be incredibly reassuring. If you would like to explore this through personalised testing and support, you can find out more here.

Menopause itself is reached after twelve months without a period. From month thirteen, a woman is considered postmenopausal.

Why do menopause symptoms feel so intense

Menopause is not just about “sex hormones”. It affects the brain, nervous system, metabolism, gut, muscles, bones, immune system, and how resilient you feel day to day.

Many women experience multiple symptoms at the same time, which is why it can feel like everything is falling apart at once.

Common menopause and perimenopause symptoms

Symptoms can include:

•             Mental health and emotional well-being, including increased anxiety, low mood, irritability, sudden rage, tearfulness, loss of confidence, low self-esteem, feeling lost, low motivation, apathy, and depression.

•             Poor sleep, especially waking between 2am and 4am, difficulty falling asleep, early waking, non-restorative sleep, and constant fatigue.

•             Cognitive and neurological symptoms, including brain fog, forgetfulness, poor concentration, word-finding issues, dizziness, vertigo, shakiness, internal tremor sensations, palpitations, and increased sensitivity to noise and stimulation.

•             Weight and body composition changes, including weight gain, especially around the middle, increased fat storage, reduced muscle mass, and changes in body shape, despite no major dietary changes.

•             Increased inflammation and pain, including joint pain, frozen shoulder, carpal tunnel type symptoms, sore feet, plantar fasciitis, Achilles pain, muscle aches, headaches, and migraines.

•             Skin, hair, and connective tissue changes include itchy skin, dry skin, thinning skin, slower wound healing, dry or coarse hair, hair thinning or shedding, brittle nails, and changes in collagen and skin elasticity.

•             Eyes, nose, mouth and ears, including dry or gritty eyes, blurred vision, sinus congestion, post-nasal drip, itchy ears, tinnitus, sore tongue, burning mouth, and changes in taste or smell.

•             Digestive and metabolic changes, including bloating, reflux, nausea, constipation, slower digestion, food sensitivities, increased histamine reactions, and signs of sluggish or fatty liver.

•             Bladder and pelvic symptoms, including increased urinary urgency or frequency, leaking, recurrent UTIs, bladder sensitivity, and pelvic floor changes.

•             Vaginal and sexual health changes, including vaginal dryness, irritation, burning, pain during intimacy, increased risk of thrush and UTIs, vaginal atrophy, and reduced libido or sensation.

•             Muscle, bone, and physical resilience, including loss of muscle tone and strength, reduced exercise tolerance, slower recovery, increased risk of injury, loss of bone density, and fear of frailty or falls.

•             Temperature regulation issues, including hot flushes, night sweats, cold intolerance, sudden chills, flushing, and difficulty regulating body temperature.

•             Immune and allergy type changes, including increased allergies, worsening hay fever, eczema, asthma flares, and heightened inflammatory or autoimmune symptoms.

Immune and allergy type changes including worsening hay fever, eczema, asthma flares, increased allergies, and heightened autoimmune or inflammatory symptoms.

Weight gain is not about willpower

One of the biggest frustrations during menopause is weight that will not shift, even when you eat less or try harder.

This is not a failure of discipline.

•             Falling oestrogen increases insulin resistance

•             Muscle mass naturally declines, lowering metabolism

•             Stress and poor sleep drive cravings and fat storage

•             High insulin keeps the body in storage mode, especially around the abdomen

This is why calorie counting alone often backfires in midlife.

Protein and muscle are menopause power tools

Protein is not just about food choices. It is a hormonal strategy.

Adequate protein supports:

•             Muscle mass and metabolism

•             Blood sugar stability

•             Appetite control and reduced cravings

•             Bone strength and long-term independence

•             Mood, motivation, and mental clarity

Most women benefit from protein at every meal, alongside strength or resistance-based movement, to protect muscle and long term metabolic health.

Your gut matters more than you think

The gut plays a key role in clearing old hormones, especially oestrogen. When gut health suffers, hormones can be recirculated, worsening symptoms.

Poor gut function can contribute to:

•             Bloating and digestive discomfort

•             Mood changes and anxiety

•             Increased inflammation

•             Sleep disruption and fatigue

•             Histamine reactions, which often worsen during perimenopause

Supporting digestion and bowel regularity is a foundation, not an optional extra.  When gut symptoms are persistent, severe, or accompanied by anxiety, inflammation, weight gain, or worsening hormone symptoms, gut testing can be invaluable. The gut plays a major role in clearing hormones, regulating inflammation, and supporting mood and immunity. Imbalances in gut bacteria, poor digestion, sluggish bile flow, or ongoing low grade infection can all worsen menopause symptoms. Testing allows us to target support more precisely, rather than layering supplements or dietary changes without understanding what is actually driving the problem.

Lifestyle support that actually works

This is not about perfection, restriction, or punishing your body. It is about consistency and working with your physiology during a time of recalibration.

Helpful foundations include eating regularly with enough protein, protecting sleep and nervous system health, strength based movement alongside gentle daily activity, managing stress and learning to say no, morning light exposure, time outdoors, reducing constant digital stimulation, and making time for joy, creativity, and rest.

A final word

Menopause is not a personal failure or something you should just push through. It is a significant biological transition that deserves understanding and support.

With the right foundations, many symptoms can improve, energy can return, and long term health can be protected.

And above all remember this.

You are not imagining it.

You are not broken.

And you are not alone.

If you are tired of guessing and want support tailored to your symptoms, history, and lifestyle, you can book a menopause consultation here.