More Than Hot Flushes: 5 Menopause Changes You Need to Know

Dr Lucy here. I am a 57 yo menopausal woman and I’m embarrassed to say that as a doctor the menopause transition completely blindsided me. There was so much about menopause that I didn't know- even as a female GP until I was personally affected. This is why I have done so much extra training in Menopause management. For me, it was night sweats, terrible sleep and morning anxiety and while the night sweats were fairly obvious, the morning anxiety was so new to me as was the sleep thing. I thought I must have been stressed and even though I did lots of stress management around relaxation (hello hypnosis) it wasn't quite enough.

Menopause brings significant hormonal changes that can affect multiple systems in the body and many of these changes are permanent. So yes the perimenopause period where hormones fluctuate can be challenging, but the permanent decrease in hormones in the post-menopause period brings its own set of issues.

Here are five key areas affected by menopause, along with practical tips for management

#1 Vasomotor Changes (Hot Flushes and Night Sweats)

Symptoms: Hot flushes, characterised by sudden waves of intense heat, often accompanied by sweating and facial flushing, are a hallmark of menopause. These episodes can last from a few seconds to several minutes and may occur multiple times daily. Night sweats, which are hot flushes during sleep, can disrupt rest, leading to fatigue and irritability. Some women don't get flushes per se but notice they are running hot all the time.

Management:

• Menopausal Hormone Therapy (MHT): MHT is the most effective treatment for reducing the frequency and severity of vasomotor symptoms.
• Lifestyle Adjustments: Avoid triggers such as caffeine, alcohol, spicy foods, and stress. Cooling techniques like wearing breathable fabrics, layering clothes or using fans can help. Weight Loss is also helpful as Body fat acts as an insulator, making heat dissipation more difficult.
• Hypnosis: Clinical hypnosis has been shown to reduce the intensity and frequency of hot flushes by promoting relaxation and improving autonomic regulation.
• Non-Hormonal Medications: For women who cannot use MHT, there are medications that can offer relief.
  

#2 Musculoskeletal Syndrome of Menopause

Symptoms: The musculoskeletal system—including bones, muscles, tendons, and ligaments—is significantly affected by menopause due to declining oestrogen levels. Symptoms include joint pain (commonly called "menopausal arthritis"), muscle weakness, reduced flexibility, and an increased risk of osteoporosis.

Tendon-related issues are also prevalent, with conditions such as:

• Plantar Fasciitis: Pain in the sole of the foot due to inflammation of the plantar fascia tendon.
• Gluteal Tendinopathy: Pain on the outer hip caused by weakened gluteal tendons. This often worsens with walking uphill or lying on the affected side at night.
• Frozen Shoulder (Adhesive Capsulitis): Stiffness and pain in the shoulder joint that limits movement and can take years to resolve without treatment.

Management:

• Exercise: Incorporate weight-bearing activities like walking or resistance training to maintain bone density and muscle strength. Gentle stretching exercises can improve flexibility and reduce stiffness in tendons.
• Low Carb Real Food Diet: A diet rich in nutrient-dense foods like non-starchy vegetables, healthy fats (e.g., avocado), and quality protein supports musculoskeletal health while reducing inflammation that exacerbates joint pain or tendon issues.
• MHT: Oestrogen therapy can help preserve bone density, reduce joint inflammation, and improve tendon health by supporting collagen production.

#3 Genitourinary Syndrome of Menopause (GSM)

Symptoms: GSM includes a range of symptoms affecting the vaginal and urinary systems due to oestrogen deficiency. Common complaints include vaginal dryness, itching, burning sensations, painful intercourse (dyspareunia), urinary urgency or frequency, and recurrent urinary tract infections.

Management:

• Local Oestrogen Therapy: Low-dose vaginal oestrogen is highly effective for restoring vaginal tissue health and alleviating GSM symptoms without significant systemic absorption.
• Non-Hormonal Options: Use vaginal moisturisers regularly for hydration and lubricants during intercourse to reduce discomfort. Pelvic floor exercises can improve bladder control and reduce urinary urgency.
• Lifestyle Tips: Stay hydrated and avoid irritants like harsh soaps or synthetic underwear that can worsen symptoms.

#4 Cardiometabolic Changes

Symptoms: Menopause increases the risk of cardiovascular disease (CVD) due to increased inflammation (oestrogen is antiinflammatory) blood pressure, insulin resistance, and weight gain—particularly around the abdomen. These changes stem from declining oestrogen levels combined with age-related metabolic shifts.

Management:

• Low Carb Real Food Diet: A low carb diet supports metabolic health by improving insulin sensitivity and reducing inflammation.
• Exercise: Regular aerobic activity such as brisk walking or swimming combined with strength training helps maintain a healthy weight while improving cardiovascular markers like blood pressure and blood sugar control.
• MHT Timing Matters: Starting MHT within 10 years of menopause may provide cardioprotective benefits for certain women.

#5 Brain Changes: Cognition and Mood

Symptoms: Many women experience "brain fog" during menopause—difficulty concentrating or remembering things—as well as mood swings or heightened anxiety due to fluctuating oestrogen levels impacting neurotransmitters like serotonin in the brain.

Management:

• MHT Benefits: Early initiation of MHT may support cognitive function but should not be used solely for this purpose unless other menopausal symptoms warrant it.
• Lifestyle Strategies: Regular physical activity improves blood flow to the brain while reducing stress hormones that impair cognition. A low carb real food diet rich in omega-3s from fatty fish or flaxseeds supports brain health by reducing neural inflammation. Prioritising sleep hygiene is also essential for cognitive clarity and mood stability.
• Mental Health Support: Cognitive behavioural therapy (CBT) is an effective tool for managing mood swings or anxiety during menopause. Social connection is equally important—stay engaged with friends or family to boost mental well-being.

As a lifestyle medicine physician, I am all about optimising our lifestyle and minimising chronic disease by rebalancing our hormones. This includes our metabolic hormones, our stress hormones and our sex hormones.

The 6 main pillars that we focus on can be summarised as the 6 S's
✔️ Sustenance - Nutrition is a powerful lever to improve insulin sensitivity
✔️ Sleep - Prioritising sleep also improves insulin sensitivity and reduces cortisol
✔️ Strength - Muscle is the great metabolic organ
✔️ Stress Management Skills - Most people think that they need to remove external stressors to gain relief but developing skills to manage those stressors is what we teach.
✔️ Sunshine - Working with your circadian rhythm and being outside is good for us
✔️ Social Connection - Loneliness significantly affects both mental and physical health

Many women need MHT (menopause hormonal therapy) as well. Not only does MHT improve their physiology but it can also give them the capacity to implement lifestyle changes. Hormones and lifestyle medicine work synergistically.

So ladies, if you are struggling with menopausal symptoms or wonder if MHT is right for you then please have a chat with your doctor or you can book in to see me at our new telehealth clinic: http://www.rlmtelehealth.com/menopause

With love and great health

Dr Lucy and Dr Mary XX

The next round of the 12 Week Mind Body Rebalance starts in May. If you want to improve your metabolism, manage your mindset and discover tools that make it easy to implement then join the waitlist now: https://www.rlmedicine.com/12WMBR 

Dr Mary Barson and Dr Lucy are the founders of Real Life Medicine. They help women who have been on every diet under the sun, optimise their health and achieve long lasting weight loss without feeling miserable or deprived.

They do this with their 3 step framework that

• Improves metabolism
• Develops mindset skills
• Provides tools to implement it easily into busy lives

With this comes increased energy, vitality and confidence.

You can avoid chronic disease and stop living life on the sidelines!