Menopause Basics and Unusual Symptoms

Carolyn Khoo
Feb 5
8 min read

Updated: 2 days ago

Menopause does not happen overnight. It unfolds in stages and affects far more than your periods or temperature. Most people know about hot flushes, night sweats and mood changes. Fewer realise how many other systems shift during this time or how unpredictable the transition can be.

This guide walks you through the basics of what happens, when it happens and why your body reacts the way it does. It also highlights symptoms that rarely make it into public conversations but are common in clinics and everyday life. The aim is simple. You deserve explanations that make sense and support that feels grounded in evidence, not guesswork

The Stages

1. Perimenopause

Perimenopause is the transition leading up to menopause. It is when hormones begin to fluctuate and symptoms often appear.

According to the British Menopause Society, perimenopause commonly begins around age 47 in the UK. Evidence from the Cleveland Clinic shows an average duration of around 4 years, while the Mayo Clinic reports a wider range of 2 to 8 years. Some people experience symptoms for as long as 10 years if their cycles begin changing earlier.

During perimenopause your periods may become irregular, heavier, lighter or unpredictable. Hot flushes, sleep disruption, digestive changes, mood shifts and sensory symptoms often begin during this stage because hormones start to vary sharply.

2. Menopause

Menopause is confirmed once you have gone 12 consecutive months without a period with no other medical explanation. This definition is used by the NHS, the World Health Organisation and menopause specialists.

Most women in the UK reach natural menopause at around age 51, based on national population data and British Menopause Society guidance.

Natural Early Menopause

Some people reach menopause naturally before age 45. This is called early menopause. When it happens before age 40, it is known as premature ovarian insufficiency.

Research shows that early menopause can be genetic. Ovarian ageing patterns and the number of follicles you are born with are partly inherited. Some women naturally have fewer viable follicles, so hormone production changes earlier. Autoimmune conditions, chromosomal differences such as Turner syndrome and environmental factors can also contribute. In many cases there is no clear identifiable cause and the ovaries simply age more quickly because of inherited biology.

Induced Menopause

Menopause can also occur earlier for medical reasons.

• Surgical menopause happens when both ovaries are removed, which stops oestrogen production immediately.

• Treatment induced menopause can follow certain chemotherapy drugs or pelvic radiotherapy.

• A hysterectomy, even when ovaries remain, can bring menopause forward because blood flow to the ovaries is reduced.

During menopause oestrogen levels fall to their lowest point and symptoms often intensify. This stage marks the end of reproductive hormone cycling.

3. Post-menopause

You reach menopause once you have gone 12 consecutive months without a period.

The time after you reach that point is called post-menopause, and this stage lasts for the rest of your life.

Your hormones now remain low and steady rather than fluctuating as they did during perimenopause. Some symptoms settle because the hormonal swings stop. Others continue or shift because your body is now living in a long term low oestrogen state. Bone density can decline faster, cardiovascular risk rises and joint or sleep changes can persist. Some people experience hot flushes for several years while others see them ease.

Post-menopause is your new hormonal baseline. How you feel in this stage depends on your general health, your hormone levels and the support or treatment you choose.

Widely Known Symptoms

Hot flushes and night sweats

The brain area that regulates temperature becomes more reactive when oestrogen falls. Small shifts in body temperature trigger an exaggerated cooling response which causes sudden waves of heat, sweating and disrupted sleep.

Mood changes

Oestrogen influences serotonin and dopamine. When hormone levels fluctuate the brain becomes less efficient at regulating emotional responses which can lead to irritability, anxiety or sudden drops in mood.

Sleep problems

Hormone changes affect the body clock and the depth of your sleep. Lower oestrogen fragments sleep cycles and lower progesterone removes a natural calming effect. Night sweats and cortisol spikes further disrupt your sleep and leave you exhausted.

Brain fog

Oestrogen supports areas of the brain responsible for attention and memory. When levels fall your brain processes information more slowly which makes you lose your train of thought or forget everyday details. Stress and poor sleep intensify this.

Weight changes

Lower oestrogen reduces muscle mass and changes the way your body stores fat. Muscle burns energy even at rest. When muscle declines your metabolic rate drops which increases abdominal fat even if nothing else changes. Oestrogen also affects insulin sensitivity which contributes to these shifts.

Unusual Symptoms

Digestive changes

Oestrogen helps regulate bowel movement and supports gut bacteria. When levels fall digestion slows and gut sensitivity increases which leads to bloating, constipation, reflux and IBS like symptoms. The gut also becomes more reactive to stress during perimenopause.

Mouth and oral discomfort

Your gums, tongue and salivary glands contain oestrogen receptors. Lower levels reduce saliva and increase nerve sensitivity which causes dry mouth, burning sensations, altered taste and gum tenderness. Burning mouth syndrome is more common during and after menopause.

Dry eyes

Tear production relies on stable hormone levels. When oestrogen and androgens fall the tear film becomes unstable which leads to dryness, irritation and light sensitivity.

Balance sensitivity, dizziness and vertigo

Your inner ear and vestibular system control balance, movement awareness and spatial orientation. They rely on stable hormone levels to regulate inner ear fluid, nerve signalling and how your brain interprets motion. When oestrogen falls these signals become less consistent which makes the inner ear more reactive. This can create a mix of symptoms including light unsteadiness, stronger motion sensations, dizziness or brief episodes of positional vertigo when you turn your head or change direction quickly.

Tinnitus and sound sensitivity

The auditory system contains oestrogen receptors. When levels drop the brain may filter sound differently which can increase tinnitus or make certain noises feel sharper or more intrusive.

Difficulty hearing in noisy places

Separating speech from background noise relies on fast processing in the auditory cortex. Oestrogen supports these pathways. When levels fall the brain struggles to filter what matters from what does not which makes busy environments harder to tolerate.

Adult onset asthma

Oestrogen interacts with immune pathways that regulate airway inflammation. When levels fall the airways can become more reactive which increases the likelihood of wheezing or new asthma symptoms appearing in midlife.

Thyroid problems

Thyroid issues become more common in midlife and overlap heavily with menopausal symptoms. Falling oestrogen may alter immune activity which increases the risk of thyroid imbalance.

Joint pain and stiffness

Oestrogen reduces inflammation and supports cartilage. When levels fall inflammation increases and joint tissues become less protected which leads to stiffness in the hands, knees, hips and jaw.

Changes in motivation and drive

Oestrogen supports dopamine pathways involved in motivation and reward. When levels dip these pathways work less efficiently which can make you feel flat or disconnected from your usual drive.

Did You Know Menopause Can Change Your Sense of Temperature in Both Directions. Everyone talks about hot flushes, but fewer people realise that falling oestrogen can also make you feel colder than usual. The same brain centres that overreact to heat can underreact to cold, so your temperature comfort range becomes narrower. This is why some menopausal women need layers even when others feel warm

Managing Symptoms

You cannot control the hormonal changes but you can control how supported your body is. Evidence consistently shows that three approaches make the biggest difference: medical options where appropriate, everyday health habits and complementary therapies that support the nervous system.

1. Hormone Replacement Therapy

HRT is the most effective treatment for hot flushes, sleep disruption, low mood, vaginal dryness and bone loss. It replaces the hormone your body no longer produces consistently.

Many people remain cautious because of old breast cancer fears. These fears came from earlier studies using types of HRT that are no longer prescribed. Newer research shows the risks were overstated. In the United States regulators have recently instructed manufacturers to remove outdated warnings from HRT information leaflets because they were no longer supported by evidence.

HRT is not suitable for everyone but it should not be dismissed because of misinformation. If symptoms are affecting your quality of life you deserve a balanced discussion about whether HRT is right for you.

2. Your General Health

Daily habits carry more weight during menopause because the body becomes more sensitive to stress, inflammation and blood sugar changes.

Nutrition

Lower oestrogen affects gut bacteria, blood sugar control, bone health and energy regulation. A diet built around protein, vegetables, whole grains and healthy fats helps stabilise blood sugar and reduce digestive sensitivity.

Exercise

Strength training protects bone density and muscle mass. Cardiovascular exercise supports mood, sleep and heart health. Consistency matters more than intensity.

Mental Health

Hormonal changes affect emotional regulation. Anxiety, irritability and low mood are common. Talking therapies, structured routines and stress reduction techniques can ease the emotional load and prevent symptom escalation.

3. Complementary Therapies

Complementary therapies help your body cope with the physical and emotional load of menopause by calming the nervous system and reducing pain signals.

Massage

Hands on therapy reduces tension, improves circulation and supports deeper sleep. During menopause many people carry tension in the jaw, neck, shoulders, abdomen and lower back. At Khoo Massage Therapies your Menopause Massage is a full body treatment with targeted pressure point work designed to ease hot flushes, headaches, digestive discomfort and fatigue.

TCM (Traditional Chinese Medicine) And Acupuncture

Acupuncture has been known to help with hot flushes, sleep disruption and anxiety by influencing the autonomic nervous system. Traditional Chinese medicine can also support digestion and stress regulation during perimenopause. I will be writing another blog in the future exploring this.

Mind Body Therapies

Meditation, breathwork and gentle movement practices reduce cortisol and support emotional regulation. Lower cortisol often leads to fewer night sweats, calmer digestion and more predictable sleep patterns.

Menopause Is A Full Body Change

It deserves support that reflects your symptoms, your lifestyle and your goals. Whether you choose medical treatment, lifestyle changes, complementary therapies or community support, you do not have to navigate this alone.

Did You Know You Do Not Need Hormone Blood Tests To Be Taken Seriously. If you are age 45 or older and showing clear symptoms of perimenopause or menopause, you should be offered support without needing hormone blood tests. Both the British Menopause Society and NICE state that diagnosis in this age group must be based on symptoms alone because hormone levels fluctuate too much to give reliable results. Younger women can also be diagnosed by symptoms, especially if their cycles are changing or they have typical perimenopausal signs. Hormone tests may be used sometimes in women under age 45, but they are not required for your symptoms to be recognised or taken seriously. This guidance is designed to prevent women being dismissed, delayed or told that “your tests look normal” despite experiencing real menopausal symptoms.

Support Beyond Treatment

Menopause is overwhelming when you do not have the right information or people around you. This is why I created an online community called Bite Club for peri and menopausal women who want evidence based guidance, connection and real peer support. It gives you a place to share experiences, learn from others and feel understood at a time when your body and priorities are shifting.

If you'd like to book a Menopause Massage with Carolyn, please click one of her services below:

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