Spotlight on Menopause

New research highlights a gap between the symptoms people associate with perimenopause and those they actually experience.

When people think about perimenopause, hot flashes may be one of the first symptoms that comes to mind. Changing periods, night sweats and weight changes may also be familiar signs.

But the experience of perimenopause can be much broader.

A large international study led by Mayo Clinic researchers in collaboration with Flo examined what people know about perimenopause and what symptoms they actually experience. The study included 17,494 participants from 158 countries, making it one of the largest studies of its kind. The findings were published in Menopause, the journal of The Menopause Society. 

The results revealed a striking difference between the symptoms commonly associated with perimenopause and those participants reported experiencing.

Among more than 12,000 participants over age 35, fatigue and exhaustion were the two most commonly reported symptoms, each affecting 83%.

Other frequently reported symptoms included:

• Fatigue — 83% 
• Exhaustion — 83% 
• Irritability — 80% 
• Low mood — 77% 
• Sleep problems — 76% 
• Digestive issues — 76% 
• Anxiety — 75% 

The numbers were even higher among participants who identified themselves as being in perimenopause. In this group, 95% reported exhaustion and 93% reported fatigue, rates that were higher than those reported for hot flashes. 

The researchers distinguished between the two experiences. In the study, exhaustion included effects such as reduced performance, impaired memory, difficulty concentrating and forgetfulness, while fatigue referred more specifically to physical exhaustion. 

This distinction is particularly interesting because symptoms such as difficulty concentrating, forgetfulness and feeling mentally drained may not immediately be recognized as potentially occurring during the menopause transition.

The study also asked participants what symptoms they associated with perimenopause.

Hot flashes topped the list at 71%. Sleep problems followed at 68%, with weight gain at 65%. Compare that with what participants actually reported experiencing, and an important awareness gap begins to emerge.

For many women, perimenopause may not begin with the stereotypical hot flash. It may instead feel like persistent tiredness, disrupted sleep, difficulty concentrating, irritability, anxiety or simply not feeling quite like yourself.

That does not mean these symptoms are always caused by perimenopause. Fatigue, mood changes, sleep problems and cognitive difficulties can have many causes. But the findings demonstrate why it can be helpful to look at the overall pattern of changes occurring during midlife rather than relying on one or two traditionally recognized symptoms.

Perimenopause can last for several years, and symptoms may affect much more than physical comfort. Mayo Clinic researchers noted that symptoms can have a significant effect on daily life, relationships and work. Caregiving responsibilities and other health conditions may add further strain, potentially contributing to fatigue and emotional stress. 

This may be particularly important when symptoms are subtle. Someone experiencing irregular periods together with poor sleep, increasing fatigue and difficulty concentrating may recognize that these changes could be part of the menopause transition. Someone experiencing mainly exhaustion or mood changes may be less likely to make that connection.

Greater awareness of the range of symptoms associated with perimenopause may therefore help women recognize changes earlier and have more informed conversations with their healthcare providers.

Hot flashes remain an important and commonly recognized symptom of the menopause transition, but they are only one part of a much larger picture. Perimenopause can be associated with changes in menstrual cycles, sleep, mood, concentration, energy, vaginal and urinary health, sexual health and other physical symptoms. The combination, timing and severity of those changes can vary considerably from one woman to another. 

The Mayo Clinic study reinforces something increasingly important in conversations about menopause: there is no single perimenopause experience.

The symptoms one woman notices first may be completely different from those experienced by another.

Recognizing the Broader Picture 

If you are approaching midlife and noticing changes that seem unrelated, it may be useful to consider them together. Changes in your menstrual cycle can provide an important clue, but keeping track of sleep, energy, mood, concentration, hot flashes and other symptoms can also help reveal patterns over time.

This does not mean assuming that every new symptom is caused by perimenopause. New, persistent, severe or concerning symptoms should be discussed with a healthcare provider, who can consider other possible causes as well as the menopause transition.

What this research does suggest is that our understanding of perimenopause needs to extend beyond the symptoms people have traditionally been taught to expect.

For many women, exhaustion, fatigue, sleep disruption or mood changes may be an important part of the experience too.

Most conversations about menopause focus on midlife. But for some women, menopause arrives much earlier, sometimes during their 20s or 30s, when friends may be building careers, starting relationships, having children, or planning families.

A recent article from Psychology Today, written by cognitive behavioral therapist Angela Dingwall, highlights an aspect of early menopause that can receive far less attention: its psychological and emotional impact.

While younger women may experience many of the same physical symptoms associated with menopause later in life, experiencing those changes decades earlier can create an entirely different set of challenges. 

Menopause before age 45 is considered early menopause, while menopause before 40 is considered premature menopause. According to the article, around 5% of women in the UK experience menopause before age 45 and approximately 1% before age 40. For some, it occurs because of premature ovarian insufficiency. For others, menopause may be brought on by surgery involving removal of the ovaries, sometimes as part of treatment for conditions such as cancer or endometriosis. 

Whatever the circumstances, experiencing menopause at a young age can mean confronting physical and emotional changes long before they were expected.

One of the most striking themes raised by Dingwall is the feeling of being out of step with your peers. A woman experiencing menopause in her 20s or 30s may be surrounded by friends discussing pregnancy, children, relationships, and future plans while she is dealing with hot flashes, fatigue, sleep disruption, anxiety, memory or concentration difficulties, and changes in fertility.

The experience can also affect how someone sees herself. Menopause, fertility and aging may suddenly become immediate concerns at a time when she hadn't expected to think about them for many years. That disconnect can contribute to feelings of isolation, particularly when mainstream conversations about menopause rarely represent younger women. 

For some women, early or premature menopause also means facing changes in fertility before they have had children, or even before they have decided whether they want them. Dingwall notes that the loss of that choice can bring grief, sadness, anger or confusion, even when having children had not previously been a central life goal. 

This is something Enlli Thompson's recent story brought into sharp focus. After ovarian cancer treatment resulted in surgical menopause at just 19, she had to confront not only cancer and sudden hormonal changes, but also an unexpected change to the future she had imagined.

Stories like hers illustrate why discussions about early menopause need to encompass more than physical symptoms.

Sleep problems, fatigue, anxiety, low mood, and difficulties with memory and concentration can also affect work, relationships and confidence.

And these difficulties can interact.

For example, fatigue may make someone worry about how well she is performing at work. Anxiety can then make sleep more difficult, potentially contributing to further fatigue.

Recognizing these patterns doesn't mean that symptoms are "all in the mind." Instead, it illustrates how physical symptoms, thoughts, emotions and everyday experiences can influence one another. 

The article highlights cognitive behavioral therapy (CBT) as one potential form of support. CBT does not reverse the hormonal changes associated with menopause or replace appropriate medical treatment. Instead, it can provide strategies for coping with some of the emotional and psychological effects associated with menopause.

These may include techniques for managing anxiety and stress, improving sleep, responding to difficult thoughts and developing strategies for coping with symptoms such as hot flashes.

For women experiencing early menopause, psychological support may therefore form one part of a broader, individualized approach to care.

Hot flashes and night sweats may be among the most recognizable signs of menopause, but some of the changes women experience are far less visible.

Brain fog, difficulty concentrating, forgetfulness, anxiety, irritability, low mood, and feeling emotionally overwhelmed can all occur during the menopause transition. Yet because these symptoms can have many possible causes, the connection with changing hormones may not always be immediately recognized.

For some women, these cognitive and emotional changes can be among the most disruptive aspects of menopause, affecting work, relationships, confidence, and everyday life.

Many women describe moments when familiar words seem harder to find, names temporarily disappear from memory, or concentrating on several things at once suddenly feels more difficult.

These experiences are often described collectively as brain fog. They can include forgetfulness, difficulty focusing, slower recall, losing a train of thought, or feeling less mentally sharp than usual.

Hormonal changes may play a role, but menopause does not happen in isolation. Poor sleep, stress, anxiety, hot flashes, medications, health conditions, and other factors can also affect memory and concentration.

That is why new or persistent cognitive symptoms should not automatically be assumed to be menopause.

Emotional changes can also be significant during perimenopause and menopause.

Some women experience increased irritability, anxiety, mood changes, or a lower tolerance for stresses they previously managed more easily. Others describe simply not feeling like themselves.

The menopause transition may coincide with considerable pressures in other areas of life, from careers and relationships to caring for children or aging parents. Sleep disruption and persistent physical symptoms can add another layer.

The result can be a complicated combination of hormonal, physical, emotional, and life-stage factors rather than one simple cause.

Unlike a hot flash, cognitive and emotional symptoms aren't necessarily visible to anyone else.

Forgetfulness may be dismissed as getting older. Difficulty concentrating may be blamed on a demanding job. Anxiety may be treated as an isolated mental-health concern without considering whether menopause could be contributing.

That does not mean every cognitive or emotional change during midlife is caused by menopause. Instead, greater awareness can help women recognize when a change deserves further discussion with a healthcare provider.

If changes in memory, concentration, anxiety, mood, or emotional wellbeing are persistent, worsening, or interfering with everyday life, talk with your healthcare provider.

Other medical conditions, medications, sleep disorders, mental-health conditions, nutritional deficiencies, and other factors can sometimes cause similar symptoms and may need to be considered.

Seek prompt medical attention for sudden or severe cognitive changes, confusion, neurological symptoms, or significant changes in mental health.

Menopause is often thought of as a transition that happens naturally during midlife. But for some women, menopause can occur much earlier, and sometimes very suddenly, as a result of medical treatment.

Enlli Thompson was just 19 when she was diagnosed with a rare form of ovarian cancer. Her treatment eventually required a hysterectomy and removal of her remaining ovary, putting her into immediate surgical menopause and meaning she could no longer carry a pregnancy.

Her experience highlights a side of menopause that receives far less attention: what happens when menopause is brought on by cancer treatment or surgery, particularly at a very young age.

Natural menopause usually develops gradually as ovarian hormone production changes over time. Surgical menopause can be very different.

When both ovaries are removed before natural menopause, the resulting loss of ovarian hormones is abrupt. Symptoms can therefore appear suddenly rather than developing gradually. Women may experience hot flashes, night sweats, sleep disruption, mood changes, vaginal and sexual-health symptoms, and other effects associated with declining estrogen levels.

For someone experiencing this at 19, the transition can be profoundly different from that of friends and peers who may not expect to think about menopause for decades.

For Enlli, one of the most difficult consequences was learning that she would not be able to have biological children in the way she had imagined.

She told BBC Wales that learning she would not be able to have children herself was devastating, and she broke down and cried as she grieved the future she had imagined. However, following fertility treatment, Enlli was able to freeze some of her eggs. She also spoke about how the experience changed her perspective on life. 

Enlli described experiencing symptoms commonly associated with menopause, including hot flashes, brain fog, and fatigue. However, she acknowledged that she cannot be certain whether these symptoms are related to menopause, chemotherapy, or a combination of the two. 

Her story is an important reminder that medically induced menopause can involve much more than managing physical symptoms. Fertility, relationships, sexuality, body image, emotional wellbeing, and plans for the future may all be affected.

Surgical menopause occurs when both ovaries are removed before natural menopause, causing ovarian hormone production to fall abruptly. It differs from natural menopause, which typically develops gradually. Menopause occurring before age 40 is generally described as premature menopause.

Experiencing surgical menopause during the teenage years is unusual and can bring physical and emotional challenges at a stage of life when menopause may be completely unexpected.

Menopause management following cancer treatment is highly individualized and may depend on factors including the type of cancer, treatment received, age, symptoms, medical history, and other health considerations.

Women experiencing menopause following cancer treatment should discuss symptom management and longer-term health needs with their oncology and healthcare teams.

Source note: This Spotlight feature is based on Enlli Thompson's account reported by Danielle Herbert for BBC Wales and published on MSN. 

Many women expect menopause to begin with hot flashes or the end of their periods. In reality, the transition often starts much earlier, and the first signs can be subtle, unexpected, and easy to dismiss.

Recent research found that around one in three women aged 35 and older are unsure whether they are in perimenopause, highlighting just how confusing this stage of life can be.

Perimenopause is the transitional stage before menopause. It usually begins during the mid-40s, although some women experience changes earlier or later. It can last anywhere from four to eight years, and in some cases even longer. 

Unlike menopause, which is confirmed after 12 consecutive months without a menstrual period, there is no single test that clearly identifies perimenopause. Hormone levels naturally fluctuate from day to day, so diagnosis is usually based on symptoms, menstrual history, age, and an overall clinical assessment rather than one blood test. 

Many women are surprised that perimenopause can begin before their periods become irregular.

Possible symptoms include:

• Changes in menstrual cycles 
• Hot flashes or night sweats 
• Poor sleep 
• Brain fog 
• Mood changes or anxiety 
• Fatigue 
• Vaginal dryness 
• Weight changes 
• Reduced libido 

Some women experience only a few symptoms, while others notice changes affecting several areas of their health.

The recent study found that uncertainty was greatest among women with more severe symptoms. Many participants reported difficulty recognizing whether their symptoms were caused by stress, ageing, other health conditions, or perimenopause itself. Others described feeling dismissed or being told they were "too young" to be entering this stage. 

Recognizing that perimenopause can begin gradually helps validate women's experiences and encourages earlier conversations with healthcare professionals.

Perimenopause is a natural life transition, not an illness. Understanding what is happening in your body can make it easier to recognize symptoms, explore treatment options when appropriate, and make lifestyle changes that support your long-term health.

The more women understand about perimenopause, the less confusing and isolating this stage of life becomes.

When shoulder pain isn't "just getting older"

Most women have heard about hot flashes and night sweats, but far fewer know that menopause may also be associated with painful musculoskeletal conditions such as frozen shoulder.

According to recent media reports, actress Penélope Cruz recently spoke about her own experience with hormonal changes during perimenopause and highlighted frozen shoulder as one of the symptoms many women don't expect. Her comments have sparked wider conversations about the many ways menopause can affect the body beyond the symptoms most people recognize. 

Frozen shoulder, medically known as adhesive capsulitis, is a condition that causes pain, stiffness, and a gradual loss of movement in the shoulder joint. Everyday activities such as reaching overhead, fastening a bra, getting dressed, or sleeping comfortably may become increasingly difficult.

The condition usually develops gradually and often progresses through three stages:

• Freezing: increasing pain and reduced movement 
• Frozen: stiffness becomes more noticeable while pain may lessen 
• Thawing: shoulder movement gradually improves 
• 
  

Recovery often takes many months and, in some cases, more than a year. 

Researchers continue to study the relationship between menopause and frozen shoulder. While menopause is not thought to directly cause the condition, frozen shoulder is considerably more common in women between 40 and 60 years of age, the same years many women experience perimenopause and menopause.

Experts believe declining estrogen may influence connective tissues, inflammation, and joint health, potentially contributing to an increased risk in some women. Other factors, including diabetes, thyroid disease, previous shoulder injury, and prolonged shoulder immobility, may also increase the likelihood of developing frozen shoulder. 

Because frozen shoulder often develops gradually, many women assume they have simply slept awkwardly or strained a muscle.

If shoulder pain persists, movement becomes increasingly restricted, or everyday activities become difficult, it's important to seek medical assessment. Early diagnosis can help identify the cause and guide appropriate treatment.

Treatment may include:

• Gentle stretching and physical therapy 

• Pain-relieving or anti-inflammatory medications 

• Corticosteroid injections in selected cases 

• Addressing underlying medical conditions 

• Discussing menopause management with a healthcare provider where appropriate 

Treatment is individualized and depends on the severity of symptoms and the underlying cause. 

Penélope Cruz's willingness to discuss a lesser-known menopause-related issue helps broaden public understanding of what women may experience during midlife.

While every woman experiences menopause differently, greater awareness means women are more likely to recognise unexpected symptoms, seek appropriate care, and realise they are not alone.

Sometimes the most valuable conversations are the ones that remind us menopause can affect far more than hot flashes.

Many women don't begin thinking about menopause until symptoms appear. But growing awareness is shifting the conversation from simply managing symptoms to preparing for this important stage of life before it begins.

While every woman's experience is different, the health habits developed during your 40s, and even earlier, can influence how you feel during perimenopause, menopause, and beyond.

Perimenopause often begins several years before the final menstrual period. During this time, hormone levels fluctuate, and symptoms such as hot flashes, sleep disturbances, mood changes, brain fog, and irregular periods may gradually develop.

Although menopause cannot be prevented, building healthy habits may help support overall well-being and reduce the impact of some symptoms.

Regular exercise supports heart health, bone strength, muscle mass, mood, and healthy weight management. Aim for at least 150 minutes of moderate-intensity activity each week, together with strength training on two or more days.

A diet rich in vegetables, fruits, whole grains, legumes, lean proteins, and healthy fats provides important nutrients for long-term health. Calcium, vitamin D, adequate protein, and fiber become especially important during midlife.

Sleep often becomes more challenging during perimenopause. Establishing good sleep habits before symptoms become disruptive may help improve sleep quality over time.

Chronic stress may worsen menopause symptoms for some women. Regular relaxation, mindfulness, hobbies, social connections, and physical activity all contribute to emotional well-being.

Midlife is an excellent time to review blood pressure, cholesterol, blood sugar, vaccinations, cancer screening, and bone health with your healthcare provider.

Preparing is about healthy ageing

Preparing for menopause isn't about fearing what's ahead; it's about investing in your future health.

Many of the habits that support menopause also reduce the long-term risk of heart disease, osteoporosis, type 2 diabetes, and other age-related conditions.

Rather than waiting for symptoms to appear, menopause can be viewed as an opportunity to build lifelong habits that support healthy ageing.

Small changes made today may have lasting benefits for years to come.

When most people think of menopause, symptoms like hot flashes, night sweats, and mood changes usually come to mind. But many women experience a range of lesser-known symptoms that often go unrecognized or are mistaken for unrelated health conditions.

Recent media reports highlighting these "hidden" menopause symptoms are helping raise awareness that menopause affects far more than reproductive health. Hormonal changes influence almost every system in the body, including the eyes, skin, joints, bladder, digestive system, and brain.

Estrogen receptors are found throughout the body, which is why changing hormone levels can lead to such a wide variety of symptoms.

While every woman's experience is unique, some lesser-known menopause symptoms include:

• Dry eyes
• Burning mouth
• Itchy skin
• Tingling sensations
• Changes in body odor
• Heart palpitations
• Dizziness
• Tinnitus (ringing in the ears)
• Joint and muscle aches
• Electric shock sensations

Many of these symptoms improve over time or can be managed with appropriate treatment and lifestyle changes.

One of the least recognized menopause symptoms is dry eye disease.

Hormonal changes can affect the glands that produce the oily layer of tears, causing tears to evaporate more quickly. Women may experience:

• Dryness
• Burning or stinging
• Grittiness
• Redness
• Blurred vision
• Light sensitivity

Recent research has shown that dry eye disease is more common after menopause and often goes undiagnosed because many women don't realize it may be linked to hormonal changes.

Simple measures such as preservative-free artificial tears, taking regular screen breaks, staying hydrated, using warm compresses, and seeking advice from an eye care professional can often help relieve symptoms.

Many women spend months, or even years, searching for explanations for symptoms they never thought could be related to menopause.

Recognizing that menopause affects the whole body can reduce unnecessary worry, encourage earlier conversations with healthcare providers, and help women access appropriate support.

No woman should feel that her symptoms are "all in her head" simply because they aren't widely discussed.

Some women experience only a few symptoms, while others notice changes affecting multiple areas of their health and wellbeing.

Understanding the full range of possible menopause symptoms helps women feel more prepared and reassured. Most importantly, it reminds us that menopause is a whole-body transition, not just a reproductive one.

The more we talk openly about menopause, including the symptoms that are less often discussed, the easier it becomes for women to recognize changes, seek help when needed, and navigate this stage of life with confidence.

Despite affecting half the population, menopause remains surrounded by myths and misconceptions. Outdated information, conflicting advice on social media, and years of limited discussion have left many women unsure what to believe.

Recent media reports highlighting common menopause myths serve as an important reminder that understanding the facts can help women feel more prepared, make informed healthcare decisions, and navigate this stage of life with greater confidence.

One of the biggest misconceptions is that every woman reaches menopause at a specific age.

In reality, every menopause journey is different. While the average age of menopause is around 51–52 years, perimenopause can begin several years earlier, and the timing varies widely from person to person.

Understanding that symptoms may begin long before periods stop can help women recognize changes earlier and seek support when needed.

Declining estrogen levels can contribute to vaginal dryness, discomfort during sex, and changes in libido. However, menopause does not signal the end of intimacy.

Many effective treatments, including vaginal moisturizers, lubricants, vaginal estrogen, menopausal hormone therapy (when appropriate), and open communication with healthcare providers and partners, can help women maintain a satisfying sex life.

Although fertility declines with age, pregnancy remains possible until menopause has been reached, defined as 12 consecutive months without a menstrual period.

Women who do not wish to become pregnant should continue using contraception until advised otherwise by their healthcare provider.

Many women believe a simple blood test can confirm whether they are in perimenopause.

For most women, this isn't necessary. Hormone levels naturally fluctuate throughout the menopause transition, making a single blood test unreliable. Healthcare providers usually diagnose perimenopause based on symptoms, menstrual history, and age, using blood tests only in specific situations.

The growing menopause market has led to countless supplements claiming to "balance hormones" or eliminate menopause symptoms.

While some supplements may help certain women, there is currently no supplement that cures menopause. Women should be cautious of products making unrealistic claims and discuss supplements with their healthcare provider before starting them.

Many women notice changes in body shape during midlife, particularly increased abdominal fat.

While hormonal changes influence where fat is stored, research suggests that aging, reduced muscle mass, and lifestyle factors play a larger role in overall weight gain than menopause itself. Regular physical activity, strength training, balanced nutrition, and good sleep remain the most effective long-term strategies.

Misconceptions about menopause can delay diagnosis, discourage women from seeking treatment, or create unnecessary fear about what lies ahead.

The good news is that menopause is increasingly being discussed openly by healthcare professionals, researchers, employers, and public figures. As awareness grows, women have access to more evidence-based information than ever before.

Understanding the facts allows women to make informed decisions about their health and recognize that menopause is a natural life transition—not something to fear.

Knowledge replaces uncertainty with confidence, helping women approach menopause with greater understanding, support, and optimism.