Menopause Mini-Series: Part 1 — What is menopause? | Rodolico Health
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This article is part of a short series on menopause and perimenopause, designed to provide clear, evidence-based information across what can often feel like a complex and confusing area. We begin by understanding what menopause is and how it presents, before moving on to practical approaches to managing symptoms, and finally looking in more detail at hormone replacement therapy (HRT) and when it may be appropriate.
What is menopause?
Menopause is often described as a single moment in time, but in practice it’s a transition that unfolds gradually. Medically, menopause is defined as the point when a woman has gone 12 consecutive months without a menstrual period, marking the end of natural fertility. The average age in the UK and Europe is around 51, though it varies widely.
What’s less commonly appreciated is that the hormonal changes leading up to menopause can begin many years earlier. The phase before the final period is known as perimenopause, and symptoms can start up to 8–10 years before periods stop completely. During this time, hormone levels, particularly oestrogen, fluctuate rather than simply decline, which explains why symptoms can feel unpredictable.
A personal reflection from practice
Menopause wasn’t a major focus during medical training. Like many doctors trained in that era, much of the teaching around treatment, particularly hormone replacement therapy (HRT), was often overly cautious following concerns raised in the early 2000s.
In hindsight, and with the benefit of more robust, longer-term data, we now understand that many women were denied access to effective and important treatment because of risks that were later clarified, refined, or in some cases overstated. As the evidence base evolved, so too did clinical guidance.
At the same time, treatment itself has moved on. The development of transdermal options (such as patches and gels) has been particularly important, offering effective symptom control while reducing certain risks associated with older oral preparations, especially in relation to clotting.
Working in general practice in the UK, I found that menopause became a substantial part of day-to-day clinical work. That prompted a more deliberate effort to revisit the evidence, deepen my understanding, and ensure I was recognising symptoms early and managing them appropriately.
Alongside this, my work as a senior clinician at the National Migraine Centre offered a different perspective. It became clear how closely hormonal fluctuation and migraine are linked (especially during perimenopause), when instability in oestrogen levels can worsen migraine frequency and severity.
It’s now an area of medicine I particularly value, because done well, it allows us to support not just symptom control, but overall wellbeing at a pivotal stage of life.
Women’s health, and in particular menopause care, has become a core focus of my clinical practice, ensuring women receive clear, evidence-based support, timely diagnosis, and access to effective treatment when they need it.
Common symptoms
Menopause affects each person differently, but there are patterns we see frequently:
- Hot flushes and night sweats
- Changes in menstrual cycle (irregular, heavier or lighter periods)
- Sleep disturbance
- Low mood or anxiety
- Reduced concentration or “brain fog”
- Vaginal dryness and discomfort
- Reduced libido
These symptoms are largely driven by fluctuating and eventually declining oestrogen levels.
Less obvious (but equally important) symptoms
- Joint aches and stiffness
- Palpitations
- Headache or worsening migraine
- Changes in skin and hair quality
- Urinary symptoms (urgency, frequency, recurrent infections)
- Reduced confidence or sense of self
- Pain during sex (often related to vaginal dryness)
Because these symptoms are not always immediately linked to menopause, they can be misattributed or simply endured without support.
Neurodivergence and menopause
An area that is increasingly recognised, but infrequently discussed, is the impact of menopause on neurodivergent women, including those with ADHD and autistic women.
Oestrogen interacts with dopamine and serotonin pathways involved in attention, mood, and executive function. As levels fluctuate, many women notice a shift in how their brain functions, with previously manageable traits becoming harder to regulate.
This can present as decompensation, including increased cognitive load, reduced organisation, heightened sensory sensitivity, and fatigue.
For autistic women, this may include greater sensitivity to noise, light, and temperature, alongside increased reliance on routine. Previously effective coping strategies may become harder to sustain, leading to overwhelm and withdrawal.
These changes are increasingly recognised as biologically influenced and are often under-recognised in clinical settings, sometimes misattributed to anxiety or low mood.
Why diagnosis is usually clinical
A common question is whether a blood test can confirm menopause. In most cases, it doesn’t add much value.
Hormone levels can fluctuate significantly, meaning a single test may be misleading. For this reason, menopause is usually a clinical diagnosis based on symptoms and history.
In practice, careful listening and recognising patterns over time is far more useful than relying on a one-off test.
The role of symptom awareness
Many women describe a period of “not quite feeling themselves” before recognising menopause as the cause. Tracking symptoms over time can help build a clearer picture and guide decision-making.
A broader view—and why treatment matters
Menopause is not just about hormones, it often overlaps with work, family responsibilities, and changes in identity. Recognising this wider context is important.
For some women, symptoms are mild. For others, they can significantly affect quality of life.
This is where treatment, particularly HRT, becomes important. The evidence now supports its role as a safe and effective option for many women when used appropriately.
In clinical practice, stabilising hormonal fluctuation can be genuinely transformative.
We’ll explore this in more detail in a follow-up article.
If you would like to discuss any symptoms you are experiencing, you are very welcome to get in touch or book an appointment.
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