Figure 1: During the menopause a woman’s hormonal balance changes gradually. The end of the fertile years can be challenging, but it also offers an opportunity for a fresh start.
Menopause is a distinctive natural phase in a woman’s life. Besides the cessation of menstrual bleeding after the menopause, this stage of life is associated with other physical and psychological changes. In this blog article you will learn what happens in the body before, during and after the menopause, and which typical complaints may occur. You will also find helpful diet and lifestyle tips to support you in facing the changes of the menopause feeling stronger and more optimistic.
Menopause in women: Farewell and an exciting new beginning
For women, the menopause marks the end of the fertile years. The medical term is “climacteric”, derived from the Greek word klimaktér (translated: “ladder of life”). The term indicates that the menopause is a time of upheaval during which a woman’s hormonal balance changes step by step. With the first period during puberty the menstrual cycle begins, repeating many times throughout a woman’s life. New eggs mature repeatedly and are released at ovulation. Over the years, however, the supply of eggs slowly dwindles – the menopause begins.
The age at which this happens varies from woman to woman. For most women the menopause begins in their mid-40s. Fluctuations and declines in the female sex hormones oestrogen and progesterone can lead to various symptoms commonly referred to as “menopausal complaints”. Yet this new life phase also has positive aspects: many women use the climacteric to refocus and prioritise their own well‑being. Approaching this life stage positively is all the more important as women’s life expectancy continues to rise and they therefore spend an increasing portion of their lives in the postmenopausal phase.[1]
From pre- to post-menopause: the stages of the menopause
The menopause is a lengthy process that typically lasts ten to fifteen years in total. It can be divided into different phases that flow into one another and whose durations are highly variable.
Pre-menopause
In the years before the menopause the productivity of the ovaries decreases and hormone production gradually declines. Progesterone usually begins to fall first while oestrogen often remains relatively stable for a time. Common signs of pre‑menopause include changes to the menstrual cycle (shorter or longer cycles), sleep problems and increased irritability. Early menopause usually begins in the late 30s or early 40s and often lasts several years. In rare cases premature menopause can occur between the ages of 30 and 35. Removal of the ovaries, chemotherapy and radiotherapy, thyroid disorders, autoimmune diseases or smoking are common causes.
Peri-menopause
In the immediate phase before the menopause oestrogen levels fluctuate and fall significantly. Cycles become irregular and typical menopausal complaints such as hot flushes, sleep disturbances and mood swings may occur. Perimenopause begins roughly one to two years before the final menstrual period (menopause) and ends one year afterwards. As long as ovulations continue to occur, pregnancy is still possible during perimenopause. Women who do not wish to become pregnant are therefore advised to use contraception until about the age of 52.
Menopause
Menopause refers to the exact time of the last menstrual bleed. On average, women experience menopause between the ages of 51 and 52. Whether a bleed was the last one can only be determined in hindsight. If no further bleeding occurs for 12 months, the time of menopause can be established retrospectively.
Post-menopause
One year after the last period the post‑menopause begins. By then the female body has usually adapted well to the low oestrogen levels. As the hormonal balance re‑establishes, menopausal complaints generally decrease. By the age of 55 to 60 most women are largely free of symptoms and leave the menopausal phase behind them.
More than just hot flushes: typical complaints during the menopause
Figure 2: The hormonal changes during the menopause are usually accompanied by physical symptoms such as hot flushes, sleep disturbances and mood swings.
More than 80 percent of women who reach menopause experience psychological or physical symptoms during this time.[2] These vary individually in severity and in the degree of distress they cause. Menopausal complaints should be taken seriously, as they can have consequences not only for the women themselves but also for society. This is confirmed by a survey by the Berlin School of Economics and Law (HWR Berlin), in which 2,119 women aged 28 to 67 were questioned. Ten percent of respondents said they wanted to retire earlier or had already done so because of menopausal complaints. Another quarter reduced their working hours and almost a third of women were on sick leave or took unpaid leave due to symptoms during the menopause.[3]
Below we present the most common menopausal complaints with their main characteristics.
Hot flushes and night sweats
A sudden intense sensation of heat, often followed by profuse sweating, is experienced by many women during the menopause. Night sweats in particular are common. Hot flushes may occur only occasionally or several times a day and often last several minutes. Typical accompanying symptoms include a pounding heart, flushing of the face and chest and subsequent chills. The cause of these heat episodes is probably the brain’s temperature centre, the hypothalamus. Because oestrogen levels fluctuate during the menopause the hypothalamus receives misleading signals and mistakes a normal body temperature for overheating. To “cool down” the body, blood vessels widen, which leads to heat, flushing and increased sweating.
Sleep disturbances
Sleep problems and lack of energy are often the first signs of the onset of the menopause. Often it is the night sweats mentioned earlier that interrupt sleep and reduce overall sleep quality. Progesterone, which has a calming and relaxing effect, also plays a role. When progesterone levels fall during the menopause it can become difficult to fall asleep and frequent night awakenings may occur.
Changes in connective tissue
As oestrogen levels fall during the menopause collagen production also decreases. Since collagen is the body’s main structural protein, this has consequences: connective tissue becomes weaker and loses elasticity, which favours the development of cellulite. Skin also often becomes thinner and drier. Oestrogen deficiency can also affect veins and circulation: as venous valves weaken, blood can pool more easily and varicose veins or spider veins may develop. Impaired lymphatic flow can also lead to fluid retention (oedema).
Weight gain
Many women notice unwanted weight gain, particularly around the abdomen, during the menopause. The causes of extra pounds are varied and only partly directly related to the menopause. Natural reductions in basal metabolic rate in middle age mean the body requires less energy. If daily calorie intake is not adjusted to the reduced energy needs, weight gain occurs. In addition, the body loses muscle mass with age, which lowers the basal metabolic rate further. Changes in appetite and cravings due to hormonal fluctuations during the menopause can also promote weight gain.
Osteoporosis
Oestrogen again plays a key role in bone health: normally the hormone protects bones by inhibiting certain bone‑resorbing cells called osteoclasts. With declining oestrogen levels during menopause, bones lose density and stability, increasing the risk of fractures. To help prevent osteoporosis, a diet rich in vitamin D, calcium and protein as well as regular strength training can be sensible measures.
Loss of libido
The decline in sex hormones can lead to reduced sexual desire. As a consequence of oestrogen deficiency vaginal dryness and painful intercourse are not uncommon. Changes in weight, skin and mood during the menopause can also cause women to feel less attractive in their bodies and contribute to a reduced libido.
Psychological symptoms
As a study by Cardiff University found, the likelihood of experiencing a first episode of major depressive disorder is increased by around 30 percent during the menopause.[4] It is not uncommon for depressive moods or depression to occur during the menopause. Even more common are mood swings, which are promoted by fluctuating hormone levels. If you regularly experience symptoms such as increased irritability, lack of drive, concentration difficulties or feelings of emptiness and despair, you should definitely seek medical advice.
Free and self‑confident: the positive sides of the menopause
In our society the menopause is unfortunately still often treated as a taboo subject. When it is discussed openly, the focus is usually on physical complaints. Many women therefore view the upcoming life phase pessimistically or are even fearful of it. It is all the more important to emphasise that there are at least as many reasons to look forward to the menopause! Menstrual complaints such as PMS, cycle‑related migraine or the purchase of period products belong to the past after the menopause. Many women use the new life phase to reflect on the past years, question old habits and, where appropriate, reorient themselves. This turning inward can provide self‑confidence and mental clarity. In addition, without the need for contraception, a freer sex life is often possible, bringing new depth and quality to partnerships.
Optimal nutrition during the menopause
Diet is an important lever that can significantly contribute to well‑being during the climacteric. Due to the changed metabolism and reduced energy needs, women during the menopause should pay particular attention to a balanced and nutrient‑rich diet. To maintain body weight or even lose a few kilos, experts recommend a Mediterranean‑style diet.[5] Fresh fruit and vegetables, wholegrains, pulses, a small portion of fish, nuts and olive oil may be eaten regularly. Sugar‑rich foods, white bread and red meat should be eaten only rarely or removed from the diet. In general it is sensible to focus nutrition on proteins and healthy fats rather than carbohydrates. High‑quality protein sources such as eggs, pulses or quark support the maintenance of muscle mass. Valuable omega‑3 fatty acids from linseed oil, walnuts, avocado or oily fish (e.g. salmon) can help reduce inflammation and support the function of the heart, joints and brain.
7 tips to get through the menopause healthy and relaxed
Figure 3: Your lifestyle and your inner attitude can be decisive for your well‑being during the menopause.
- Keep active: We benefit from physical activity at all stages of life – and so do we during the menopause. Regular strength training is recommended to increase bone density and help prevent osteoporosis. Endurance sports such as hiking, jogging, swimming or cycling can improve blood lipid levels in the long term and reduce the risk of cardiovascular disease. Last but not least, exercise triggers the release of certain hormones (e.g. endorphins and serotonin) that boost mood!
- Make time for yourself: Many women take on a lot of responsibility in their families, at work and in their circle of friends. Their own needs can come second. As a time of change, the menopause offers an ideal opportunity to prioritise your own well‑being. That is not selfish! If you feel relaxed and strengthened from within, it will automatically be easier for you to be there for others and cope with everyday life.
- Reduce alcohol and coffee: Both alcohol and caffeine can intensify hot flushes and sleep problems. You will do yourself a favour if you consume both substances only in moderation and not too late in the day.
- Be open to change: The menopause is a time of change. Rather than resisting it, it can help to meet this new life phase with openness and curiosity. With an optimistic mindset it is easier to recognise the positive aspects of the menopause and to successfully master possible challenges.
- Relax: The hormonal change during the menopause places considerable demands on the female body. In middle age women are also frequently faced with adult children moving out or caring for relatives, which can cause additional psychological stress. Targeted breathing exercises, yoga, meditation or a massage can provide balance and contribute to relaxation.
- Nurture important relationships: Open exchange can be enormously relieving, especially during the menopause. Talk to friends or your partner about your experiences and possible fears. This usually not only makes you feel better straight away, but also enables those around you to better understand your situation and support you as best they can during the menopause.
- Remember important preventive checks: Regular check‑ups remain important during the menopause. Talk to your gynaecologist about an individual plan for your health check‑ups so that conditions such as osteoporosis and breast and bowel cancer can be detected in good time.
Biographical
Katharina Korbach regularly writes blog posts about medicinal plants and natural active substances for the Narayana Verlag. Early on she developed an interest in language and began writing her own literary texts. A serious illness during her final school years led to an intensive engagement with health and nutrition topics that continues to this day. After repeated failures of conventional medical treatments she chose a more self‑effective, naturopathic therapeutic approach. A plant‑based diet was a key element in her path to recovery.
Katharina studied Cultural Studies (B.A.) and Applied Literary Studies (M.A.). In 2022 she published her debut novel “Sperling” with Berlin Verlag. She now lives in Berlin as a freelance author, medical editor and lecturer. In her free time she prefers to spend time with friends or doing barre training. She also loves to travel and try out new vegan recipes.
[1] Talaulikar V. Menopause transition: Physiology and symptoms. Best Pract Res Clin Obstet Gynaecol. 2022 May. https://pubmed.ncbi.nlm.nih.gov/35382992/.
[2] Gracia CR, Freeman EW. Onset of the Menopause Transition: The Earliest Signs and Symptoms. Obstet Gynecol Clin North Am. 2018 Dec. https://pubmed.ncbi.nlm.nih.gov/30401544/.
[3] HWR Berlin (2023): MenoSupport: Ergebnisüberblick zur deutschlandweiten Onlinebefragung zum Thema Wechseljahre am Arbeitsplatz. https://blog.hwr-berlin.de/menosupport/wp-content/uploads_menosupport/2024/09/MenoSupport_Ergebnisueberblick-Befragung-Wechseljahre-am-Arbeitsplatz.pdf (accessed: 18.02.2025).
[4] Shitomi-Jones LM, Dolman C, Jones I, Kirov G, Escott-Price V, Legge SE, Di Florio A. Exploration of first onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause. Nat Ment Health. 2024. https://pubmed.ncbi.nlm.nih.gov/39421137/.
[5] Silva TR, Oppermann K, Reis FM, Spritzer PM. Nutrition in Menopausal Women: A Narrative Review. Nutrients. 2021 Jun 23. https://pubmed.ncbi.nlm.nih.gov/34201460/.
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27.02.2025
