Understanding menopause

It is not a phase

Perimenopause, the run-up to menopause, can last 4 to 8 years. Sometimes longer. Menopause itself is technically a single day, twelve months after the last period. Then post-menopause is the rest of her life.

So when she says she is going through the menopause, she usually means a years-long stretch of changing hormones, not a passing mood. It is not something to get past. It is a chapter, and you are in it together.

She is not having a bad week. She is in a years-long chapter. You are in it with her. Pace yourselves.

What is actually happening in her body

Oestrogen, progesterone, and testosterone all drop, and not in a steady line. They fluctuate wildly during perimenopause. Those three hormones aren’t only about periods. They affect:

• Mood, anxiety, depression, irritability.
• Sleep quality and depth.
• Memory, concentration, word recall.
• Energy and motivation.
• Libido and sexual response.
• Body temperature regulation.
• Joint pain and muscle tone.
• Skin sensitivity (including to touch).
• Pain tolerance.
• Confidence.
• Bone density.
• Cardiovascular health.

Almost everything you might experience in her, day to day, has a hormonal component to it. That doesn’t mean it isn’t real. It means it has a cause and, often, a treatment.

What it can look like, day to day

• Waking at 3am drenched in sweat, then unable to sleep until 5am.
• Crying in the supermarket. Snapping at people she loves. Apologising in the next breath.
• Forgetting words. Losing her phone. Walking into a room and not knowing why.
• Hot, cold, hot, cold, in the same hour.
• Lower libido, or pain during sex, that has nothing to do with you.
• Anxiety that arrives without an obvious trigger.
• Tiredness that sleep doesn’t fix.
• Suddenly not being able to drink the way she used to.
• Joint pain in the mornings.
• Itchy skin. Clothes that suddenly feel wrong.
• Sensitivity to noise, light, smell.
• A fragility, sometimes, in someone you have always thought of as the strong one.

It is not in her head. It is in her bloodstream.

This is the single most important sentence on this page. The brain you fell in love with is being asked to run on different fuel. The same woman, same heart, same humour, on a chemistry set that has changed.

She has not become a worse person. She has not become weak. She has not stopped loving you. She is doing all of it, harder.

The brain you fell in love with is being asked to run on different fuel. Same woman. Different chemistry. The love isn’t the variable.

Things that are not signals

• Lower libido is not her stopping loving you.
• Crying is not manipulation. It is a body running low on the chemicals that regulate feeling.
• Wanting more space is not a step toward leaving. It is, often, a step toward staying.
• Touch aversion is not personal. Her skin has gone strange to almost everyone, including the grandchildren.
• Forgetfulness is not lack of care. It is brain fog, real and documented.
• Irritability is not her real opinion of you. It is a nervous system running too hot.

Why she might seem like a different person

Many women in midlife describe themselves as “not feeling like themselves anymore.” That isn’t a metaphor. The combination of hormonal change, sleep deprivation, and the cumulative weight of midlife responsibilities (children, parents, work, ageing body) genuinely changes a person.

Most of that, with treatment and time, eases. The person you love is still in there. She may also be becoming someone new, slightly. Both can be true.

What HRT actually is, briefly

HRT (hormone replacement therapy) replaces the hormones her body has stopped producing. It is not the same as the older versions that scared everyone in 2002.

Modern HRT is usually a patch or gel for oestrogen, with a separate tablet for progesterone if she still has a womb. Sometimes testosterone is added. It is generally safe for most women under 60, and the risks are much smaller than the headlines from 20 years ago suggested.

If she has not yet had a proper conversation about HRT with a knowledgeable GP, that is the single most useful thing you can encourage. Treatments and alternatives has the full picture.

What helps her, from where you sit

• Read this page, and a couple of the others. Don’t announce that you’ve been reading. Just be slightly more patient, with no fanfare.
• Take some load off without being asked. Dinner cooked. Bins out. Appointments managed. Small things, often.
• Make the bedroom a soft room, not a rejection arena.
• Don’t panic about her panic. A calm partner is a regulating presence to a nervous system in chaos.
• Encourage her to see a knowledgeable GP. Offer to come with her if she wants.
• Find ways to compliment what is good, that aren’t about sex. The voice. The work. The mothering. The friend she is.
• Keep your own life going. A partner who has disappeared into the menopause is no use to anyone.

And read these next

• Communication tips, the conversations that work and the ones that don’t.
• Help for you, looking after yourself through this.
• When you can’t bear to be touched, the touch aversion side, from her perspective.
• When the desire goes, the libido side, from her perspective.