Hormones and Psychology: The Intricate Dance of The Female Body and Mind over Lifespan and Menopause

I’ve always found the inner workings of our brains and bodies completely mind-blowing. The more I learn, the more I see humans as being like an engine or a computer, as a system of moving parts with the brain as the control centre. Like any machine, every part is interconnected and needs certain components to work well, and that is specifically true to that control centre, and things can go wrong if we don’t maintain ourselves. Think of an engine that runs out of oil, or a computer that doesn't have power. They stop working and we understand why, and without blame we fix the problem and get ourselves going again. Sadly the same hasn't been true for females and hormones. We haven't understood them well, we have had to fight hard to get the problem fixed, and even then things don't always go back to running smoothly.

Not only do hormones impact our physical wellbeing but we now understand more than ever the psychological impact they have on us. As a woman I’ve spent years riding the changing waves of my hormonal tides. It feels a deeply personal journey and yet also a completely universal one too. Hormones are not just background chemistry. They are active components in how we feel, think and connect and I now specialise in menopause psychology.

Think back to puberty. One minute we are happily playing as children then hormonal surges come out of nowhere. Mood swings, big feelings, and the odd sense that your body has switched to a language you do not understand yet. Later, monthly cycles keep leaving their fingerprints on energy, focus and mood. Subtle. Persistent. Very real and often we are just expected to ‘get on with it’ because frankly there is a narrative that there isn’t much that can be done and because that is how it has always been.

Later, attempts to get pregnant, pregnancy, and the arrival of a new life can be joyful and complicated at the same time. After birth there is a sharp drop in hormone levels and that crash can open the door to postpartum depression. Most mothers suffer in silence as if somehow this is normal and we should get on and get over it, and as if somehow it is a personal weakness. In rare and severe cases, there can be episodes of psychosis even leading to death, all caused by hormonal change. None of this is a personal failure. It is biology meeting a huge life change.

Then there is midlife. Many of us were taught to expect menopause as a single line in the sand. In truth, most of the shifting happens before that final period. That chapter is perimenopause. Night sweats. Broken sleep. Anxiety. Brain fog. Anger. A sense that the wheels are falling off and we are not feeling our old self anymore. Menopause follows and is often wrapped in whispers and misconceptions. It is not decline. It is transition. There are good, evidence-based ways to feel better, but these are often denied us by a healthcare system that often doesn’t understand and often feels like they don’t care.

My own journey has made the link between hormones and psychology impossible to ignore. They moved together in a complex dance that shaped my memory, concentration, resilience and even how I interacted and bonded with other people. Oestrogen, for example, can lift mood and motivation by tuning brain chemicals like serotonin and dopamine. It also supports neural plasticity, which is the brain’s ability to adapt and learn. So, its loss can negatively impact all of those things and we can start to feel like an inferior version of our formes selves. These are not small nudges. They are meaningful shifts that have been ignored for so long.

In this post I want to peel back the layers. We will look at how oestrogen, progesterone and their metabolites influence mood and cognition. We will touch on neural plasticity and why that matters for memory and decisions. We will also talk about the bigger picture. Society often trivialises the emotional, physical, and psychological side of hormonal cycles and scientifically it has been widely ignored as something women just ‘go through’.

So, let’s explore this rich and sometimes bumpy terrain together. It is a journey of understanding our biology and celebrating the resilience and beauty of being human.

Understanding Female Puberty: How it all starts

If you ever want to stand back and appreciate how hormones impact the human brain, look at young girls pre and post puberty.  One minute they are happily playing with toys and their friends, holding a parents hand as they skip blissfully and happily around, the next they are self-conscious about their changing bodies, fixated on interpersonal issues, often highly emotional, with personality shifts, of anger and sadness, that you couldn’t imagine in the child just a few years earlier. 

Puberty can feel like stepping onto a rollercoaster that no one quite prepared you for. One moment everything feels normal, and the next, your body, your feelings, and even your thoughts seem to shift and stretch in ways you didn’t expect.  Everyone might have had lessons or discussions about the practicalities of what is physically happening when breasts and pubic hair starts to grow, but no-one talks about how all of that feels.

At the heart of puberty is a huge hormonal shift.  It all starts in the brain with the hypothalamus, a small but mighty area that acts like a command centre. It sends a chemical signal to the pituitary gland, which then releases gonadotropins. These hormones prompt the ovaries to start producing oestrogen and progesterone, the major players in female evolution:

• Oestrogen fuels breast development, body shape changes, and the start of the menstrual cycle.

• Progesterone supports menstrual cycle regulation and prepares the body for potential pregnancy later on.

It’s not just the levels of hormones that change; it’s the daily fluctuations that can feel so intense. Mood swings, sudden bursts of energy (or tiredness), irritability, and even tearfulness often link back to these hormonal surges and yet are often dismissed as behavioural traits.

For me one of the best ways to look at this is to think alcohol! So most of you will have experienced alcohol and therefore know what its like in the moment to have had a few too many drinks, and to then wake the following day with less alcohol in your system, but feeling the after effects!. One minute you are bubbly, energetic and the life of the party, the next morning you are sluggish, moody, maybe a headache, maybe snapping because you feel unwell, or just cognitively slow. Then the following day there is no alcohol in your system and you are feeling so much better. You see and feel a rapid change in mood, energy and cognitive function depending on the level of alcohol in your system.

Well hormones can impact the brain just in the same way but because they are secreted within our bodies in unknown and unmeasurable doses on a daily basis, rather than watching the glasses of wine disappear, it often goes unrecognised, even by us, and so we are often labelled moody, or irritable. I wonder how we might interact with ourselves if we knew what was happening and could say, ''ooh I had too much oestrogen yesterday, no wonder I feel rough''. So let's go back to hormone and the brain.

Neurological Changes: Rewiring the Brain

Puberty doesn’t just change the body; it remodels the brain.  During this time:

• The amygdala, the brain’s emotion centre, becomes extra active which is partly why feelings can feel so big and overwhelming and why we see teenagers often struggling with their emotions.

• The prefrontal cortex, responsible for reasoning and impulse control, is still under construction. (This part won’t fully mature until the mid-20s! so we really shouldn’t be making life decisions before then!! a note to anyone thinking we should let young adults do what they want or make life-changing decisions at this age) This is why teenagers seem to stop listening to us and often seem to engage in more risky behaviours during this period.

• The brain undergoes synaptic pruning, it trims away unused connections and strengthens important ones, making thinking and learning more efficient over time and allowing more focussed led interests.

This brain development means that teenagers might sometimes react more emotionally, take more risks, find it harder to regulate intense feelings, and start to focus on themselves more fully. It’s not just bad behaviour; it’s brain growth in action.  We have all either been there, or watched our children go through this!

Pause for thought: Before we go any further, I just want you to take a moment to think about this.  Think of the physical, emotional, behavioural and cognitive changes that happen during this time.  They are enormous. And it is ALL controlled by hormones, with your brain orchestrating the which, when, and how much of each hormonal release.  Mind-blowing, eh? If they can cause these massive changes in just a few short years by being switched on, you can start to realise the impact they have as they shift and eventually get turned off. So, let’s take a quick look at some other common times of hormonal change.

Hormones During and After Pregnancy: The Body’s Incredible Adaptation

Pregnancy is often described as a miracle and when we look at what happens hormonally, it’s easy to see why.  The body doesn’t just grow a baby; it transforms every system to nurture new life, guided by an extraordinary hormonal symphony.

Right from the very beginning, pregnancy triggers a dramatic rise in key hormones:

• Human Chorionic Gonadotropin (hCG): Often called the "pregnancy hormone," hCG is what pregnancy tests detect. It helps maintain the pregnancy in the early weeks and signals the body to stop releasing eggs.

• Progesterone:  Levels skyrocket to support the uterine lining and prevent contractions too early. It also relaxes smooth muscles which is why some women experience heartburn, constipation, and a need to slow down.

• Oestrogen:  Oestrogen rises steeply, promoting blood flow, supporting the placenta, and preparing the body for breastfeeding. It’s also linked to that well-known "pregnancy glow" (and sometimes to heightened emotions).

• Relaxin:  This hormone softens ligaments and joints, making the pelvis more flexible for childbirth but it can also contribute to balance changes and joint aches.

• Prolactin: Prolactin prepares the breasts for milk production, and even during pregnancy, some women may notice small leaks of colostrum.

• Oxytocin: (sometimes called the "love hormone") floods the brain during breastfeeding and skin-to-skin contact, helping mothers’ bond with their babies and promoting feelings of calm and connection.

The amazing way that we can 'grow' a baby and the bodily changes that allow pregnancy and birth to happen are hormonally driven. Mind blowing right? All these changes explain why pregnancy can feel physically and emotionally intense. From fatigue and nausea to vivid dreams and mood shifts, hormones are behind much of it.  We are flooded or deprived of a range of chemicals. And despite the fact that hormones are responsible for all of this, they are often dismissed in society as a negative thing or as 'trivial'.

Sadly on a negative side it can also be hormones that prevent, or even end pregnancies too early. It really is worth getting expert advice if you are struggling. If you are struggling to get pregnant or with pregnancy loss, please consider reaching out for support.

After Pregnancy: The Postpartum Hormonal Reset

The moment the baby (and the placenta) is delivered, hormone levels plummet particularly oestrogen and progesterone.  This dramatic drop is normal, but it can lead to some challenging emotional and physical shifts:

1. Baby Blues: Around 70–80% of new mothers experience mood swings, tearfulness, and irritability in the first few days postpartum. These feelings usually pass within a week or two as the body recalibrates.

2. Postnatal Depression: In some cases, the hormonal drop, combined with physical exhaustion and emotional adjustment, can trigger more lasting depression. It's important to seek support early if low mood persists beyond two weeks. 

3. Postpartum psychosis: One of the most serious mental health conditions has a very sudden onset and although research is ongoing, hormonal shifts are believed to play a key role.  The sudden crash in oestrogen and progesterone after childbirth, combined with physical exhaustion, sleep deprivation, and the massive emotional adjustment to new motherhood, can trigger vulnerabilities in brain chemistry.  It typically starts within the first few days to two weeks after childbirth.  It’s characterised by a sudden, severe shift in mental state, including symptoms such as hallucinations, delusional thoughts, paranoia and very often extreme suicidality.

It’s important to understand that none of these conditions are a personal failing or a sign of weakness, they are hormonal and need support. And yet again women struggling are often seen negatively and without compassion.

Important note: Postpartum psychosis is a medical emergency.  With the right treatment (which usually involves hospital care and psychiatric support), most women recover fully.

Postpartum hormones: what changes in the body

After birth, oestrogen and progesterone levels fall quickly, while prolactin and oxytocin rise to support milk production and bonding. That sharp shift explains many early physical changes. Night sweats and temperature swings are common as the body resets fluid balance. Breasts feel fuller and more tender as milk “comes in,” and nipples can be sensitive while feeding establishes. Lower oestrogen, especially during breastfeeding, often brings vaginal dryness and discomfort with sex; simple lubricants or local vaginal oestrogen (if appropriate for you) can help. The uterus contracts back to its pre-pregnancy size over several weeks, which can cause crampy afterpains.

Relaxin lingers for a time, so joints and ligaments remain looser than usual and the pelvic floor has worked hard and may feel weak, with urinary urgency or leakage. Thyroid function can fluctuate in the months after delivery, occasionally causing fatigue, palpitations or mood shifts that look like routine postnatal tiredness, so it is worth checking if symptoms persist. Hair shedding typically peaks around three to four months as follicles reset from pregnancy’s growth phase; it looks dramatic but usually regrows. It doesn't sound much fun does it, and yet new mums are meant to be blissful at the arrival of their new born.

Pregnancy and postpartum are periods of monumental hormonal shifts, not just physically, but emotionally too. Understanding these changes helps normalise what so many new mothers experience: the highs, the lows, the moments of deep love, and the moments of overwhelm.

I think when we add this to the new social pressure and norms on a new mother it’s a disaster waiting to happen.  In times past a new mother would have stayed in bed for up to 30 days nursing herself and her new-born, with others cooking and cleaning for her.  Now on day two we expect them to make us coffee when we pop round to see them, and they try and juggle keeping their homes tidy, looking fabulous for social media photos on top of healing gaping wounds in their bodies, changing hormones and lack of sleep. It starts to make sense of why child rearing can feel such a burden at times.

After our child rearing years are over, life often just follows the monthly ebb and flow of hormonal change until age takes hold and we head towards another time of great hormonal change.

Understanding Perimenopause: The long road

Perimenopause can feel like stepping onto a road that keeps changing gradient without warning. One month you sleep fine, the next you are wide awake at 3 a.m. with a racing mind. Periods can arrive early, late, heavy or not at all. It is common to feel “not quite yourself” and to wonder what switched. Personally, I look back on this time with a bit of a sense of horror. I was relatively young and I feel like I lost sight of who I was at times, what I wanted, what was important to me, as I flicked between lack of sleep, feelings of absolute rage for no apparent reason, and struggling to think straight. All made worse by a healthcare system that at the time didn't offer me hormone replacement, at a time I didn't know to ask.

At the heart of perimenopause is shifting hormone signalling between brain and ovaries. The hypothalamus and pituitary keep sending their cues, but the ovaries respond less predictably. Oestrogen and progesterone start to fluctuate, sometimes spiking, sometimes dropping, and the cycle rhythm wobbles. You are still cycling, just not as smoothly and in some ways that is what is so hard.  Oestrogen and progesterone remain the major players:

• Oestrogen supports temperature control, sleep architecture, attention and joint health. When it swings, hot flushes, night sweats, brain fog and joint aches can appear.

• Progesterone is naturally sedating for some people. As ovulation becomes erratic, progesterone can dip, which may affect sleep quality, anxiety and premenstrual symptoms.

• It is not only the average hormone levels that matter. The day-to-day variability is often what people feel most intensely. This explains why symptoms can come in waves.

• Thermoregulation circuits in the hypothalamus become more sensitive. Small changes in oestrogen narrow the temperature comfort zone, which triggers hot flushes and night sweats.

• Stress and mood networks can become more reactive. This is why anxiety, low mood, irritability and a shorter fuse can show up even if you have never struggled before. I work with so many women, who initially come to see me because they think they have had sudden onset depression or anxiety later in life, after always being so well, and then we reveal peri-menopause and the understanding starts.

• Attention and memory systems can feel taxed. Many describe word-finding issues and slower recall when sleep is disrupted or flushes are frequent. I remember not even being able to end sentences even when I had initiated them.

For most people over 45, perimenopause is a clinical, symptom-led diagnosis. Blood tests are usually not needed unless you are younger, periods have stopped very early, or there is another reason to investigate.

Understanding Menopause: Crossing the threshold

Menopause is technically the point twelve months after your final menstrual period. It is a single date on the calendar, but it sits within a longer story. The years before are perimenopause. The years after are post-menopause. Many people arrive at this point with a mix of relief and questions.

Ovarian oestrogen and progesterone production falls to lower steady levels and the steadiness is what allows adjustment and feels more stable. The brain continues to signal, but the ovaries have largely completed their reproductive role so the brain produces less. Some symptoms ease as the hormonal rollercoaster settles, while others persist or emerge because of the new baseline. This is the impact of those hormonal changes:

• Oestrogen remains vital for bone turnover, urogenital tissue health, and aspects of cardiovascular and brain function. Lower long-term levels can influence bone density, vaginal and urinary comfort, and body composition. This is why replacement therapy can be vital even if menopause and long after the symptoms has gone.

• Androgens decline more gradually. Sexual desire is multifactorial, but hormonal context, relationship factors, sleep and mood all play a part.

• Thermoregulation may remain sensitive for a while. Hot flushes and night sweats often fade, though for some they continue without support.

• Sleep and cognition usually improve once nights are more settled. Ongoing insomnia benefits from behavioural sleep strategies and, where appropriate, targeted treatment. I can't impress enough how working on your sleep can have the biggest impact of all.

• Mood can stabilise, but if low mood or anxiety persist, it is worth assessing for contributory factors such as thyroid issues, iron deficiency, sleep apnoea or life stressors.

Menopause is not an ending so much as a new operating system. You no longer have the hormones that your body has been used to working with for so many years, so it's like getting your engine to run on different, less technical oil.  With the right information and support, many people find it is a stage where energy and focus return, sleep steadies, and life feels aligned again.

Hormones, memory and concentration

Many people describe perimenopause and early post-menopause as “I can do it, but it takes more effort.” Names sit on the tip of the tongue. You walk into a room and forget why. Reading needs re-reading. This is not you losing your sharpness. It is a brain responding to hormonal change, sleep disruption and stress load, all at once.

As we have seen oestrogen is a key supporter of thinking. It nudges the systems that help you pay attention, learn and store new memories. It supports the hippocampus, which is the brain’s filing clerk for facts and places, and it keeps the chemistry of focus and motivation in good balance. When oestrogen fluctuates, the brain’s signalling feels less smooth and word-finding or mental stamina can dip. Progesterone and its metabolite allopregnanolone act on calming GABA pathways. When ovulation becomes erratic, that settling influence can be less consistent, which some feel as jittery attention or a shorter fuse. Sleep is the third piece. Night sweats fragment deep sleep, which is when the brain consolidates memory and clears metabolic waste. Even a few broken nights can make perfectly normal thinking feel harder.

Anxiety and depression: the psychology behind the feelings

Perimenopause is a period of biological change with powerful psychological ripples. Anxiety and low mood in this phase are not character flaws or a sudden loss of resilience. They are understandable responses to shifting brain chemistry, broken sleep, changing roles and the meanings we attach to symptoms.

Oestrogen helps regulate the systems that keep mood, attention and stress responses balanced. It supports serotonin and dopamine signalling and protects sleep architecture. When oestrogen swings, the brain’s signalling feels less smooth. Word-finding, attention and emotional steadiness can wobble. Progesterone and its metabolite allopregnanolone usually calm the nervous system through GABA pathways. Irregular ovulation makes that calming influence inconsistent, which some experience as edginess or a shorter fuse.

Night sweats and early waking fragment deep sleep. Even a few broken nights raise cortisol, lower frustration tolerance and reduce access to perspective taking. Poor sleep does not cause every symptom, but it amplifies almost all of them. Hot flushes, palpitations and dizziness are intense bodily signals. The mind understandably scans for danger and starts predicting the next episode. That anticipation creates a loop of hypervigilance, safety behaviours and more anxiety.

Anxiety often shows up as health worry, social withdrawal, irritability or a feeling of being constantly “on edge.” Some notice panic-like episodes tied to flushes or poor sleep. Depression can look like a loss of interest, reduced drive, slowed thinking and a sense that everything takes more effort. Rumination grows. Confidence shrinks. So many women I work find relief from the mental and physical side of peri-menopause once they start to understand and work with it.  If you notice the following then it might be time to seek help.

• Low mood most days for more than two weeks, loss of interest, or thoughts that you would be better off not here

• Panic attacks, significant avoidance or severe sleep loss

• Heavy bleeding, iron deficiency risk, thyroid symptoms or marked cognitive decline

• Alcohol or sedative use creeping up to cope

Hormones and How We Look.

As if all that wasn't enough our hormones change how we look in the mirror. You may find yourself asking “Why do I suddenly look more tired, softer round the middle, and less like ‘me’?”

As oestrogen begins to ebb and fluctuate in perimenopause, the skin loses some of its natural “bounce.” Oestrogen helps collagen production and water-holding in the deeper layers of skin. When levels dip, skin can feel drier, a little thinner, and fine lines show more easily. It’s not that you’ve done anything wrong; the scaffolding is being quietly remodelled. Add in poorer sleep from night sweats and you get the puffy-tired look that no concealer can truly hide.

Sebum also shifts. Some people feel suddenly dry; others get that confusing mix of dryness with breakouts. Pigmentation can become patchier too, think melasma or sunspots that were once faint and now seem louder. Oestrogen usually keeps melanocytes (pigment cells) well behaved, so when it falters, old sun exposure tends to announce itself.

Hair tells the tale as well. With time, androgens (our “traditionally male” hormones that we all have) exert more influence relative to oestrogen. That can mean a subtle widening of the parting or more hair shedding in the shower, while chin or upper-lip hairs become bolder. It’s not vanity to care about this; hair is part of our identity. The follicles are simply responding to a new hormonal balance, plus the usual midlife stressors and iron or thyroid fluctuations for some.

Body shape naturally migrates. Oestrogen has long helped us store fat more on hips and thighs. As it recedes, the pattern shifts towards the abdomen. You haven’t “lost discipline”; your metabolism is playing by new rules. Visceral fat (the internal kind) is more metabolically active and can nudge insulin and cholesterol in the wrong direction. That’s one reason a previously comfortable weight can creep despite similar eating, and why strength training and protein matter more now than they did at 30.

Eyes and smile change in quieter ways. Falling oestrogen reduces tear-film stability, so eyes feel dry and look a touch red or tired. Gums can become a little more sensitive. None of this is dramatic on its own, but together it reads as “older” even when your energy is good.

When you start to see all of this you start to appreciate the impact of hormones on our functioning.  The same hormones that have been overlooked or dismissed for so long are truly like the oil that keeps our engine going and as you have less, the body struggles to operate in the same way.

Hormones, Roles and Relationships: why people-pleasing often shifts.

As hormones shift, many people notice a quiet but striking recalibration in how they relate to others. It is not just mood. The old instinct to smooth things over, keep everyone happy and say yes to every request can soften. For some this feels like a breath of fresh air. For others it is unsettling, especially if people pleasing has long served as a strategy for safety, belonging or identity.

On top of all the biological functions, oestrogen also impacts our sociological function as it speaks to the brain systems that tune social sensitivity, stress responses and sleep. When levels fluctuate or settle lower, emotional bandwidth can feel different. Poor sleep and hot flushes chip away at patience and capacity, which makes constant caretaking and keeping others happy harder to sustain. Progesterone often has a calming, settling quality for some people. As ovulation becomes erratic, that steadying influence can change, and irritability or the tendency to overcommit can stand out more starkly.

Life stage matters as well. When the intense focus on child rearing eases, many people take a fresh look at workload, boundaries and the give and take in key relationships. You might find you care less about impressing everyone and more about how you actually feel day to day. Long-standing imbalances become harder to ignore. You are quicker to notice unequal emotional labour, small acts of weaponised incompetence, or patterns where you do the scheduling, remembering and soothing while others coast. Friendships can shift. Some deepen with honesty. Others feel tiring if they depend on you always being the listener or planner.

In couples, sexual connection can wobble when sleep is poor, vaginal dryness is unaddressed, or resentment has built up. I remember flashes and outbursts of emotions that really impacted some of my relationships during this time. I mean shouting at a partner for putting something in the 'wrong place' seems irrational at the best of times and on repeat it can really become an issue. Communication and practical fixes usually help more.

Why women’s health and hormones have been side-lined.

I’m not here to preach, just to describe the system we inherited.

For a long time, the way we studied illness, taught clinicians and organised services has made it easy for women’s concerns to be downplayed and even ignored. For a long time, the “standard” patient in textbooks and trials was male. Women were often excluded from research because menstrual cycles were seen as a complicating variable, and because of concerns about pregnancy risk. That meant symptoms, doses and side effects were calibrated on male bodies, then applied to everyone else. It also meant there was less interest in studying women's issues. If fewer women are in studies, we learn less about how conditions present in women, how medicines behave across the cycle, and how menopause affects health.

Those gaps filter down into training. Many clinicians received minimal teaching on perimenopause, PMDD or the nuances of hormonal contraception beyond the basics. When time is tight in primary care, subtle hormonal patterns are easy to miss. For many, it has looked like ten-minute appointments where complex symptoms are squeezed into a single label such as stress or “just hormones”, with a suggestion to come back if it doesn’t settle. It has meant trying to describe hot flushes, brain fog, palpitations, low mood and poor sleep, only to leave with an antidepressant that partly helps but never addresses the full picture. It has been being told heavy or painful periods are normal, that perimenopause cannot be happening “at your age”, or that vaginal pain will improve on its own. That history explains why so many of us have felt unheard. In all fairness, it is also hard ro explain to someone who hasn't been through these hormonal changes just how debilitating they are. I mean 'getting hot', not sleeping well, feeling sad, struggling to think, when presented in parts, or presented to a young or male doctor, might not seem that important. But when you are living in a body that doesn't feel your own, then its of vital importance.

There is also the everyday context. Many women carry the invisible load at home and at work, so health gets pushed to the bottom of the list. Taking time off for symptoms has not always been supported because it’s a female issue seen as something to be got on with. Culturally, we have been encouraged to be stoical, to cope, to be “low maintenance”. Women have had to 'suck it up' and stay in work when unwell, fearful for their careers.

When you have learnt to minimise your needs, it is easy to accept reassurance instead of investigation, and to delay returning when things do not improve.  It is as if because biology is at play women should just accept pain, discomfort and distress or be labelled as hormonal, hysterical, or overreacting. If you hear that enough, you start to second-guess yourself. You apologise for asking questions. You make your explanations shorter. You choose not to mention the symptom that feels embarrassing, even though it matters. Over time, people adapt by coping around the problem rather than expecting the problem to be solved.  I was once told by a gynaecologist when he finally sent me for a scan and found a problem after I had been asking about a symptom for nearly a year, that the reason it had been missed was because ‘there were a lot of whinging women’ and he had assumed I was one of them!!!! That was a very long time ago, and I would like to think things have changed.

None of this means clinicians do not care. Most I now work with do care, deeply. It simply means the knowledge they were given has gaps. It means services have been set up to handle single issues, not interconnected ones. And it means women have had to work harder to be taken seriously and to access treatments that now exist and are effective. We know from research that if women and men report pain to their GP that men are more likely to be given pain killers and women more likely to be given anti-depressants!

The good news is that the tide is turning. Research is broadening, guidance is clearer, and workplaces are starting to make practical adjustments. My aim here is to name what many have experienced so that readers feel less alone, and to offer a joined-up, evidence-based map forward rather than to criticise. When we recognise how we got here, it becomes much easier to get where we need to go.

A Joined-Up Way Forward

So, what can be done about it rather than just struggle on. It is important to know that more recent research is highlighting that HRT options long after menopause can have positive effects in terms of bone density, heart and brain health, so they are not just for symptom reduction. If your GP is responsive, book in to discuss symptoms and options. If you are not getting a positive response, ask for referral to a clinician with menopause or hormone expertise. Bring a tidy symptom snapshot to the appointment so decisions are easier.

Treat this like regular servicing for you as a machine, rather than waiting for smoke and signs you are breaking down. I mean you take your car for a service once a year, but then neglect your own working engine. Track things for two to four weeks: sleep and night waking, mood and anxiety, any cycle pattern if you still bleed, energy and brain fog, movement, alcohol and caffeine. If symptoms do not fit the usual story, ask your clinician to check the basics: blood pressure, lipids and blood sugar where relevant; thyroid and iron if fatigue and hair changes sit beside heavy periods; and a medication review if mood or libido shifted after a new prescription.

HRT options at a glance

A good consultation covers benefits, risks and fit for you and this blog is not medical advice just highlighting what could be available. Your clinician will tailor dose and route to your history, symptoms and preferences. In general, what is on offer are:

• Oestrogen: transdermal patches, gels or sprays are often first choice because they have a lower blood-clot risk than oral forms. Doses are adjusted to symptoms and side effects, then reviewed.

• Progestogen: needed if you have a uterus to protect the lining. Options include micronised progesterone by mouth on a continuous daily schedule or cyclically, or a levonorgestrel intrauterine system for endometrial protection. Regimen and dose are matched to bleeding pattern and tolerance.

• Local vaginal oestrogen: creams, tablets or a ring for vaginal dryness, discomfort with sex or recurrent urinary symptoms. These can be added to or used without systemic HRT and can be continued long-term with review.

• Testosterone: consider only if low sexual desire persists despite optimised HRT and other causes have been addressed. This is off-label in the UK and should be initiated with specialist guidance, with blood-level monitoring and follow up.

Contraindications and cautions should be checked. These include a history of oestrogen-dependent cancer, unexplained vaginal bleeding, active or recent clot, stroke or heart attack, or severe liver disease. Where HRT is not suitable, or is declined, non-hormonal options and targeted local treatments can still help.

Herbal and natural options people often try.

Here’s a practical, plain-English rundown of herbal and “natural” options that some people find helpful for perimenopause and menopause. This is general information, not medical advice, and you should always check with your GP before taking supplements. Quality, dose and interactions vary a lot between products, so run anything new past your GP or a menopause-experienced clinician first. In the UK, look for products with the THR (Traditional Herbal Registration) logo to ensure basic quality and dosing information.

• Black cohosh (Actaea/Cimicifuga racemosa)

  May modestly ease hot flushes for some, but evidence is mixed. Rare cases of liver problems have been reported, so avoid if you have liver disease and stop if you develop dark urine, itching or fatigue. If you try it, use a standardised extract and review after 8–12 weeks. Avoid with a history of breast cancer unless your specialist advises. Possible interactions with other medicines.

• Soy isoflavones and red clover (phytoestrogens)

  Can give small to moderate reductions in hot flushes for some people. Whole soy foods are a sensible first step; supplements vary and may interact with medicines.  Not usually recommended if you are on tamoxifen or have had breast cancer unless your oncology team agrees.

• Sage (Salvia officinalis)

  Small trials suggest sage can reduce flush frequency, though results are variable and studies are small. Typical products use standardised tablets or liquid extracts. Check labels and review at 4–8 weeks.

• Siberian rhubarb extract (ERr 731, Rheum rhaponticum)

  Several European studies report improvement in common menopausal symptoms. Data are promising but not as extensive as for HRT, so use with the same caution as other supplements and review regularly.

• St John’s wort (Hypericum perforatum)

  May help vasomotor symptoms or low mood in some, but has many serious drug interactions, including with tamoxifen, anticoagulants, anticonvulsants and SSRIs/SNRIs. Only consider with specialist advice and a full medication review.

• Evening primrose oil

  Popular, but current evidence does not show meaningful benefit for hot flush frequency or duration. If you choose to try it, set a short review window and stop if no clear effect.

How to trial safely (quick plan)

1. Pick one option at a time.

2. Keep a 2–4-week symptom diary for hot flushes, sleep, mood and any side effects.

3. Stop if no clear benefit, or if you notice side effects.

4. Share your notes with your GP or menopause specialist to decide next steps.

Beyond hormones: habits that move the dial.

There are other practical ways you can help yourself. Sleep itself is a treatment. Protect it with consistent bed and wake times, a wind-down that starts at the same time each evening, lower bedroom temperature, blackout where safe, and a caffeine cut-off at least eight hours before bed. Heat symptoms often improve with layered nightwear, a bedside fan and avoiding heavy evening meals.

Nutrition supports symptoms and long-term health. Protein at each meal helps muscle maintenance when oestrogen falls. A fibre-rich, plant-forward pattern supports gut health and cardiometabolic risk. Calcium-rich foods and vitamin D status protect bone. Alcohol can worsen flushes, sleep and mood. Many people feel better with more alcohol-free days and smaller pours.

Movement is medicine for hot flushes, sleep, mood, bone and metabolic health. Combine resistance training for muscles and bone with brisk walking or other aerobic activity for heart and brain. Short, regular bouts win over perfect plans.

Mind-body approaches round things out. Brief paced breathing, mindfulness skills, and cognitive strategies for worry loops reduce distress and can complement HRT or act as stand-alone support where HRT is not an option. Relationship hygiene matters: talk openly about symptoms, capacity and division of labour, and adjust routines together so support is shared rather than assumed.

If your GP cannot help or access is difficult, seek a menopause-experienced clinician or therapist.

Final Note

Hormones are magnificent. They build, reshape and sustain the female body and brain from the first stirrings of puberty to the quieter seasons of post-menopause. The same chemistry that kindles growth, bonding and learning can, at other times, bring heat, sleepless nights, tender moods and foggy thinking. Across a lifespan we meet both the wonders and the horrors of hormonal change, sometimes in the very same week. Naming that truth is not negative. It is honest, and honesty is the start of feeling better. Imagine instead of saying to yourself I'm moody and struggling, say I am lacking oestrogen today, no wonder my brain doesn't want to work as well.

Understanding the psychological impact of these shifts matters. Hormones tune attention, memory, motivation, stress responses and how safely connected we feel. When they move, our inner world moves with them. That does not mean we are at the mercy of biology. It means we can match support to the moment. Evidence-based care can include HRT where appropriate, targeted local treatments, sleep and lifestyle adjustments, and practical changes at home and work. Small, steady interventions often return a sense of steadiness and self.

Working with a clinical psychologist who understands this terrain helps you join the dots. Together we can map patterns, calm the nervous system, unhook from worry loops that often turn up during this time, and rebuild habits that protect mood, sleep and relationships. We can also address the stories that so many of us were handed about coping quietly, people-pleasing or minimising needs. Therapeutic work gives you language and tools so you can advocate for the care you deserve and make decisions with confidence alongside your GP or specialist.

You are not broken. You are adapting to a powerful biological process that touches every domain of life. With informed support, compassionate psychology and a plan that fits your values, it is entirely possible to feel well, think clearly and stay connected to what matters through every chapter of hormonal change.

As always until next time

Carla