Shrouded in social discomfort, the perception of menopause is framed by our culture. Understanding menopause better can help you create a more positive, empowered experience.

As menopause approaches, it can bring with it the same sense of the unknown felt at puberty. What’s going to happen to my body? Is what I’m experiencing normal? If you’re feeling unsure about what to expect, you’re not alone.

Given half the population journey through this natural biological stage, surprisingly little is known about it, remarks Dr Nicola Gates, clinical neuropsychologist at Brain and Mind Psychology, Sydney and author of The Feel Good Guide to Menopause.

“Society’s always been uncomfortable with women’s reproductive sexual health,” Gates says, citing the furore over TV sanitary pad adverts. Menopause also has the double-edged sword of being associated with ageing.

The what and when

Simply defining menopause is confusing. Technically speaking, it refers to the permanent end of menstruation. Due to the irregularity of a woman’s cycle in the lead-up to this event, you’re considered to have reached menopause retrospectively 12 months after your final period, explains naturopath Ruth Trickey in Women, Hormones and the Menstrual Cycle.

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A whole lot more happens before and after that! “Around our mid-40s, a women’s oestrogen levels start to gradually diminish to become that of a man,” Gates explains. “Puberty is the increase in sexual reproductive hormones, menopause is the gradual diminishment of them. You’re going from a high dose to support fertility to this low dose that supports normal body and brain function. All our body systems have to adjust, and that’s why we get these symptoms in menopause.”

Because menopause, perimenopause and postmenopause are so arbitrary, Gates prefers the term “menopause transition” to encompass the entire time you’re impacted with symptoms.

Fact or fiction: how true are these common beliefs about menopause?

Menopause starts around 50, and symptoms go for one to two years

In Australia, the average age of menopause is 51, Gates says. While menopause can occur for some in their early 40s or late 50s, it’s most typical between 45 and 55. For many women, menopause occurs prematurely as the result of a medical procedure or health issue.

Most women underestimate the length of the menopause transition. Four years is the average length; however, symptoms can last much longer than previously thought — up to 10 years or more, according to the British Journal of Family Medicine.

The average age of menopause varies between cultures. For example, Mayan women have been reported to experience menopause around 45 years of age.

My body no longer makes oestrogen

In menopause, your ovaries cease producing oestrogen. However, your adrenal glands continue to make the hormone, Gates says. Fat tissue also produces some oestrogen. But as your ovaries produce the lion’s share, the levels drop significantly.

Hot flushes are the most common symptom

Yes, you got it. About 60 per cent of Australian women experience hot flushes, Gates says.

Di Wallace, a naturopath and natural health and support service manager at the Australian Menopause Centre, says other common symptoms include night sweats, poor sleep, headaches and fluid retention. “The list of symptoms is massive,” she says. “And poor sleep exacerbates everything else.”

I’m going to gain weight

While not inevitable, weight gain is one of the biggest complaints voiced by women experiencing menopause, Wallace says. “During menopause, metabolism changes dramatically. Many menopausal women try to flog themselves harder with exercise and grow frustrated they’re not losing weight. It’s not working because their body is going through a shift.”

The bigger picture is that often there’s a lot going on at this time, she says. “Maybe, because they’re tired, they stop exercising. They’re getting hot flushes, cranky and exhausted, it’s a whole encompassing experience, and for some women it really rocks their world. They may use the coping mechanisms, like food and wine, that used to work.” On top of that, women are also carrying more weight than 10 years ago, she adds.

Menopause is a health disorder

In The Feel Good Guide To Menopause, Gates reveals how historical domination of the state, religion and medicine by males has shaped the treatment of menopause as a disease.

When Australian university researchers asked four focus groups of women aged 40–64 years for their opinion, they found most viewed menopause as a natural progression. They believed society’s view on menopause and ageing to be mostly negative, low-profile and in need of change. Furthermore, they wanted minimal interference in terms of treatment, and favoured lifestyle therapies such as yoga, exercise and meditation. They also attributed much of their stress to lifestyle factors.

Menopause equals declining health

Postmenopausal women do have an increased risk of health issues, including osteoporosis, stroke, cardiovascular problems and diabetes, linked to loss of the protective benefits provided by oestrogen, Gates says.

Obscuring the issue is the natural ageing process and the fact midlife women can have a lot going on. “It’s easy to misattribute things to menopause because it’s such a big change in your life,” Gates says. “What tends to happen is that other health issues are often exacerbated by menopause.”

I’m getting dementia

Gates says women in menopause commonly report cognitive difficulties, like brain fog, memory and word-finding problems. This can lead some to fear they’re developing dementia.

“Oestrogen plays a role in memory and brain metabolism,” she explains. “So brain fog is a common symptom experienced by women when they don’t have their normal hormone load. They can lose their usual emotional equilibrium too, because oestrogen and progesterone support normal, healthy positive mood.” A research review by Dr Gail Greendale and colleagues suggests cognitive symptoms tend to resolve themselves postmenopause.

Stress and fatigue also tax our mental abilities and emotions. “Women of our generation have a lot more on our plates than those of previous generations,” Gates reminds us.

It’s all downhill for my sex life

On the upside, you can enjoy sex free of the inconvenient monthlies and unwanted pregnancy. On the downside, the decline in reproductive hormones can cause vaginal changes (like dryness) and low libido that’s less fun.

The Melbourne Women’s Midlife Study found dryness and painful sex the most common sexual problems, with symptoms ranging from none or mild to debilitating. Vaginal dryness increased with age — from 4 per cent in early perimenopause to 47 per cent three years later.

Your perspective on this depends on yourself and your partner, your openness to employing solutions like lubricants, and cultural context. A survey by Yale Medical School found women in Denmark, Sweden and Norway felt much less impacted by symptoms than their peers in the US, UK, France and Canada. It’s hypothesised that in more sexually open, feminist societies these changes are seen as less of a drag.

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Menopause equals ageing and lost femininity

Negative cultural conditioning associated with ageing can contribute to depression in menopause. “You have to put it in cultural context,” Gates says. “When HRT [hormone replacement therapy] came out in the 60s the advertising campaign basically told women they were crippled, castrated and no longer attractive.”

Research shows women in healthy, positive relationships report fewer issues with menopause, Gates says. “Whereas if you’ve got a partner who celebrates youth and beauty, menopause obviously is a very scary, challenging time.”

“Being 50-something isn’t old,” writes Ruth Trickey in Women, Hormones and the Menstrual Cycle, “but for all sorts of complex reasons, women have somehow confused ageing and menopause … it’s not the energetic 50-year-old, it’s the 80-year-old they visualise.”

Learning from other cultures

Australian research (in BMC Women’s Health) suggests culture has a stronger influence on attitude to menopause than any other factor. The researchers note that, “In the Arab world, the word corresponding to the menopausal and midlife period means ‘desperate age’, implying a pessimistic outlook towards menopause. Native American Indian women do not have a single word for menopause and the Japanese have no equivalent word for the English phrase ‘hot flush’, which could indicate the relative unimportance of the symptoms or subject to daily discourse.”

They found that in most indigenous cultures the menopause transition is mostly seen as a positive experience with such women considered wise, valuable members within their communities.

Supporting change

Because menopause coincides with midlife, it’s a good prompt to take stock of your physical and emotional wellbeing and start developing a lifestyle that supports you to flourish, Gates says. “Studies all show a healthy lifestyle supports a healthy transition through menopause. Underlying health problems like obesity, a bad diet, alcohol and cigarette use all exacerbate problems,” she says. “Existing mental health or relationship issues also make it more difficult.”

Plant-based is a girl’s best friend

Cross-cultural research suggests those who eat less dairy foods and meat suffer fewer symptoms. A comparison of the menopause experience of Mayan and Greek women found three-quarters of the Greek women suffered from hot flushes and none of the Mayan women did. The Mayan women consumed a diet rich in corn, beans and vegetables. The Greek women also enjoyed lots of plant foods, but also regularly ate meat, fish and dairy.

Other studies suggest that Asian women eating traditional diets (which tend to be more plant-based, low-fat and dairy-free) suffer fewer symptoms than Westerners. Such differences erode when Asian women take up the Western diet.

Friend your liver

Wallace recommends supporting the liver because of its role in metabolising hormones. Reduce alcohol, too many processed fats and other things that clog up the liver, and enjoy more of a clean diet rich in leafy greens and veg, she says. “It’s reducing those loads.”

Cut the carbs

If weight gain is an issue, Wallace recommends cutting refined, processed carbs and sugars from your diet. “What women used to eat and never have much issue with, they can’t seem to do now,” she says. “The body slows down and drops a gear. Where you used to be able to burn off all those calories, it can’t do that now.” Especially avoid sugar at night. “A sugar load at night hits the bloodstream and feeds the problem of insomnia,” she says.

Exercise regularly

Exercise can kick-start the metabolism and improve your mood, Wallace says. If you’re exhausted, don’t flog yourself. “Look at meditation or more holistic exercise like yoga or dance, which is potentially less strenuous, but still provides weight resistance,” she suggests.

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Crash out

With many menopausal women plagued by sleep issues, this is the time to make your bedtime environment as zzzz-promoting as possible. Go for light-blocking curtains, cool, comfy bed linen and layers you can easily cast off, over thick, stuffy doonas.

Herbal help

Valerian tea can aid sleeping. Wallace also suggests adrenal tonics, such as ginseng, to nourish the adrenal system and support energy levels.

A 2019 review of 19 clinical trials (published in PLOS One) found Chinese herbal medicine as effective as HRT at reducing hot flushes. The study authors attributed this to oestrogen-like qualities in the herbs. Popular herbs in the preparations included peony, dong quai, Bupleurum, Scutellaria (skullcap)and Ziziphus.

A 2011 Swiss study found that fresh sage reduced intense hot flushes in participants by 50 per cent within four weeks. Other herbs with touted benefits include red clover and black cohosh.

Supplement

Supplementation can boost your system if you have a deficiency, Wallace says. For those having trouble with sleep or nervous problems, she prescribes gamma-Aminobutyric acid (GABA), a neurotransmitter inhibitor with a calming effect. Vitamin B in the morning can help lift your energy levels.

Cut back, chill more

Women going through menopause often need to reduce stimuli in their life. “They need to do more relaxation, stress relief and mindfulness that calms the body down,” Wallace says. “We live in a society that’s so busy. Contemplate changing things that stress you or change your attitude toward them.”

Cultivate self-compassion

A Victorian study (published 2015 in the journal Maturitas) found that self-compassion and feeling in control were strong indicators of wellbeing in women going through menopause. Gates says, “Studies show women who view menopause as a natural phase in life understand it and have a positive view of it, don’t experience it so bad.”

With people living longer, the average woman today spends much of her life in the postmenopause state. “Menopause is a wonderful point in a woman’s life,” Gates concludes. “You’re free of cycling sexual hormones, being a sexual object and mothering. Discover yourself and blossom.”