By Dr Tonia Mezzini

Menopause is not a single moment in time. It is a transition, one that can unfold gradually, bringing with it a range of physical and emotional changes that are often misunderstood, minimised, or simply not spoken about enough.

As a sexual health physician, and as someone who has supported many women through this stage of life, I want to acknowledge something important: your experience is valid. Whether your symptoms feel mild or overwhelming, there is support available, and there are ways to navigate this transition with greater comfort and confidence.

Understanding What’s Happening

Menopause typically occurs between the ages of 45 and 55, marked by the end of menstrual cycles. However, the years leading up to it, known as perimenopause, can bring fluctuating hormone levels that affect the entire body.

Oestrogen, in particular, plays a vital role in many systems, including the brain, skin, bones, heart, and urogenital tissues. As levels decline, it’s common to experience symptoms such as:

• Hot flushes and night sweats
• Sleep disturbances
• Mood changes, including anxiety or low mood
• Brain fog or difficulty concentrating
• Joint aches
• Changes in skin and hair

Each woman’s experience is different, and symptom severity does not always correlate with hormone levels alone.

Vaginal Atrophy: A Common but Under-Discussed Concern

One of the most significant yet often underreported symptoms is vaginal atrophy. As oestrogen declines, the tissues of the vagina and urinary tract can become thinner, drier, and less elastic. This may lead to:

• Vaginal dryness or irritation
• Discomfort or pain during intimacy
• Increased urinary urgency or recurrent urinary tract infections

These changes are not something you simply have to “put up with.” They are medical in nature and can be treated effectively.

Management options may include:

• Local oestrogen therapy (such as creams, tablets, or pessaries), which works directly on the vaginal tissues with minimal systemic absorption
• Non-hormonal moisturisers and emollients, which can provide symptomatic relief
• Pelvic floor physiotherapy, particularly if urinary symptoms are present

Importantly, these treatments can be tailored to your individual needs and medical history.

A Holistic Approach to Symptom Management

Menopause care is not one-size-fits-all. It requires a thoughtful, personalised approach that considers your symptoms, lifestyle, medical background, and preferences.

Some of the key pillars of management include:

1. Hormonal Therapies
Menopausal hormone therapy (MHT) can be highly effective for many women, particularly for hot flushes, night sweats, and vaginal symptoms. It is not suitable for everyone, but when prescribed appropriately, it can significantly improve quality of life.

2. Nutrition and Lifestyle
A balanced diet rich in whole foods, adequate protein, healthy fats, and calcium supports both hormonal and bone health. Regular movement — including strength training — can help maintain muscle mass, support metabolism, and improve mood.

Sleep hygiene, stress management, and reducing alcohol and caffeine intake can also make a meaningful difference.

3. Mental and Emotional Wellbeing
Hormonal changes can influence neurotransmitters, affecting mood and resilience. It’s important to recognise when additional support is needed, whether through counselling, mindfulness practices, or medical treatment.

4. Skin, Hair, and Body Changes
Changes in collagen, hydration, and elasticity are common. While these can feel confronting, there are supportive treatments and skincare approaches that can help you feel more comfortable in your skin.

Opening the Conversation

Too often, women feel they need to endure menopause in silence. Symptoms like vaginal dryness or discomfort during intimacy can feel difficult to raise, even with a healthcare provider.

I encourage you to have these conversations. They are not only appropriate, they are essential.

Menopause doesn’t have to be scary. It is a transition into a new phase of life, one that can be navigated with knowledge, support, and care.

If you are experiencing symptoms, know that you do not have to manage them alone. With the right guidance, you can navigate this experience informed, supported, and in control of your health.