By Kate Field | Understanding change. Supporting balance. Ageing well |
Published 5 September 2026 | ~ 10 minute read |
“Why don’t I feel like myself?” It is one of the things I hear most often from women in their 40’s and 50’s. The follow up question is sometimes “Is it menopause?”
Sometimes it is about confidence. You always trusted your judgement but suddenly you’re questioning every decision. Sometimes it is the word that disappears halfway through a sentence, the name of someone you’ve known for years, or the reason why you went upstairs.
Perhaps you feel anxious for no obvious reason or are snapping at the people you love. Maybe you’re lying awake at 3am replaying things that would once have barely registered. The increase in dress size when you haven’t changed what or how you eat. Individually, these things can seem unremarkable. We all forget words. We all have bad nights. We all feel overwhelmed occasionally. Those jeans are a bit tighter on some days. But when they begin to happen together, it’s clue that something more may be going on.
You don’t just feel tired, anxious, forgetful or rounder. You start to feel like someone else.
What exactly is menopause?
“Menopause” is often used to describe the whole mid-life hormonal transition, but medically it has a much more precise meaning. It’s the point at which you have gone for 12 consecutive months without a period (provided you are not using hormonal contraception that affects your bleeding). It can therefore only be identified retrospectively. You do not necessarily know that you have had your final period until a year has passed. So technically “menopause” is a single moment in time. It does not describe the years leading up to your final period or everything that may follow this point.
The time before menopause is generally called perimenopause. The years after it are called postmenopause. You may also occasionally hear the word climacteric. This is a less commonly used term for the wider transition from the reproductive to the non-reproductive phase of mid-life. Dr Vonda Wright uses the word menolescence, drawing a parallel with adolescence at the other end of our reproductive lives. I rather like it, as it reinforces that it is an extended period of time with hormonal fluctuations during that time.
Also, puberty is widely recognised as a period of enormous physical, cognitive and emotional change. We understand that a young person’s body and brain are recalibrating in response to changing hormones, and we give them some space and understanding. Yet at the other end of our reproductive lives, women are often expected to continue as normal, without information, support or even recognition that another significant recalibration is taking place.
Definitions are useful, but they do not tell the whole story
Medical definitions are important. They allow clinicians and researchers to describe stages consistently. But a definition is not the same thing as a diagnosis, and it is not always a good description of a woman’s lived experience.
The established criteria for defining “perimenopause” rely heavily on changes to the menstrual cycle, but if a woman is on contraception that stops periods, or continues to have regular cycles, then establishing “perimenopause” by this single criteria is unhelpful. The updated NICE guidance says that, in an otherwise healthy woman aged 45 or over, perimenopause can generally be identified from recently developed vasomotor symptoms, such as hot flushes and night sweats, together with changes to her menstrual cycle. Routine hormone tests are not usually needed.
The difficulty is that some women begin experiencing other symptoms before they notice an obvious change in their periods or have any of the proverbial hot flushes. Research suggests that a minority of women experience little or no obvious change in cycle length before their final period.
This can create a frustrating gap. A woman may be experiencing poor sleep, anxiety, brain fog, joint pain or a profound loss of confidence, but be told that she cannot be perimenopausal because her periods remain regular. The terminology may be technically defensible but if fails to help the woman who is struggling.
Why does menopause happen?
Women are born with a finite number of immature eggs held within follicles in the ovaries. Over time, the number and quality of the remaining eggs decline. Ovulation becomes less predictable and eventually stops. As ovarian function changes, so does the production of a range of hormones including oestrogen and progesterone. This is not usually a smooth, steady decline.
During the hormonal transition, hormone levels can fluctuate considerably. Oestrogen in particular may sometimes rise higher than usual before eventually settling at a lower level. This helps explain why symptoms may come and go, change over time or seem to bear little relationship to what happened the previous month.
Eventually, hormone levels settle at a lower level and periods stop. This is a normal biological process, not an illness. That does not mean its effects are always mild or that women should simply put up with them. This natural transition can still have a profound impact on health, relationships, work and quality of life – in the short and, as we are coming to understand, the longer term.
When does menopause happen?
Menopause usually occurs between the ages of 45 and 55, with 51/52 commonly quoted as the UK average. However, averages can hide substantial variation.
Age at natural menopause differs between individuals and across populations. Research has found differences associated with ethnicity, geography, smoking, health and socioeconomic circumstances. The experience and severity of symptoms also vary considerably.
Menopause between the ages of 40 and 44 is described as early menopause. When ovarian function declines before the age of 40, this is known as premature ovarian insufficiency, or POI. These women may experience symptoms associated with these hormonal changes in their late 30’s and early 40’s but not make the connection to menopause. Women who have children later in life may overlook perimenopause symptoms, assuming that poor sleep, exhaustion, anxiety or brain fog are simply the ripples of parenthood.
Menopause can also be caused by medical treatment or surgery. Removal of both ovaries causes an immediate surgical menopause. Some cancer treatments and medications can also temporarily or permanently affect ovarian function. A hysterectomy removes the womb, so periods stop, but it does not necessarily cause immediate menopause. If one or both ovaries remain, they may continue producing hormones, although menopause may happen earlier than it otherwise would. These distinctions matter because early, premature and treatment-induced menopause can have different implications for treatment and long-term health.
How long does the hormonal transition last?
This is an area where I think our understanding will continue to evolve. The NHS currently says that symptoms commonly last for seven to nine years, although they may continue for longer. Some symptoms may begin during perimenopause, while others, including vaginal dryness and joint pain, can persist or develop after menopause. Reproductive ageing begins before many women would identify themselves as perimenopausal, and some symptoms can continue well into postmenopause. The lived transition can therefore be much longer than the terminology suggests.
So, there is no standard timeline. One woman may experience a relatively short and manageable transition. Another may notice changes across many years. Symptoms can improve, return or be replaced by something different.
It is tempting to look for a definitive list of symptoms, but studies and clinical resources use different lists. Some focus on the symptoms most clearly associated with hormonal change. Others capture a much broader range of experiences reported by women. The important point is not whether there are 34 symptoms, 50 symptoms or more than 100. It is that [peri]menopause can affect far more than periods and temperature regulation.
It can affect sleep, cognition, mood, joints, muscles, skin, bladder health, sexual wellbeing, energy and confidence. It can also exacerbate existing conditions like asthma, eczema and migraine. The combination and impact will be different for each woman. Not every new symptom in midlife is caused by [peri]menopause. But [peri]menopause deserves a place in the conversation and shouldn’t be dismissed because you aren’t 50, having hot flushes and intermittent periods.
Why can it affect how you think and feel?
Hormones do not operate isolated within the reproductive system. Our hormones flow through every system in our body, so when those hormones start to decrease, they affect every system. They interact with processes throughout the body and brain, including those involved in circadian rhythms, emotional regulation, mental acuity, metabolism, gastrointestinal function, musculoskeletal health, lymphatic and cardiovascular systems and the sympathetic nervous system (our fight or flight response).
Symptoms can then begin to influence one another. Poor sleep can make concentration harder. Struggling to concentrate can undermine confidence at work. Loss of confidence can increase anxiety. Anxiety can make sleep even more elusive. And the sympathetic nervous system stays on amber alert, making it impossible to settle into a parasympathetic state (rest, digest, recovery).
Physical changes occur too. A body that once felt familiar and dependable may become uncomfortable, unpredictable or less capable. That can affect what you do and how you see yourself. Then there is everything else happening in midlife – work may be demanding; children may still need you or may be leaving home; parents may require more support; other relationships may be changing. You may already be carrying too much and hormonal changes do not make those pressures disappear. But they may change the capacity you have to manage them – this is not a failure; it is a wake-up call to start putting yourself first. Additionally, our existing physical and mental health, previous experiences of hormonal change, lifestyle, diet and wider circumstances can all shape how [peri]menopause is experienced.
This is why two women of the same age can have very different hormonal transitions.
The Menopause Body Snatcher
I call this experience the Menopause Body Snatcher. Not because menopause changes who you fundamentally are, but because it can make you feel as though you have lost sight of the person you have always been. The capable woman is still there. So is the intelligent one, the funny one, the adventurous one and the person who used to cope without analysing every decision afterwards. But she may be harder to find beneath exhaustion, anxiety, brain fog and a body that no longer responds quite as expected.
Understanding this matters because, without an explanation, it is easy to make the experience feel like ‘not coping’ or a failure. You may decide you are no longer good enough at your job. That you have become bad-tempered or unreliable. That you are losing your edge. That this is simply what getting older looks like and nothing can be done. Those thoughts can shape the decisions you make, sometimes long before you realise hormones may be part of the picture.
Could it be something else?
Not every change in midlife should be attributed to [peri]menopause. Thyroid conditions, iron or vitamin deficiencies, medications, sleep disorders, depression and other health conditions can produce overlapping symptoms. New, persistent, severe or worrying symptoms should not simply be written off as hormones. Changes to bleeding may also need investigation, particularly very heavy bleeding or any bleeding postmenopause.
That is why a conversation with a good healthcare professional matters. Keeping a record of what has changed helps. Include symptoms that do not immediately appear menopausal, when they began, whether they come and go, and how they affect your work, sleep, relationships and normal activities. The impact matters as much as the symptom itself.
For your healthspan
It is understandable to focus on immediate relief when symptoms are disrupting your life. But menopause is also a useful point at which to look further ahead. Healthspan means the years we spend in good enough physical, cognitive and emotional health to continue doing the things that matter to us. It is not simply about living longer. It is about retaining capability, independence, connection and enjoyment as we age.
The choices that support us through menopause can also help build the foundations for a healthy later life. These may include looking after bone and cardiovascular health, supporting our gut biome, maintaining muscle strength, flexibility and balance, protecting sleep and remaining socially connected. Eating well, exercising and supporting mental wellbeing may help with current symptoms while also helping you remain well in the future.
This is not about frightening you with a doom and gloom picture of the future or pretending we can control every health outcome. It is about recognising that menopause is more than something to endure until the symptoms pass. It is a transition that may give us an opportunity to pause, understand what is changing, and make more conscious choices about the decades ahead.
What can you do?
If you no longer recognise yourself, you do not have to dismiss it, hide it or simply try harder. Start by noticing the pattern. Write down what has changed. Find credible, evidence-based information and speak to a healthcare professional about your symptoms and options. There is no single answer that is right for every woman.
HRT can be highly effective for many menopausal symptoms – but not all. Whether to take it is an individual decision based on your symptoms, health, preferences and balance of benefits and risks. Other treatments and forms of support may also be appropriate, or needed, in combination with HRT.
The aim is not necessarily to become exactly who you were before. Menopause is a transition, and transitions can change us – often for the better. But change does not have to mean losing yourself either. You may emerge with a clearer understanding of what you need, perhaps after years of putting everyone else first. Understanding what is happening is the first step towards feeling steadier, making informed choices and deciding what you want the next part of your life to look like.
Afterall, understanding changes everything.
The Mareopause perspective
As appropriate for the blog, The Mareopause perspective will explore what each subject can mean for equestrian women, both in and out of the saddle.
For equestrians, feeling unlike yourself may first become obvious around horses, as it is often the only place where you can be yourself. You might notice a hesitation before doing something that once felt routine. You may forget a dressage test, become overwhelmed when your horse grows tense or the discomfort in your hips makes riding a painful chore rather than the joyous escape it usually is.
Poor sleep, pain, changing strength, anxiety and slower processing can all affect how safe and capable you feel in the saddle. It is easy to conclude that you have lost your nerve, that age is catching up with you or that you and your horse are no longer right for one another.
Sometimes a different horse, coach or activity genuinely is the right decision. But before leaping to a decision that may affect the rest of your horsey life, it is worth stepping back and asking whether the hormonal transition is playing a part. Remaining involved with horses can support movement, learning, connection, purpose and joy. These things matter now, but they also matter for our long-term healthspan. Your confidence has not necessarily disappeared. It may be responding to a body and brain carrying far more than anyone can see.
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About Kate
Kate Field CMIOSH is a human sustainability and future of work strategist, keynote speaker and founder of Balanced Transition. Drawing on more than 20 years’ global experience spanning regulation, workplace health, organisational culture and commercial strategy, she explores how artificial intelligence, demographic change and longer working lives are reshaping work, wellbeing and organisational performance.
Kate is also an Accredited Menopause Coach and founder of Mareopause, a menopause community for equestrian women. A lifelong equestrian who trained as a BHSAI, she combines evidence, strategic insight and lived understanding to explore menopause, midlife health and ageing in life, at work and in the saddle.
Sources and further reading
- NICE: Menopause, identification and management
- NHS: Menopause and perimenopause
- Women’s Health Concern: Menopause resources
- Wright, Vonda (2025) Unbreakable. Penguin Random House
- Management of the Menopause (7th Edition, 2026). Edited by Haitham Hamoda. British Menopause Society
This article provides general information and does not replace personalised medical advice. Speak to an appropriately qualified healthcare professional about symptoms, diagnosis and treatment.