Far from being just the end of menstruation, this transition involves hormonal, brain, cardiovascular, and metabolic changes that influence sleep, mood, weight, sex life, and overall quality of life. Increasingly, European and Spanish research is shedding light on what happens in the female body, and at the same time, the market has discovered a new economic goldmine in menopause , forcing us to refine our judgment and adopt a more critical perspective.
A long and poorly explained stage: from climacteric to menopause
In consultations and in daily life, many women begin to notice changes around age 40 : less energy, vague discomfort, poorer sleep, and emotional ups and downs that tend to be normalized or experienced with shame. This is menopause , the transitional phase in which hormones fluctuate even though menstruation continues.
As explained by Spanish gynecologists specializing in this stage, perimenopause can last several years and during this period most of the typical symptoms associated with menopause appear: hot flashes, night sweats, sleep disturbances, changes in sexual desire, vaginal dryness, weight gain and mood swings.
Menopause is only considered "official" after 12 consecutive months without a period. By then, the reality is that the body has been changing for a long time, often without the woman associating it with hormones or receiving a clear explanation at her healthcare provider.
Data from recent barometers on menopause , promoted in collaboration with the Spanish Association for the Study of Menopause, indicate that between 75% and 80% of women have symptoms and that, around a quarter, they experience them severely, with a direct impact on their work, social and relationship life.
Hot flashes, sleepiness, and mood: when the body and mind go their own way
Hot flashes and night sweats remain the most well-known symbol of menopause, but for many women, they aren't the worst of it. In addition to the physical discomfort, they repeatedly interrupt sleep , leaving sleepless nights and mornings filled with a fatigue that can't be remedied with just a cup of coffee.
Sleep health specialists in Spain emphasize that these disturbances are not just a passing annoyance. Recent research conducted in the United Kingdom, analyzing nearly 125.000 women , shows that the menopausal transition is associated with changes in the brain's gray matter in key areas for memory, emotional regulation, and decision-making—the same areas affected in neurodegenerative diseases.
Magnetic resonance imaging (MRI) scans of thousands of participants have shown a loss of brain volume in postmenopausal women, associated with increased anxiety, depression, poorer sleep quality, and higher antidepressant use. For specialists in dental sleep pathology and neuroscience consulted for this study, the message is clear: impaired sleep has a real impact on the brain and cannot be reduced to "nerves" or simple stress.
Those who work with women of this age insist that, after 45, what were once simple tips—watching dinners, respecting schedules, reducing screen time—become almost “biological obligations” if they want to maintain restful sleep. Large dinners that had no consequences in their 30s now spike cortisol levels and significantly disrupt sleep.
Hormones, brain and hormone therapy: what is known and what is not
Estrogen and progesterone are not just reproductive hormones: they influence neurotransmitters like serotonin and melatonin , temperature regulation, and metabolism. That's why, when hormonal fluctuations begin, many women feel "out of control": irritability, crying spells for no apparent reason, easy laughter, and, at the same time, apathy or lack of concentration.
For years, some of these symptoms have been treated as classic depressive episodes , with the consequent prescription of antidepressants, without addressing the hormonal background or the particularities of this stage. The new neurophysiological approach suggests that menopause is also a neurological process that requires a broader perspective, combining mental health, endocrinology, and sleep medicine.
In this context, hormone replacement therapy (HRT) is at the center of much of the debate. In countries like the United Kingdom, it is used by around 15% of women, while in Spain its use remains relatively low, partly due to fear of an increased risk of breast cancer and partly due to a lack of balanced information.
Recent studies suggest that hormone therapy does not reverse the loss of gray matter observed in the brain after menopause. At best, it may offer slight improvement in certain cognitive functions, such as reaction time, but it does not "cure" the brain decline associated with this stage of life.
However, experts in menopause who use it in clinics point out that, when properly prescribed and at low doses, it can be key for some women with severe symptoms, improving their quality of life, rest, and pain, always assessing the balance between risks and benefits individually and with close medical monitoring.
Heart and menopause: the other side of risk
In Spain, cardiovascular diseases are the leading cause of death in women, ahead of cancer. However, when a woman consults a doctor for chest pain, palpitations, or shortness of breath, the suspicion of heart disease often remains low, and the symptoms are attributed to anxiety, stress, or digestive problems.
Female cardiologists from the Spanish Society of Cardiology have been warning about this gender bias for years. The historical lack of women in clinical trials (often less than 30% of participants) has meant that much of the evidence on cardiovascular prevention and treatment has been extrapolated from male populations, despite the fact that female anatomy, physiology, and metabolism respond differently.
Menopause is considered one of the so-called "critical windows" for prevention. The drop in estrogen is associated with changes in lipids, blood pressure, and insulin sensitivity , as well as a redistribution of body fat from the hips and buttocks to the abdomen, increasing visceral fat, which is directly related to the risk of heart attack and stroke.
Consensus documents published in the Spanish Journal of Cardiology advocate that menopause consultations should no longer focus solely on hot flashes and urogenital symptoms, but should systematically include assessments of blood pressure, lipid profile, weight, abdominal circumference, lifestyle habits, and, very importantly, obstetric history such as preeclampsia, gestational diabetes, or premature births, which are now recognized as markers of long-term cardiometabolic risk.
Osteoporosis, muscle mass and the role of exercise
Another issue that arises with menopause is bone health . The drop in estrogen accelerates the loss of bone mineral density, increasing the risk of osteoporosis , a disease in which bones become so fragile that a stumble or an everyday movement can cause fractures.
Nutritionists and bone metabolism specialists remind us that, from this stage onward, it's important to go beyond the classic message of "take calcium" and pay attention to vitamin D , which is key for calcium to be properly incorporated into bone. It's not just about avoiding levels at the lower limit, but about aiming for truly optimal levels, combining controlled sun exposure, diet, and, if necessary, supplementation.
Foods rich in calcium , such as small fish with bones (sardines, anchovies), some vegetables, nuts, and fermented dairy products, can help meet daily requirements. In addition, increasing importance is being placed on high-quality protein , distributing it well throughout the day, including at breakfast.
The other essential component is strength training . Recent clinical trials have shown that both low-intensity and moderate-intensity physical activity reduce symptoms of anxiety and depression in women going through menopause, while also helping to maintain muscle mass and protect bones.
Experts recommend at least two or three weekly sessions of adapted strength training, along with more daily movement to avoid the " hidden sedentary lifestyle " of those who train for half an hour a day but spend the rest of the day sitting down.
Pelvic floor, sexuality and quality of life
Among the less visible but more frequent symptoms are pelvic floor problems and urogenital atrophy . The decrease in estrogen causes an increase in vaginal pH, intense dryness, and changes in the mucous membranes that can cause pain during sexual intercourse, recurrent urinary tract infections, and a feeling of urinary urgency.
Menopause experts remind us that these changes are physiological but not "normal" in the sense of being inevitable , and that they shouldn't be accepted as a price to pay. The message that "a drop of urine when laughing is just part of the process" contributes to many women not seeking help, even though local treatments, pelvic floor physiotherapy, and various strategies exist to improve function and comfort.
In addition to the well-known Kegel exercises, there is a growing number of rehabilitation programs that combine specialized equipment, massage, and, in some cases, external vibration devices to help stimulate and strengthen the pelvic floor muscles. The goal is not only to prevent urinary incontinence but also to preserve sexual function and overall well-being.
Gynecologists and sexologists agree that, after age 40, it's wise to honestly ask yourself two basic questions: how well do you sleep and how well do you digest food ? When sleep and digestion begin to fail, it's often the first sign of hormonal changes and the impact of chronic stress on a digestive system that's key to immunity, energy, and, as is becoming increasingly clear, also to hormonal balance.
Microbiota, strobolome and hormones: the role of the gut
In recent years, a little-known but crucial player has gained prominence in this stage: the estrobolome . This is the collection of bacteria in the gut microbiota capable of producing an enzyme (beta-glucuronidase) that “recycles” inactive estrogens and returns them to the bloodstream.
Experts in hormonal health explain that, when ovarian estrogen production decreases, having a balanced estrobolome can greatly influence how each woman experiences menopause , making the transition more gradual or, on the contrary, more abrupt.
The key, however, lies in balance. If beta-glucuronidase activity is too high, circulating active estrogen increases , potentially worsening conditions related to excess estrogen, such as endometriosis or certain estrogen-dependent tumors. Conversely, menopause typically sees a decrease in this activity , resulting in less available estrogen and, potentially, more hot flashes, poorer bone health, and increased vaginal dryness.
Gastroenterologists and gut microbiota experts point out that, while these bacteria cannot restore hormone levels to those of youth, they can optimize the use of remaining estrogen if properly cared for. This is why the gut has become a priority in many menopausal health strategies.
How to modulate the microbiota through food and lifestyle
The most powerful tools for influencing estroboloma remain diet and herbal medicine . Specialists recommend a diet rich in fruits, vegetables, and fiber , providing vitamins, minerals, and antioxidants, and promoting bacterial diversity. Foods high in polyphenols—such as berries, green tea, pure cocoa, and extra virgin olive oil—also help reduce the low-grade inflammation that often accompanies this stage.
The healthy fats found in olive oil, avocados, nuts, and oily fish are essential for hormone production , maintaining a balanced metabolism, and supporting cardiovascular health. Fermented foods—such as kefir, natural yogurt, miso, tempeh, kimchi, and kombucha—also contribute beneficial bacteria and metabolites with a potential regulatory effect on the gut microbiota.
Another practical aspect is meal organization . Eating dinner earlier and leaving several hours between meals allows the gut to rest and repair its lining, which is associated with a better microbial balance and a better response to nutrients.
Regarding probiotics , there is no single product suitable for all women, but some strains, such as certain Lactobacillus, have shown interesting effects on immune and hormonal balance, especially during perimenopause. Research is also beginning on "fourth-generation" probiotics , which are more focused on regulating the functions of the gut ecosystem than on colonizing it, although their use is still highly experimental and should always be guided by healthcare professionals.
As science advances, the most consistent recommendations include a varied and minimally processed pantry , combining a Mediterranean diet with regular exercise, ensuring adequate nighttime rest, and reducing sustained stress as much as possible.
Menopause in the shop window: menowashing and hormonal marketing
Alongside the advancement of scientific evidence, the market has identified menopausal women as a high-interest segment with significant purchasing power and underserved needs. The result is a boom in supplements, cosmetics, apps, devices, and "menopause-specific" programs that, according to international estimates, already generate billions of euros and are expected to continue growing in the coming years.
This phenomenon has given rise to the term “menowashing” , used to describe marketing strategies in which generic products are repackaged and sold as specific solutions for this stage, often overpriced and without providing clear benefits compared to standard versions.
Among the risks highlighted by health and gender experts is the remedicalization of menopause , presenting it as a chronic illness that requires continuous intervention and customized products. This can fuel unjustified fears, push women toward unnecessary treatments, and reinforce the idea that the menopausal body is, in essence, a “defective” body that needs to be corrected.
At the same time, many women perceive a disconnect between marketing rhetoric and their actual experiences . Studies conducted in Spain indicate that a large majority believe brands are not doing enough to genuinely support them, and that they do not feel represented in advertising about this stage of life.
To ensure that current visibility doesn't become a passing fad or a mere sales tactic, communication and public health specialists emphasize the importance of health literacy : learning to read labels, being wary of miraculous promises, looking for quality seals, and prioritizing information endorsed by scientific societies and independent organizations.
Changing the narrative: from private taboo to public health
Although the situation may seem overwhelming, one message is repeated by gynecologists, cardiologists, neuroscientists, and science communicators: menopause is an inevitable transition, but its impact is malleable . It doesn't mark a woman's decline, but rather the beginning of a new stage that, with current life expectancy, can literally encompass half a lifetime.
Preparing for that moment doesn't mean becoming obsessed, but rather getting informed in advance , asking questions, listening to your body, and not minimizing symptoms that interfere with rest, concentration, sex life, or work performance. Data indicates that a significant percentage of women experience a decline in productivity and professional visibility due to these symptoms, and many remain silent for fear of judgment in the workplace.
On a social and cultural level, various voices are calling for a greater presence of middle-aged women in the media, film, and advertising, portrayed in all their diversity and not reduced to the stereotypical image of the irritable woman with hot flashes. There are also calls for the inclusion of content about perimenopause and menopause in sex and health education from an early age, so that new generations grow up with a more informed perspective and less burdened by stigma.
Meanwhile, the most consistent strategies for navigating menopause with well-being remain largely the same as always: a balanced diet, regular exercise, good sleep hygiene, emotional support, and a critical yet open relationship with available treatments. Between medications and empty promises from the market, there is ample room for self-care and prevention that, if properly utilized, can make all the difference in how this long stage of life is experienced.
Thus, menopause ceases to be an episode suffered in silence and becomes a matter of public health, research and rights , where rigorous information, professional listening and the autonomy of women weigh as much or more than any fashionable product.
