What Women Need to Know About Menopause

Ask most women to name the symptoms of menopause and they will tell you: hot flushes and periods stopping. According to Dr Laura Wood — a GP with a background in obstetrics and gynaecology who has spent years specialising in menopause — those are usually the last symptoms to appear, not the first.

By the time a woman gets a hot flush, she may have been experiencing anxiety, disrupted sleep, low mood and unexplained weight gain for months or years, attributing them to stress, work, ageing, or the ordinary pressures of midlife. The hormonal shift responsible often goes unidentified.

Dr Wood joined Dr Nara Daubeney on Dokkcast to cover the full picture: what menopause actually is, why so many women are missed or misdiagnosed, what treatment looks like today, and why doing nothing is not the neutral option many assume it to be.

Perimenopause can start in your late thirties

Menopause is technically a single day — the last day of a woman's final period, confirmed only once a year has passed without a bleed. But perimenopause, the hormonal transition that leads up to it, can last anywhere from four to ten years, sometimes longer.

The average age of menopause in the UK is 51. That means hormonal changes can begin as early as the late thirties. Women in their mid-thirties who notice that things feel 'not quite right' are sometimes told by their GP that they cannot possibly be perimenopausal. Dr Wood disagrees.

"Those early changes start," she explains. "A lot of doctors will tell them it can't be menopause. But it can be."

One of the reasons perimenopause is so frequently missed is that its earliest symptoms — anxiety, low mood, difficulty sleeping, brain fog — are easily attributed to other causes. Women arrive in the consulting room blaming work pressure or family stress. The hormonal dimension often goes unexplored.

Blood tests are not the answer — symptoms are

It is a common assumption that a blood test will confirm whether someone is in perimenopause. The reality is more complicated.

Both oestrogen and FSH (follicle-stimulating hormone) fluctuate significantly during perimenopause, sometimes dramatically from one day to the next. A single reading can appear entirely normal even in a woman experiencing significant symptoms. Testing on one day and getting a normal result does not rule out perimenopause.

For Dr Wood, the diagnosis is clinical. "I would be getting far more on her symptoms than I would on what a blood test tells me," she says. Where she does test, it is to rule out other conditions that mimic perimenopause — thyroid dysfunction, low iron, vitamin D deficiency — rather than to confirm it.

The symptoms most women do not connect to menopause

Hot flushes and irregular periods are the symptoms most women associate with menopause. Dr Wood's experience in clinic paints a different picture.

The women who come to see her most often present with anxiety that has appeared from nowhere, persistent low mood, sleep problems, and a sudden inability to manage stress in the way they always have. Many have gained weight around the middle without changing their diet or exercise habits. Many do not feel like themselves.

"They put them all down to other things," she says. "My son's doing his GCSEs, my mum's just been in hospital. And so it goes."

The symptoms Dr Wood asks about that women often will not volunteer unless asked: vaginal dryness, pelvic floor changes, discomfort during sex, and urinary tract infections that have returned after decades of absence.

Recurrent UTIs in women in their forties and fifties are frequently a sign of declining oestrogen affecting the tissue of the vagina and bladder. Vaginal oestrogen — a topical treatment that stays local and does not carry the same considerations as systemic HRT — can reduce the risk significantly. In one study, Dr Wood notes, it reduced the risk of death from UTI in older women by 70%.

"No one talks about it," she says. "And it's really important to talk about it."

HRT: what it is, how it works, and why the fear around it is largely outdated

Hormone replacement therapy (HRT) replaces the oestrogen that the body is no longer producing at the same levels. For women who still have a womb, progesterone is added to protect the womb lining. Testosterone may also be considered later in treatment.

The preference today is to deliver oestrogen through the skin — as a gel, spray or patch — rather than by mouth. When taken orally, oestrogen passes through the liver, which can slightly increase the risk of blood clots. Through the skin, it does not. Even women with a history of blood clots can safely take transdermal oestrogen.

Much of the fear around HRT traces back to a large study in the early 2000s — the Women's Health Initiative — which was halted after researchers identified higher rates of breast cancer in participants. The conclusion at the time was stark, widely reported, and, Dr Wood argues, significantly flawed.

"There were a lot of flaws in the study. There were a lot of flaws in the reporting of the study," she says. A 30% reduction in colon cancer among women taking HRT, for example, received almost no coverage.

Putting breast cancer risk in context: in a population of 1,000 women in their fifties, around 23 will develop breast cancer over a five-year period without HRT. With combined oestrogen and progesterone HRT, that rises to approximately 27 — four additional cases per thousand. Dr Wood notes that this is comparable to the risk associated with the combined contraceptive pill, and lower than the risk associated with drinking two or more units of alcohol a day.

The long-term risks of not treating menopause

For many women, the question is whether symptoms are bad enough to justify treatment. Dr Wood's view is that the question is framed wrongly.

After menopause, oestrogen loss affects bone density, cardiovascular health, and — increasingly, the research suggests — cognitive function. These are not theoretical future risks. They are measurable changes that begin at menopause and compound over time.

On bone health: oestrogen is protective for bone density. After menopause, bone loss accelerates. Osteoporosis develops silently — there are no symptoms until a fracture occurs. One in ten people who break a hip over the age of 75 will die within a month. One in three will die within the year.

On heart health: before menopause, women are at lower cardiovascular risk than men of the same age. After menopause, that protection disappears. Cholesterol and blood pressure tend to rise. Women are thirty times more likely to die from a heart attack or stroke than from breast cancer — including women who have had a prior breast cancer diagnosis.

"There are no rewards for suffering," Dr Wood says. "We're not just putting up with something that's unpleasant. It's something that could cause serious long-term health issues if we don't address it."

Testosterone: the overlooked third hormone

Testosterone is often thought of as a male hormone. Women make it too, and levels decline with age.

Dr Wood typically addresses testosterone after a patient has been established on the right dose of oestrogen and progesterone for around six months. Its licensed indication is low libido, but she uses it more broadly — for women who are still not quite feeling themselves, or who are struggling with energy and cognitive sharpness despite optimised HRT.

The NHS recently licensed the first testosterone product designed specifically for women: Androfeme. Previously, clinicians were adapting men's products for use at much lower doses — a practical difficulty that Dr Wood describes, diplomatically, as suboptimal.

How to get the best menopause care

Dr Wood's advice for women who want to invest in their menopause health:

Start with the basics on the NHS — thyroid function, iron, vitamin D, cholesterol, blood sugar. These are available without a referral and will rule out other causes of symptoms while establishing a useful baseline.

Consider a baseline bone density scan, particularly from age 50. This is not routinely available on the NHS unless specific risk criteria are met, but prices have fallen and it provides information that cannot be obtained any other way.

See someone with a genuine specialist interest in menopause — whether a GP or a gynaecologist. Dr Wood is direct: a gynaecologist does not automatically have specialist knowledge of menopause. Many do not. It is worth checking.

Listen to the full conversation with Dr Laura Wood on Spotify, Apple Podcasts and YouTube.

Dokkcast is the podcast from Udokk — a verified health platform where only credentialled medical and wellness professionals can post. Download the app on Apple or Google Play, or visit udokk.com