What happens to the body during menopause? Menopause is not a disease, but it can profoundly change a woman’s life. What happens is a progressive decline in ovarian activity and, consequently, in the production of estrogen and progesterone. However, this hormonal change does not affect only the reproductive system. Estrogen receptors are distributed throughout body. As a result, the menopausal transition can influence sleep, mood, body temperature, skin health, muscle and bone mass, metabolism, the cardiovascular system, and sexual health. It is important to understand that menopause is not simply about stopping menstruation. It is a genuine biological transition that can manifest itself very differently from one woman to another. What are the less well-known changes of menopause that can have impact on daily life? Many women come to consultations saying, “I’m not the same person anymore, I no longer recognize myself.” They do not always experience hot flushes. Sometimes they wake up tired, sleep poorly, feel more anxious, have difficulty concentrating, lose muscle strength, experience joint pain, gain abdominal fat, or feel as though they have lost their energy. Changes in libido, vaginal dryness, pain during sexual intercourse, urinary symptoms, or simply a loss of confidence in their own body may also occur. These symptoms can seem unrelated, but when we look at the woman as a whole, we often realize that they are connected to the same stage of life. Are women seeking help earlier, or do they still feel they simply have to endure it? There is still some silence surrounding menopause, particularly when discussing sexuality, emotional changes, or loss of confidence. However, I believe we are witnessing a very positive change. Women are becoming better informed and are increasingly seeking medical advice. Nevertheless, there is still a perception that certain symptoms are simply “the price of ageing” and must be endured. We should not normalize suffering simply because it is common. Menopause is inevitable , but suffering from symptoms that interfere with sleep, work, relationships, or self-esteem does not have to be accepted as inevitable. If a woman is sleeping badly, has lost quality of life, is experiencing pain, has lost sexual desire, feels anxious, or no longer recognizes herself, she deserves to be heard by a doctor. We do not need to medicate every woman. What we need is to avoid dismissing any woman’s concerns. Can menopause affect a woman’s sexual life? Yes, and this is one of the topics most frequently left unaddressed, as many women feel embarrassed discussing it during a consultation. The reduction in estrogen levels causes changes in vulvovaginal tissues, leading to dryness, reduced lubrication, and pain during intercourse. However, sexuality is far more complex than a single hormone. Sleep, stress, body image, relationship dynamics, self-esteem, emotional changes, and the ageing process itself can all play a role. There is still some reluctance to talk about these issues, perhaps because female sexuality was undervalued for a long time. Yet in a gynecology consultation, discussing sexual health should be as natural as talking about menstruation or pelvic pain. If a woman does not raise the subject, it is the gynecologist responsibility to ask about sexual health. At what age can early menopause occur? It is important to distinguish between early menopause and premature ovarian insufficiency. Early menopause is defined as menopause occurring before the age of 45. When ovarian function is lost before the age of 40, we refer to this as premature ovarian insufficiency. This may have genetic, autoimmune, surgical, chemotherapy-related, or radiotherapy-related causes, or it may occur without any identifiable cause. In these cases, medical evaluation is particularly important , not only because of the symptoms, but also because of the impact that prolonged hormone deficiency can have on bone, cardiovascular, sexual, and overall health. Do some women experience symptoms while others hardly notice they are entering menopause? There is no single menopause experience. Genetics, the speed of hormonal transition, lifestyle, sleep, stress levels, overall health, and many other factors can influence how each woman experiences this stage of life. This is also why I do not like to view menopause solely through laboratory results. A woman is not just an FSH (follicle-stimulating hormone), estradiol, or testosterone value. She is the combination of her symptoms, clinical context, risk factors, and health goals. What is the relationship between menopause and pain that many women attribute to ageing? Musculoskeletal pain is a very common complaint during this stage and may coincide with declining estrogen levels . Some women begin to experience stiffness, joint pain, muscle pain, or a much slower physical recovery. However, there is an important point to remember: we should not automatically attribute all pain to menopause. A woman aged 48 or 50 with persistent pain should not simply be told “It’s your age”. She deserves a proper assessment. Menopause may be part of the explanation, but our responsibility is to understand the full picture. Are there medical treatments available today that allow a woman to be told, “you don’t have to live with this”? Yes, although it is important to approach treatment responsibly. There is no single “menopause prescription”. Today, we have a range of tools available: hormone therapy when appropriate, non-hormonal options, treatments aimed at vaginal health, and interventions focused on exercise, nutrition, sleep, body composition, and metabolic health. Treatment should be individualized and monitored over time. One idea I like to share with my patients is that the goal is not to make a woman return to being 30 years old. It is to help her live the coming years with health, functionality, and quality of life. Are there innovative techniques that can transform the lives of women during menopause? Innovation can be valuable, especially when used to address a specific need. In the field of intimate health, for example, regenerative technologies may be used in cases of genitourinary symptoms that significantly affect quality of life. These include: The use of CO₂ laser therapy for vulvovaginal atrophy and mild urinary incontinence; The use of platelet-rich plasma (PRP) for hydration and tissue regeneration, with promising results in cases such as recurrent vulvar fissures; The use of hyaluronic acid and collagen biostimulators to improve hydration, elasticity, and comfort. However, innovation must be kept in perspective: technology should serve women, not the other way around. Before any treatment is considered, we need to understand the problem, define the objective, and review the available evidence supporting that intervention. What should a woman not expect from an innovative menopause treatment? Miracles. There is no treatment capable of stopping ageing or restoring the body completely to what it was at the age of 30. Longevity does not simply mean living more years. It means striving to live those years with health, independence, strength, functionality, and quality of life. And that cannot be achieved through a single treatment. It is something that is built over time. How can women distinguish between treatments with medical evidence and those that are simply trends or marketing? This is one of the most important questions today. “Natural” does not necessarily mean safe, and “innovative” does not necessarily mean effective. I would encourage every woman to ask a few simple questions: Is there scientific evidence supporting it? Are there high-quality studies available? Are the benefits and risks well understood? Are there recommendations from scientific societies? Does the person prescribing or performing the treatment have specific training in this area? It is also important to be cautious of solutions that promise extraordinary results , claim to work for all women, or present menopause as a disease that needs to be cured. Medicine should be evidence-based but also individualized. The issue is not choosing between “hormonal” and “natural”; it is about determining what is appropriate and safe for each individual woman. A final message I would like all women to know, above all, that menopause does not mean losing who they are . It is a new stage of life, with real changes, but it does not have to be a phase defined by loss. Ask for help. Ask questions. Talk about what you are feeling, even when the subject still seems difficult to discuss openly. Menopause should not be seen as the end of one chapter in a woman’s life, but as an opportunity to look after her health in a more complete and holistic way. Caring for women after the age of 40 is also about caring for the woman they wish to continue being. Author: Ana Filipa Brás (gynecologist) Meet the Gynecology-Obstetrics team at Hospital da Luz and schedule your appointment. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item. English translation generated with AI and reviewed by the editorial team.
