Modern Menopause:
Empowered, Informed, Supported

Ten positive actions for menopause & perimenopause

Ten Positive Actions for Perimenopause and Menopause
By Dr Catherine Fernando, GP, East Lothian

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Perimenopause and menopause can be an emotional stage of life, but you don’t have to face it alone.  With growing awareness, better treatments and exciting new therapies, women today can be better supported than ever before.

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Here are my ten positive, practical actions to help you feel informed, hopeful and in control during perimenopause and menopause.

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1. Reframe menopause as a transition, not a problem

Menopause is a natural biological stage, not a failure of the body. While symptoms can be challenging, this is also a time when many women report greater self-confidence, resilience and clarity.

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2. Learn to recognise early changes

Perimenopause often begins in the early to mid-40’s. Subtle changes such as disrupted sleep, increased anxiety, heavier or irregular periods and reduced energy are common. Even a decade ago it was rare for women to consult about the perimenopause and most had to wait until their menopause (average age 51 years) to be considered for supportive treatment such as HRT. However, recent high profile media coverage has helped women to understand that many symptoms experienced in the decade before menopause are hormone related. This has empowered a new generation to seek support early and avoid years of unnecessary struggle.

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3. Take ownership of your health

The perimenopause is an ideal time to invest in yourself. However, this may seem practically impossible to many women in their 40’s and 50’s who are at the peak of their careers, navigating life with teenage children, and caring for elderly relatives. It is worth remembering that your health is vitally important to those you support. Simple actions such as booking health reviews for that symptom that keeps troubling you, monitoring blood pressure, having a cholesterol check, and paying attention to your mental health can make a real difference to how you feel now and in the future.

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4. Use movement as medicine

Exercise is one of the most effective tools for managing menopausal symptoms. It helps prevent osteoporosis, improves mental health and reduces risk of cardiovascular disease. Strength training using weights or resistance bands protects bones and muscles; brisk walking, cycling, dancing, aerobics, swimming, running and team sports improve heart health; and activities like yoga or Pilates can improve flexibility and reduce stress. Exercising with a friend or joining a group class can improve motivation, enjoyment and help you keep going. 

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5. Fuel your body well

Nutrition matters more than ever during menopause. Following a Mediterranean diet which is rich in wholegrains, fruits, vegetables, and unsaturated fat is a great place to start. Plant oestrogens found in soya beans, flax seeds and linseeds may help to reduce flushes.  Protein (fish, lean meat, beans, lentils, chickpeas, nuts, seeds) is important for muscle mass and strength. Calcium (milk, yoghurt, cheese, kale, sardines, tinned salmon, tofu) is good for bones. Vitamin D is also vital for bones but unfortunately most people living in the UK do not get enough vitamin D due to the lack of sunlight in winter.  The NHS recommends that everyone should consider taking a vitamin D supplement of 10 micrograms per day, particularly between October and March.

Fluctuating sugar levels can worsen hot flushes, alter mood stability, and lead to weight gain. Efforts to reduce sugar intake, as well as caffeine and alcohol (which can also worsen flushes and have a deleterious effect on sleep) will help too.

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6. Protect your sleep

Sleep disruption is common during the perimenopause. Creating calming evening routines, reducing screen time, limiting alcohol and managing stress with relaxation techniques such as meditation and deep breathing can all help. Cognitive Behavioural Therapy which can be accessed for free online at sleepio.com is also a first-line treatment for insomnia. If sleep problems persist, medical treatment — including hormone therapy — can be transformative. Rest is not a luxury; it’s essential.

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7. Consider hormone replacement therapy (HRT)

HRT remains the most effective treatment for menopausal symptoms and can significantly improve quality of life. It also reduces the risk of osteoporosis and may have cardiovascular benefits when started at the right time. Treatment is highly individual, and many different options now exist. Useful resources with factual information can be found at www.womens-health-concern.org and www.menopausematters.co.uk

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8. Alternative and new medical therapies

Many women choose not to use HRT or have medical problems (such as a strong family or personal history of breast cancer) that mean they should not be prescribed HRT. However, non-hormonal medications are available. For example, selective serotonin uptake inhibitors (SSRIs) which have long been used for anxiety and depression can help hot flushes. Newer therapies (neurokinin-receptor antagonists) directly target the temperature centre in the brain and have been found to be safe and effective for the treatment of moderate to severe vasomotor symptoms. They are currently only available on private prescription but will hopefully be approved by the NHS in the future.

Menopause treatment is an exciting area of pharmaceutical research and options for women who cannot use HRT are expanding.

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9. Address intimate and urinary health confidently

Genitourinary Syndrome of the Menopause (GSM) is a common collection of symptoms that occur due to declining levels of oestrogen.  Women may notice symptoms such as vaginal dryness, burning, itching, and pain with intercourse. Urinary symptoms, include urgency, needing to pass urine more often, discomfort when urinating, or recurrent urinary tract infections. Don’t be afraid to speak to a medical professional about intimate problems. They can help you find a treatment to suit your symptoms, personal preferences and medical history.

Simple measures like vaginal moisturisers and lubricants can ease dryness and discomfort. Local vaginal oestrogen therapy (such as creams, tablets, or rings) is very effective and safe for many people. Pelvic floor physiotherapy can also support vaginal and urinary health.

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10. Connect, share and advocate

Talking openly about menopause reduces stigma and improves care for everyone. Whether with friends, family or healthcare professionals, sharing experiences fosters understanding and support. You deserve to be heard and to receive care that works for you.

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Menopause is not something to “get through” — it is something to move through with knowledge, support and optimism. With lifestyle changes, effective treatments and growing research, women can feel stronger, healthier and more confident than ever before.

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Dr Catherine Fernando is a GP based in East Lothian with a special interest in women’s health and menopause care.

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Menopause & Perimenopause Symptom Checklist

You do not need to experience all of these symptoms to be perimenopausal or menopausal. Symptoms can fluctuate, come and go, and vary widely between women.

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Periods & hormones

• Changes in cycle length or flow

• Heavier or lighter periods

• Skipped periods

• Worsening premenstrual symptoms

Temperature & circulation

• Hot flushes

• Night sweats

• Feeling suddenly overheated

Sleep & energy

• Difficulty falling or staying asleep

• Early morning waking

• Unrefreshing sleep

• Persistent fatigue or low energy

Mood & mental health

• Anxiety or panic symptoms

• Low mood or loss of confidence

• Irritability or mood swings

• Feeling overwhelmed or emotionally fragile

Brain & cognition

• Brain fog

• Forgetfulness

• Difficulty concentrating

• Reduced motivation

Muscles, joints & body changes

• Joint aches or stiffness

• Muscle pain

• Reduced strength

• Weight changes, particularly around the middle

Skin, hair & senses

• Dry or itchy skin

• Thinning hair or hair loss

• Changes in skin texture

• Dry eyes or mouth

• Hormonal acne

Intimate & urinary health

• Vaginal dryness or soreness

• Pain during sex

• Reduced libido

• Recurrent urinary tract infections

• Urinary urgency or frequency