Menopause can be surprisingly controversial. A natural life stage that can result in important physical and mental health changes, it seems it’s only taken seriously if it’s seen as something that results in symptoms, and can be treated as a medical condition with HRT. In this blog, we look at how important hormone changes are in menopause, how they link to other body systems, and that, if we work at a whole body level, we can reduce or even remove the reliance on HRT.
Menopause is a physiological life stage, not a disease. It is not merely a biological event, but a transformative phase that significantly shapes women’s day to day experiences. There is much to celebrate about this transition. In some cultures, it’s seen as a natural, empowering shift into a period of wisdom and strength. Yet for many the changes can shine a spotlight on, and exacerbate, existing health imbalances. Symptoms might include hot flushes, sleep disruption, mood changes, cognitive complaints, weight shifts, joint pain, urogenital symptoms and more. These are not imagined and can be profoundly disruptive to work, relationships, and self‑confidence (Anto, 2025). In the UK, over 75% of women experience menopausal symptoms, with 25% describing these symptoms as severe (NICE, 2024). When we consider that there are currently an estimated 13 million perimenopausal or menopausal women in the UK, we can begin to see just how many women are likely to be affected by these issues, and why it might be seen as a societal level ‘medical issue’.
Many women are already convinced their bodies are “failing” or that the only meaningful solution is medication, usually as hormone replacement therapy (HRT). The medical model has contributed valuable options, and HRT can be life‑changing for some, but cultural framing also matters. Productivity norms, anti‑ageing messaging, and “deficiency language” (e.g., “oestrogen deficiency disorder”) subtly teach women to distrust their bodies. In clinic, this shows up as expectations of a single fix, limited tolerance for experimentation, and a focus on symptom suppression over system support.
But the core practitioner question remains: are we supporting adaptation, or defaulting to symptom suppression? Could we be unintentionally reinforcing a story that midlife female biology is broken and must be “fixed”?
Female hormones – beyond reproduction
Female hormones, including oestrogen and progesterone, are often discussed almost exclusively in the context of fertility and menstruation. Yet both exert widespread effects across nearly every body system. Their receptors are expressed in the brain, cardiovascular system, bone, immune cells, metabolic tissues, skin, and the gastrointestinal tract, highlighting their role as global regulatory hormones rather than purely reproductive ones. (Zhu, 2023)
As women transition through menopause, the decline in ovarian hormone production removes a layer of protective ‘physiological buffering’, making existing metabolic, inflammatory, neurological, or stress‑related imbalances more visible. Menopause often acts as a stress test for the system, rather than a singular pathological trigger. Let’s explore what changes that can trigger in different body systems.
Mood and cognition
Many women describe menopause as a time of “losing themselves” cognitively or emotionally. Oestrogen plays a central role in cerebral glucose metabolism, mitochondrial efficiency, synaptic plasticity, and cerebral blood flow, supporting memory, attention, mood regulation, and stress responsiveness through its actions on neurotransmitters (including serotonin and dopamine) and neuroinflammation. (Bendis 2024)
Progesterone modulates GABAergic signalling, exerting calming, anxiolytic, and neuroprotective effects. It’s also anti‑inflammatory, antioxidant, and myelin‑supporting. (Fedotcheva, 2025)
When these hormones decline, poor sleep, chronic stress, glycaemic instability, micronutrient insufficiency, or neuroinflammation, may be amplified, resulting in anxiety, low mood, “brain fog,” and reduced stress tolerance.
Metabolic and cardiovascular health
Before menopause, women typically display a more favourable cardiometabolic profile than men. Oestrogen supports endothelial function, vascular flexibility, lipid metabolism, insulin sensitivity, and body fat distribution. (SenthilKumar 2023)
Reduced oestrogen is associated with increased visceral adiposity, worsening insulin resistance, adverse lipid shifts, and endothelial dysfunction, all of which increase cardiovascular risk. In obesity, adipose tissue shows altered expression of oestrogen receptors and dysregulation of key enzymes involved in oestrogen metabolism (e.g. aromatase). This means that although adipose tissue can produce oestrogens, obesity impairs effective oestrogen signalling, reducing its protective metabolic and anti‑inflammatory effects and reinforcing dysfunction. (Kuryłowicz, 2023)
Menopause does not cause cardiometabolic disease, but existing insulin resistance, hypertension, or chronic inflammation are more likely to result in pronounced metabolic and vasomotor symptoms.
Bone and connective tissue
Oestrogen is a key regulator of bone remodelling, inhibiting bone resorption while supporting osteoblast activity. Its decline accelerates bone turnover, increasing fracture risk, particularly in the early postmenopausal years. (Lee, 2026)
Bone loss can also arise from the interconnected effects of oestrogen deficiency, gut dysbiosis, and immune‑driven inflammation. Loss of oestrogen disrupts microbial composition and increases risk of permeability and systemic inflammation, promoting pro‑osteoclastogenic cytokine signalling. Through this ‘gut–bone–immune’ axis, chronic low‑grade inflammation accelerates bone resorption and contributes to osteoporosis. (Chen, 2025)
Joint pain, stiffness, and connective tissue discomfort may similarly reflect loss of hormonal anti‑inflammatory and tissue‑protective effects. Menopause can accelerate muscle loss (sarcopenia) as declining and fluctuating oestradiol disrupts muscle‑protective pathways, impairing muscle repair and regeneration, increasing inflammation, altering mitochondrial function and energy metabolism, and can promote fat infiltration and apoptosis in muscle. (Menzies, 2026).
Inflammation
Oestrogen influences both innate and adaptive immunity, modulating cytokine production, T‑cell differentiation, B‑cell activity, and overall inflammation. Declining oestrogen alters these regulatory pathways, contributing to increased immune activation and low‑grade inflammation. There can be increased prevalence of inflammatory and autoimmune conditions, altered infection responses, often observed in postmenopausal women. (Chakraborty 2023)
It may be more likely in individuals already experiencing gut dysbiosis, metabolic dysfunction, or chronic stress, and may amplify fatigue, pain sensitivity, mood changes, and cardiometabolic risk.
Why do women experience menopause so differently?
So, each woman will experience menopause differently, because of their pre-existing health status. For example, women with higher fasting insulin levels experience earlier menopause onset, with increased risk and longer durations of vasomotor symptoms. (Athar, 2026) Existing chronic HPA‑axis activation can worsen menopausal symptom severity and persistence. (Kuck, 2024)
As menopause increases nutrient requirements affecting bone, cardiovascular, metabolic and neurological health, suboptimal micronutrient status may exacerbate fatigue, mood changes, and other menopausal symptoms. (Erdélyi, 2023)
Changes in gut function and microbial diversity can disrupt the ‘oestrobolome’, altering recycling of oestrogens. Dysbiosis, often exacerbated by low fibre intake and slower transit, promotes inflammation and metabolic dysfunction, worsening menopausal symptoms such as vasomotor instability, mood changes, and bone loss. (Wang, 2025)
Inflammatory conditions of joints, fascia, and connective tissue may feel more symptomatic in women with pre-existing inflammation. (Khoudary, 2025)
Stressful life events, socioeconomic disadvantage, relationship strain, caregiving burden, prior mental health history, and negative expectations about menopause all also substantially influence the risk and severity of depressive and anxiety symptoms in menopause. (Brown, 2024)
Supporting the ‘Whole Woman’ in Menopause
Understanding the complex relationships between sex hormones and other systems invites a more nuanced clinical narrative. Menopause is not simply a state of hormone “deficiency,” but a whole‑body transition that exposes resilience or fragility across interconnected systems. When hormones decline, the body has less capacity to compensate for dysregulated glucose control, chronic stress, inflammation, poor sleep, or inadequate nutrition. For practitioners, this reinforces a personalised, systems‑based approach, helping women adapt the changes, supporting not only their hormonal balance, but also those other systems, to the mutual benefit of both.
We must also consider the social and cultural context of menopause. As a ‘later life’ stage, it often coincides with peak career responsibility, increased stress, multiplying demands, caring for children or ageing parents, family/relationship changes, grief, identity shifts, and potentially changing or loss of purpose. All of these can of course massively contribute to the health changes observed. While no protocol can compensate for an unsustainable life context, practitioners can support by non-judgmental listening, validating the client’s lived experience, helping them reconnect with agency and self‑trust, ensuring the changes we suggest are practical and achievable, and, of course, connecting them to other professional support they may need.
Supporting the ‘whole woman’ in menopause means seeing symptoms as signals, not failures. We see menopause as a systems transition, not a deficiency state. We prioritise long‑term health alongside short‑term relief. We help women feel capable, not fragile. And, ideally, where medical intervention is considered, we aim to integrate not polarise medical and nutritional approaches.
We don’t have to choose between “toughing it out” and “medicating everything”. Menopause can be supported intelligently, compassionately, and holistically, whether a client uses HRT or not. In fact, by supporting holistically, taking a wider view, we may well reduce reliance on HRT, or mean it is not needed at all. As holistic practitioners, our contribution is unique. We can help women stabilise the terrain, understand their bodies, and adapt with strength. The goal isn’t necessarily not to use medical approaches, but to ensure women don’t lose sight of their body’s remarkable capacity to change and thrive, promoting a renewed state of balance, in tune with the ‘second spring’.
References
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Last updated on 19th March 2026 by cytoffice
