What happens to hormones during the menopausal transition?

During the menopausal transition, ovarian follicular activity declines, reducing both oestrogen and progesterone production. Oestradiol levels fluctuate erratically during perimenopause — sometimes higher than premenopausal levels and sometimes very low — before declining steeply in the years surrounding the final period. Progesterone drops earlier in the transition as anovulatory cycles become more common. FSH rises progressively as the pituitary tries to stimulate declining ovarian function. These hormonal shifts underlie the wide range of symptoms characteristic of the menopausal state.

Why do women experience menopause differently?

The menopausal experience varies significantly between individuals, influenced by: genetic factors (family history of symptom severity); ethnicity (Black and Hispanic women report more vasomotor symptoms; Asian women often report fewer); body weight (more adipose tissue produces more oestrone, a weaker oestrogen, which may buffer some symptoms but is associated with increased breast cancer risk); smoking status (smokers experience an earlier menopause); stress and mental health history; and general baseline health.

Is the menopausal state a medical condition or a natural life stage?

It is both. Menopause is a universal and natural life transition that all women undergo — not a pathological state. However, for many women, the hormonal changes produce symptoms that significantly impair quality of life, sleep, relationships, and work, and that benefit from medical support. The previous tendency to trivialise or normalise menopause symptoms ("it's natural — just get on with it") left many women undertreated. The contemporary approach acknowledges both the natural nature of menopause and the genuine medical support that can meaningfully improve quality of life.

What is genitourinary syndrome of menopause?

Genitourinary syndrome of menopause (GSM) — formerly called vaginal atrophy — describes the collection of vulvovaginal and urinary symptoms resulting from declining oestrogen in the tissues of the vulva, vagina, urethra, and bladder. Symptoms include vaginal dryness, itching, burning, discomfort during intercourse, and urinary symptoms including urgency, frequency, and recurrent urinary tract infections. Unlike vasomotor symptoms (which often improve over time), GSM is a progressive condition that does not improve without treatment. Local vaginal oestrogen is highly effective and has minimal systemic absorption.

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Menopausal state

The transition marking the end of reproductive years characterized by physiological shifts.

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Reviewed by Dr. Ian Henderson · Microbiobial Health & Medicine26 March 2026Research-supported

Quick answer

The menopausal transition marks the end of reproductive years, involving significant hormonal shifts — particularly declining oestrogen — that affect bone density, cardiovascular health, mood, sleep, and thermoregulation. Integrative approaches including HRT alternatives, phytoestrogens, lifestyle medicine, and mind-body practices are widely used for symptom management.

Do any of these feel familiar?

The menopausal transition is experienced through a wide range of physical and emotional changes — most prominently hot flushes, night sweats, disrupted sleep, and vaginal dryness
Many women also describe significant mood fluctuations, anxiety, or an unexpected low mood during the transition
Brain fog — difficulty concentrating, forgetting words, or feeling mentally slower — is frequently reported and often alarming to women who were not aware it could be a menopausal feature
Weight changes, joint stiffness, and a reduced libido are also common
Many women describe the menopausal state as a time of recalibration — physically, emotionally, and in terms of identity and priorities

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