THE DECODEMENO GLOSSARY
80 menopause terms,
in plain English.
From abdominal fat shift to vasomotor symptoms: the language your doctor uses, decoded. US-specific. Evidence-based. Educational only, never medical advice. Updated May 2026.
A
Abdominal fat shift
The mid-life redistribution of body fat from hips and thighs (gynoid) toward the belly and around the organs (android). As estradiol falls in perimenopause, the liver makes less SHBG, free testosterone goes up a touch, and fat parks itself around the middle. It's not laziness, it's a hormonal storage switch. Visceral fat (the deep belly fat) drives insulin resistance and cardiovascular risk, which is why waist circumference matters more than the scales after 45.
See also: Insulin resistance · Visceral adipose tissue · Weight gain (peri)
Adipose tissue
Body fat. Not just storage, adipose tissue is endocrine, meaning it makes hormones. After menopause it becomes the main site of estrogen production (via aromatase converting androgens to estrone), which is why very thin post-menopausal women can have more vasomotor symptoms. Visceral adipose tissue (around the organs) is the troublesome kind: pro-inflammatory and metabolically risky. Subcutaneous adipose tissue (under the skin) is largely benign.
See also: Visceral adipose tissue · Adipose tissue
Adrenal fatigue
Not recognized by mainstream medicine. The Endocrine Society explicitly rejects "adrenal fatigue" as a diagnosis. The story, that chronic stress "exhausts" your adrenals, causing fatigue, brain fog and low mood, has no robust evidence base. The symptoms are real, but they have other causes: perimenopause itself, thyroid issues, sleep apnoea, depression, anemia, B12 deficiency. Genuine adrenal disease (Addison's, Cushing's) exists and is diagnosed with proper testing, not by saliva cortisol panels.
See also: Cortisol · Thyroid (and meno)
Anxiety (peri)
New or worsened anxiety is one of the most reported perimenopausal symptoms. Mechanism: progesterone, which has a calming, GABA-like effect, similar to how Valium works, drops first in perimenopause, often two years before estrogen does. The amygdala becomes more reactive. Risk goes up further if you have a history of PMS, PMDD or post-natal depression. CBT is first-line for mild cases. HRT (estrogen) helps many. SSRIs/SNRIs if severe. Cutting alcohol and caffeine helps a surprising amount.
See also: GABA · Micronized progesterone · SSRI
ApoB
Apolipoprotein B. A blood test that counts the number of "bad" cholesterol particles, every LDL, VLDL and Lp(a) particle carries one ApoB. It's a better predictor of cardiovascular risk than the standard LDL-C number, because it captures particle count, not just cholesterol concentration. Worth asking your doctor for in mid-life, especially if your LDL is borderline or you have a family history of heart disease. The NHS doesn't run it as standard yet, private labs do. Target: under 0.9 g/L for most; under 0.6 if higher risk.
See also: LDL cholesterol · Lp(a) · Triglycerides
B
Bioidentical hormones
Two very different things share this name. (1) FDA/MHRA-approved "body-identical" HRT, estradiol patches/gels and micronized progesterone (Utrogestan), molecules identical to what your body makes, regulated, prescribed on the NHS. These are the gold standard. (2) Compounded "bioidentical" creams and pellets mixed by private clinics, often promoted as "natural" or "customized", NOT regulated, often supraphysiological doses, with documented harms. The Menopause Society, NICE and Jen Gunter all warn against the compounded version. The first is excellent; the second is dangerous.
See also: HRT (hormone replacement therapy) · Micronized progesterone · Estradiol (E2)
Bisphosphonates
First-line drugs for osteoporosis. Alendronate (Fosamax), risedronate (Actonel), zoledronate IV. They slow the cells that break down bone, letting bone-building cells catch up. Taken weekly or monthly orally, or yearly IV. Common side effects: esophageal irritation (must take with water, stay upright 30 min). Rare but real risks with long-term use: atypical femoral fracture, osteonecrosis of the jaw, risk is low and bone fracture risk is much higher if untreated. Usually 3–5 years on, then a drug holiday.
See also: BMD (bone mineral density) · DEXA scan · Osteoporosis
Black cohosh
A popular herbal supplement for hot flushes (Remifemin, MenoHerb). Honest take: meta-analyses are equivocal. Some trials show modest improvement over placebo, others show none. The mechanism isn't estrogenic, despite the marketing. Real concerns: roughly a quarter of products tested don't actually contain the right plant, and there are documented (rare) cases of liver toxicity. NICE doesn't recommend it. If you want to try it, source from a reputable brand, give it 12 weeks, and stop if your liver enzymes go funny.
See also: Hot flushes · Phytoestrogens
BMD (bone mineral density)
How much mineral (mostly calcium) is packed into your bones. Measured by DEXA scan, reported as a T-score: 0 to -1 is normal, -1 to -2.5 is osteopenia, below -2.5 is osteoporosis. Bone loss accelerates in the year before your final period and continues for about three years after, you can lose around 6% in that window alone. After 50, NICE recommends a DEXA if you have risk factors (family history, low BMI, early menopause, steroid use, smoker).
See also: DEXA scan · Osteopenia · Osteoporosis
Brain fog
The mid-life cognitive haze, forgetting words mid-sentence, losing your train of thought, walking into a room and forgetting why. Mechanism: estrogen is fuel for the brain's glucose metabolism. As estradiol falls, the hippocampus and prefrontal cortex run on less energy. PET scans show roughly a 30% drop in brain glucose use during the transition. The good news: it's largely temporary. Studies show cognition stabilizes and partly rebounds 3–4 years post-menopause. It's a pause, not a decline. Sleep, exercise and HRT all help.
See also: Insomnia (peri) · Estradiol (E2) · MIND diet
C
CBT-I
Cognitive Behavioral Therapy for Insomnia. The most effective long-term treatment for perimenopausal insomnia, more effective than sleeping pills, with no rebound. It's not "sleep hygiene tips". It's a structured 6–8 week program: sleep restriction (paradoxically spending less time in bed first), stimulus control, cognitive restructuring of "if I don't sleep, I can't function" thoughts. Available on the NHS via Sleepio in many areas. Recommended by NICE NG23 for menopausal insomnia. Try this before zopiclone.
See also: Insomnia (peri) · NICE NG23 guideline
Cervical cancer screening
Smear test. In the UK: every 3 years from 25 to 49, every 5 years from 50 to 64. The NHS now tests for high-risk HPV first; if HPV-positive, the sample is examined for cell changes. Local vaginal estrogen does NOT increase cervical cancer risk and won't affect your smear result. If you're past 64 and have had three consecutive negative tests, you're discharged from the program. Worth attending: cervical cancer is preventable.
See also: Vaginal atrophy
Cortisol
Your main stress hormone, made by the adrenal glands. Cortisol is supposed to peak in the morning and fall through the day. In perimenopause, falling estrogen makes the hypothalamic-pituitary-adrenal axis more reactive, so the same stressor produces a bigger cortisol spike, and recovery is slower. This is why you feel "wired and tired" and wake at 3am. Chronically high cortisol worsens insulin resistance, blood pressure, sleep and belly fat. Not the same as "adrenal fatigue" (which isn't a thing).
See also: Adrenal fatigue · Insomnia (peri)
Creatine
The most well-evidenced sports supplement, and quietly excellent for mid-life women. 3–5g daily of creatine monohydrate supports muscle mass, strength and bone health when combined with resistance training. Newer evidence: a measurable benefit on memory and mental fatigue in post-menopausal women, possibly because the brain runs on phosphocreatine too. Cheap ($10/month), safe, no loading phase needed. Skip flavoured "women's" versions, plain creatine monohydrate is the one.
See also: Resistance training · Sarcopenia
Cycle irregularity
The first clinical sign of perimenopause: cycles that vary by 7 or more days from one to the next (e.g. a 25-day cycle then a 36-day one). Then skipped periods. Then 60+ day gaps. Mechanism: ovulation gets unreliable, progesterone production falters, estrogen swings wildly. Once you've gone 60 days without bleeding, there's a 95% chance your final period is within 4 years. Heavy/long bleeding is common but worth flagging to your doctor, fibroids, polyps and endometrial hyperplasia can hide here.
See also: Endometrial hyperplasia · Fibroids · Perimenopause
D
DEXA scan
Dual-energy X-ray absorptiometry. The gold-standard scan for bone density, low-radiation, painless, takes 10 minutes. Two key sites measured: lumbar spine and hip. Results: T-score compares you to a healthy young adult; Z-score compares you to your age group. On the NHS, you'll get one if you have risk factors for osteoporosis (early menopause, family history, low BMI, steroid use, previous fragility fracture). Privately, around $100. Often used alongside FRAX to estimate 10-year fracture risk.
See also: BMD (bone mineral density) · Osteoporosis
DHEA
Dehydroepiandrosterone. A precursor hormone made by the adrenals, converted into estrogen and testosterone in body tissues. DHEA falls steadily from your 30s. Oral DHEA supplements: weak evidence for libido, mood or cognition, not recommended by The Menopause Society or NICE. Vaginal DHEA (prasterone/Intrarosa) is a different story: FDA-approved for painful sex from vaginal atrophy, converted locally to estrogen and testosterone, useful for women who can't have systemic HRT (e.g. some breast cancer survivors).
See also: Testosterone (in women) · Vaginal atrophy
Dyspareunia
Painful sex. In mid-life, almost always from vaginal atrophy (now called GSM): thinning, drying vaginal tissue caused by falling estrogen. Affects roughly half of post-menopausal women. Unlike hot flushes, it doesn't go away on its own, it gets worse. Standard of care: vaginal estrogen (Vagifem, Estring, Imvexxy, or cream). Effect at 6 weeks, full effect 2–3 months. Available in the UK without prescription (Gina). Lubricants and moisturisers help too, but they don't fix the underlying tissue change.
See also: Genitourinary syndrome of menopause (GSM) · Vaginal atrophy
E
Early menopause
Menopause between 40 and 45 years old. Affects roughly 5% of women. Distinct from POI (under 40). Causes: idiopathic (most common), genetic, autoimmune (thyroid, lupus), surgical (hysterectomy with ovaries removed), or treatment-induced (chemo, radiotherapy, GnRH agonists). Health consequences are not trivial: higher risk of cardiovascular disease, osteoporosis and cognitive decline. NICE recommends HRT until at least the average age of natural menopause (51) to replace what your body would otherwise have made.
See also: POI (premature ovarian insufficiency) · HRT (hormone replacement therapy)
Endometrial hyperplasia
Thickening of the womb lining. In perimenopause, when ovulation gets patchy, you produce estrogen but not enough progesterone to balance it, so the lining keeps building up. Symptoms: heavy, prolonged or unpredictable bleeding. A scan plus a biopsy diagnoses it. Two flavours: without atypia (low cancer risk, treat with progestogen, often a Mirena coil) and with atypia (5–10% may already harbor cancer, often treated with hysterectomy). Any bleeding after 12 months without periods always warrants a doctor visit.
See also: Cycle irregularity · Micronized progesterone
Endometriosis
When tissue similar to the womb lining grows outside the womb, on ovaries, bowel, bladder. Affects roughly 1 in 10 women. Endometriosis often improves at menopause as estrogen falls, but can persist or even be triggered by HRT in some women. If you have endometriosis and start HRT, combined continuous (estrogen plus continuous progestogen, not cyclical) is preferred to suppress any residual tissue. A history of endometriosis is NOT a contraindication to HRT, despite what some doctors still think.
See also: HRT (hormone replacement therapy)
Estrobolome
The gut bacteria that metabolize estrogen. Roughly 60 species in your colon make an enzyme called beta-glucuronidase, which reactivates estrogen that the liver had marked for excretion, sending it back into circulation. A healthy estrobolome supports steady estrogen levels; dysbiosis (from antibiotics, ultra-processed diet, low fiber) can throw it off. Eat 30+ plant species a week, plenty of fiber, fermented foods. Not magic. But the gut-hormone link is now real science, not woo.
See also: Gut microbiome · Phytoestrogens
Estradiol (E2)
The main, most biologically active estrogen of the reproductive years. Made primarily by the ovaries. Receptors for estradiol sit in the brain, bones, joints, skin, blood vessels, bladder, vagina, gut and breast tissue, which is why falling estradiol produces a body-wide symptom pattern, not just reproductive ones. Pre-menopause: 30 to 340 pg/mL across the cycle. Post-menopause: usually under 25 pg/mL, often undetectable. Body-identical HRT replaces estradiol via patches, gels or sprays.
See also: HRT (hormone replacement therapy) · Transdermal HRT
F
Fezolinetant
Brand name Veoza (UK) / Veozah (US). The first non-hormonal drug specifically designed for hot flushes, approved by the MHRA in 2023. Mechanism: it blocks the NK3 receptor in the hypothalamus, which is what mis-fires the heat response in menopausal women. Clinical trials: roughly 60–80% reduction in moderate-to-severe hot flushes. Useful for women who can't take HRT (e.g. breast cancer history). Available on the NHS in some areas; private around $45/month. Not without side effects, liver monitoring is required for the first 9 months.
See also: Hot flushes · NK3 receptor antagonist · Vasomotor symptoms (VMS)
Fibroids
Non-cancerous growths in the muscle wall of the womb. Very common, up to 70% of women have them by 50, though many never notice. Symptoms: heavy/long bleeding, pelvic pressure, frequent urination. Fibroids are estrogen-sensitive and usually shrink at menopause. HRT can occasionally re-stimulate them, but it's not a routine contraindication. Treatment options if symptomatic: Mirena coil (often first-line), tranexamic acid, uterine artery embolization, myomectomy, hysterectomy. If you're heading into menopause, watchful waiting is often the right call.
See also: Cycle irregularity
Follicle-stimulating hormone (FSH)
The hormone the pituitary releases to tell the ovaries to ripen an egg. As the ovaries become less responsive, the pituitary shouts louder, so FSH rises. Above 30 IU/L on two tests four weeks apart suggests ovarian decline. BUT: FSH is wildly fluctuating in perimenopause, can be high one week and normal the next, which is why NICE NG23 says women over 45 do NOT need FSH testing to diagnose perimenopause. Symptoms are enough. FSH testing is useful mainly for suspected POI (under 40).
See also: NICE NG23 guideline · POI (premature ovarian insufficiency)
Frozen shoulder
Adhesive capsulitis. Painful stiffening of the shoulder capsule, with a marked drop in range of motion. Disproportionately affects women aged 45–60, the term "menopausal shoulder" is unofficial but well known among physios. A 2022 Duke study found HRT users had roughly half the rate of frozen shoulder as non-users. Treatment: physiotherapy with progressive stretching is the bedrock; corticosteroid injections for severe pain; hydrodilatation in resistant cases. Most cases resolve over 1–3 years, but can leave residual stiffness.
See also: HRT (hormone replacement therapy)
G
GABA
Gamma-aminobutyric acid. The brain's main calming neurotransmitter, it's what Valium and the like work on. Progesterone binds to GABA receptors, which is why it has a sedative, anxiolytic effect (and why micronized progesterone is taken at bedtime). When progesterone tanks in perimenopause, GABA signaling drops too, and you get the classic combo: anxiety, racing thoughts at 3am, insomnia. Magnesium glycinate and L-theanine also nudge GABA. Alcohol does, briefly, then rebounds and makes anxiety worse.
See also: Magnesium glycinate · Micronized progesterone
Genitourinary syndrome of menopause (GSM)
The umbrella term (since 2014) for the cluster of vulval, vaginal and urinary symptoms caused by estrogen loss: vaginal dryness, burning, itching, painful sex, urinary urgency, recurrent UTIs. Affects up to 70% of post-menopausal women but only about 1 in 5 ever tells her doctor. Progressive, gets worse with time, unlike hot flushes which usually settle. Gold-standard treatment: local vaginal estrogen (cream, pessary, ring). Safe long-term, near-zero systemic absorption, can be used alongside HRT or alone. NHS prescription or Gina pessary OTC.
See also: Dyspareunia · Vaginal atrophy · UTI (recurrent)
Greene Climacteric Scale
A 21-item validated questionnaire that scores menopausal symptom severity across psychological, somatic, vasomotor and sexual domains. Each item rated 0 to 3, total out of 63. Used by menopause clinics, the NHS, and research studies (including the Decodemeno quiz) to track symptom burden over time. A baseline score before starting HRT and another at 12 weeks is the standard way to measure whether treatment is working.
See also: Menopause Rating Scale · SWAN study
Gut microbiome
The 100 trillion bacteria, viruses and fungi living in your gut. In mid-life, the microbiome shifts: diversity tends to drop, and the estrobolome (the estrogen-metabolizing subset) becomes less efficient. This can affect estrogen recycling, mood (via the gut-brain axis), and inflammation. The lever you have: eat 30+ different plants a week, plenty of fiber, add fermented foods (kefir, kimchi, sauerkraut, live yoghurt). Avoid jumping on probiotic supplements unless you have a specific indication, most are washed straight through.
See also: Estrobolome
H
HDL cholesterol
High-density lipoprotein. The "good" cholesterol, it carries cholesterol back to the liver for clearance. In perimenopause, HDL often falls a touch, which is one of several reasons cardiovascular risk creeps up after menopause. Target: above 1.2 mmol/L for women. Levers: regular cardio exercise, monounsaturated fats (olive oil, nuts, avocado), oily fish, moderate alcohol (the only useful thing alcohol does, and not enough to recommend drinking). Cigarettes hammer HDL.
See also: ApoB · LDL cholesterol · Triglycerides
Hot flushes
Sudden waves of heat sweeping over the face, neck and chest, lasting 2–4 minutes. Skin is genuinely hot to touch. Often followed by chills, redness, palpitations, sometimes nausea. Affects 80% of women in transition. Mechanism: without estrogen's gating, hypothalamic neurons mis-fire the heat-loss response. The NK3 receptor pathway is what fezolinetant blocks. Average duration: 7.4 years. Roughly a quarter of women are "super-flushers", over a decade. HRT is gold-standard, around 95% effective in 4–6 weeks.
See also: Fezolinetant · Night sweats · Vasomotor symptoms (VMS)
HRT (hormone replacement therapy)
Replacing the estrogen (and progesterone, if you still have a womb) that the ovaries stop making. Modern HRT in the UK: transdermal estradiol (patch/gel/spray) plus oral micronized progesterone, body-identical, regulated, often on the NHS. NICE NG23 says benefits outweigh risks for most healthy women under 60 or within 10 years of menopause. The 2002 WHI scare that put a generation off HRT used an old oral formulation in older women; modern transdermal HRT has a much better safety profile.
See also: Bioidentical hormones · Transdermal HRT · WHI study (Women's Health Initiative)
Hyperthyroidism
Overactive thyroid. Can mimic perimenopausal symptoms: hot flushes, anxiety, palpitations, weight loss, sleep problems, irregular periods. Roughly 1 in 200 women in mid-life, worth screening for if your symptoms feel "off" or weight is dropping despite no effort. Tests: TSH (low or suppressed), free T4 and free T3 (high), thyroid antibodies (TPO, TRAb) to identify Graves' disease. Treatment: carbimazole, radioactive iodine, or thyroidectomy depending on cause. Not the same as anxiety, even if it looks like it.
See also: Thyroid (and meno)
Hypothalamus
A grape-sized region at the base of the brain. The orchestra conductor of your hormones, it regulates body temperature, sleep, appetite, mood, and tells the pituitary when to release FSH and LH. In menopause, the hypothalamus loses its estrogen gating. Thermoregulatory neurons (specifically the KNDy neurons using neurokinin B and NK3 receptors) fire too easily, which is exactly what produces hot flushes. This is the mechanism that fezolinetant targets.
See also: Fezolinetant · Hot flushes
I
Incontinence (stress / urge)
Stress incontinence: leaking when you cough, sneeze, run, jump, the pelvic floor can't hold against pressure. Urge incontinence: sudden, overwhelming need to wee, often not making it in time. Both are common in mid-life and both have non-surgical fixes. First-line: targeted pelvic floor work with a women's health physio (not just generic "squeezes"), local vaginal estrogen for urge symptoms, weight loss if relevant. Second-line: medication, pessaries, sling surgery. Not just "part of getting older", fixable.
See also: Genitourinary syndrome of menopause (GSM) · UTI (recurrent)
Insulin resistance
When your cells stop responding properly to insulin, so the pancreas pumps out more and more of it. The setup for type 2 diabetes, fatty liver, belly fat, PCOS-like symptoms in mid-life. Estrogen helps muscle take up glucose; falling estrogen plus visceral fat plus age all worsen insulin sensitivity together. The HOMA-IR test (fasting insulin × fasting glucose ÷ 22.5) flags it early, above 1.9 is suspicious. Levers: resistance training, sleep, fiber, reduce ultra-processed food, time-restricted eating.
See also: Abdominal fat shift · Visceral adipose tissue
Insomnia (peri)
Distinct from "trouble sleeping". Perimenopausal insomnia has its own signature: waking at 3am drenched, mind racing, unable to drop off. Causes are layered: night sweats waking you, falling progesterone (which is sedative via GABA), cortisol rhythm disruption, anxiety. Roughly 40–60% of perimenopausal women report sleep problems. Fixes that actually work: HRT (estrogen plus bedtime micronized progesterone), CBT-I, dark cool bedroom (18°C), magnesium glycinate, no alcohol within 3 hours of bed, no screens in bed.
See also: CBT-I · Cortisol · Magnesium glycinate
K
KEEPS study
Kronos Early Estrogen Prevention Study (published 2014, follow-up 2019). Randomized 727 healthy recently-menopausal women to oral conjugated estrogen, transdermal estradiol patch, or placebo for 4 years. Findings: HRT improved symptoms, mood, sexual function and bone density; no increase in cardiovascular events; transdermal was metabolically gentler than oral. One of the studies that helped rebuild the case for HRT after the WHI panic, supporting the "timing hypothesis", start early, benefit more.
See also: WHI study (Women's Health Initiative)
L
LDL cholesterol
Low-density lipoprotein. The cholesterol carrier most strongly linked to cardiovascular risk, it delivers cholesterol to artery walls where plaques form. In perimenopause, LDL typically rises 10–15% as estrogen falls, which is one reason cardiovascular risk climbs after menopause. NICE targets vary, but for primary prevention in mid-life: LDL under 3.0 mmol/L is a reasonable aim, lower if you have other risk factors. ApoB is a sharper measure than LDL alone.
See also: ApoB · HDL cholesterol · Triglycerides
Libido changes
Falling sexual desire affects 14 to 33% of mid-life women. Mechanism is layered: testosterone gradually falls with age (not at menopause itself), estrogen drop causes vaginal dryness making sex uncomfortable, sleep deprivation kills desire, relationship dynamics shift. Fixes start with treating the easy stuff: local vaginal estrogen for GSM, fix sleep, address mood. If desire is still low after those, off-label testosterone gel (Androfeme, or a fingertip of male testosterone gel) can help, it's prescribed privately in the UK and now sometimes on the NHS.
See also: Dyspareunia · Testosterone (in women)
Lp(a)
Lipoprotein little-a. A largely genetic cardiovascular risk factor, your level is mostly set at birth and barely changes through life. About 20% of people have elevated Lp(a) (above 50 mg/dL or 125 nmol/L), which doubles or triples cardiovascular risk independent of LDL. Worth testing ONCE in a lifetime, especially if you have a family history of early heart disease. If high, you can't lower it directly (yet, drugs are in trials), but you treat all your other risk factors harder.
See also: ApoB · LDL cholesterol
M
Macronutrients
The three macros: protein, carbohydrates, fat. In mid-life, the ratios shift, protein becomes more important, not less. Most women under-eat protein in mid-life. Target: 1.2 to 1.6 g per kg of body weight per day (so 75 to 100 g for a 65 kg woman), spread across meals. Why: protein preserves muscle (countering sarcopenia), supports insulin sensitivity, and is more satiating than carbs or fat. Carbs from whole sources, fat from olive oil, nuts, fish.
See also: Resistance training · Sarcopenia
Magnesium glycinate
The form of magnesium most useful for sleep, anxiety and muscle cramps in perimenopause. Glycinate (magnesium bound to glycine) is well absorbed and doesn't have the laxative effect of magnesium oxide or citrate. Dose: 200 to 400 mg taken about an hour before bed. Reasonable evidence for sleep onset and depth; gentler evidence for hot flushes. Cheap, safe, low side effects. Don't bother with topical magnesium sprays, the evidence is paper-thin.
See also: GABA · Insomnia (peri)
Menopause (definition)
Strictly: the day that marks 12 consecutive months without a period. It's a single date on the calendar, diagnosed in retrospect. Average age in the UK: 51. Range 45 to 55 is considered normal. Before 40 it's POI (premature ovarian insufficiency); 40 to 45 is early menopause. After menopause = post-menopause. Most of what women call "menopause" in daily speech is actually perimenopause, the years-long transition leading up to that final period.
See also: Early menopause · Perimenopause · POI (premature ovarian insufficiency)
Menopause Rating Scale
An 11-item symptom questionnaire developed in Germany in the 1990s, widely used in European research. Scores three domains: psychological, somato-vegetative, and urogenital. Each item 0 to 4, total out of 44. Compared with the Greene Climacteric Scale (which has 21 items and a slightly different structure), the MRS is shorter but covers similar ground. Both are valid clinical tools for tracking symptom severity over time.
See also: Greene Climacteric Scale · STRAW+10 framework
Micronized progesterone
Body-identical progesterone, finely ground ("micronized") so it's absorbed orally. Brand name in the UK: Utrogestan. The gold-standard progestogen for HRT, it protects the womb lining if you have a uterus, supports sleep (sedating taken at bedtime), and has the cleanest cardiovascular and breast-cancer profile of any progestogen. 100 mg nightly continuous, or 200 mg for 12 days of each month if you want a cyclical bleed. Recommended by NICE, the British Menopause Society, and every modern menopause expert.
See also: GABA · HRT (hormone replacement therapy) · Progestin vs progestogen
MIND diet
Mediterranean-DASH Intervention for Neurodegenerative Delay. A research-backed eating pattern shown in cohort studies to slow cognitive decline. Ten foods to eat: green leafy veg daily, other veg daily, nuts, berries, beans, whole grains, fish, poultry, olive oil, modest red wine. Five to limit: red meat, butter and margarine, cheese, pastries and sweets, fried food. Strong adherence in observational studies = roughly 53% lower Alzheimer's risk. Useful frame for mid-life eating that supports both brain and heart.
See also: Brain fog
N
Night sweats
Hot flushes at night, but worse, because they drench you, wake you, and shred your sleep. Same hypothalamic misfiring as daytime flushes. Documented link with cerebral white-matter hyperintensities on MRI, suggesting night sweats may not be cosmetic. Fixes: cooler bedroom (16 to 18°C), moisture-wicking nightwear (bamboo, technical fabrics), HRT (which works at the source), CBT to retrain reaction. Sheets you can throw off in seconds. Sympathetic partner.
See also: Hot flushes · Vasomotor symptoms (VMS)
NICE NG23 guideline
The UK's official menopause guideline, published by the National Institute for Health and Care Excellence. Updated November 2024. The headlines: (1) Over-45 with menopausal symptoms = diagnose clinically, no blood tests needed. (2) Offer HRT to most symptomatic women; benefits outweigh risks for most under 60. (3) Transdermal estrogen is preferred (lower clot risk). (4) Body-identical micronized progesterone preferred. (5) Vaginal estrogen for GSM is safe long-term. This is what your doctor is meant to be working from.
See also: HRT (hormone replacement therapy) · Transdermal HRT
NK3 receptor antagonist
A new class of non-hormonal drugs that block the NK3 (neurokinin-3) receptor in the hypothalamus, the receptor that, when over-fired, triggers hot flushes. Fezolinetant (Veoza) is the first one through, MHRA-approved in 2023. Elinzanetant is in late-stage trials and looks even more promising. These drugs target the actual mechanism of vasomotor symptoms without using hormones, which matters for women who can't have HRT (breast cancer history, certain clot risks).
See also: Fezolinetant · Hot flushes
O
Osteopenia
Low bone density that hasn't yet reached osteoporosis levels, T-score between -1 and -2.5 on a DEXA scan. Roughly half of post-menopausal women have osteopenia. Not in itself a disease, but a warning shot: without intervention, you're on the slope to osteoporosis. Levers: weight-bearing and resistance exercise, adequate protein, calcium 1000 to 1200 mg/day from diet, vitamin D, no smoking, sensible alcohol. HRT prevents progression. Bisphosphonates usually reserved for actual osteoporosis.
See also: BMD (bone mineral density) · DEXA scan · Osteoporosis
Osteoporosis
Bones thin enough that fractures happen from minor trauma. DEXA T-score below -2.5. Two thirds of women over 50 have either low bone mass or osteoporosis. The grim statistic: lifetime risk of hip fracture for a 50-year-old woman is around 17%, higher than her lifetime breast cancer risk. After a hip fracture at 65+, 17% will die within a year. Prevention is everything: HRT in the menopause transition, resistance training lifelong, adequate protein and vitamin D, no smoking, bisphosphonates if diagnosed.
See also: Bisphosphonates · DEXA scan · Resistance training
P
Palpitations (peri)
The sensation of your heart racing, skipping, fluttering or pounding. Reported by around 42% of perimenopausal women and 52% of post-menopausal women. Almost always benign, fluctuating estrogen plus heightened sensitivity to caffeine, alcohol, sugar and stress. BUT: palpitations should always be checked at least once with an ECG to rule out arrhythmias (especially atrial fibrillation, which becomes more common after menopause). Red flag combos requiring urgent care: palpitations plus chest pain, breathlessness or fainting.
See also: Vasomotor symptoms (VMS)
Perimenopause
The transition years leading up to menopause, typically 4 to 10 years long, often starting in the early-to-mid 40s. Cycles get irregular, estrogen swings wildly (rises AND falls, often higher peaks than before), progesterone drops first. This is when most symptoms hit hardest: brain fog, anxiety, sleep problems, mood swings, irregular periods, the first hot flushes. NICE NG23: you can diagnose this clinically in women over 45 from symptoms alone. Most women are deep in perimenopause when they think they've "got years left".
See also: Cycle irregularity · Menopause (definition)
Phytoestrogens
Plant compounds (mostly isoflavones from soy, lignans from flaxseed) that weakly bind to estrogen receptors. Effect on hot flushes: modest, in some studies. A whole-foods diet rich in soy (tofu, edamame, tempeh, miso) has reasonable evidence for symptom reduction; concentrated isoflavone supplements are less clearly useful and not without concerns. Phytoestrogens do NOT contribute meaningfully to breast cancer risk, in fact Asian populations with high lifelong soy intake have lower rates. Eat the bean, not the pill.
See also: Black cohosh · Hot flushes
POI (premature ovarian insufficiency)
Menopause before 40. Affects 1 to 3% of women. Most cases are idiopathic, no cause found, though genetic, autoimmune, surgical or chemotherapy causes account for some. Diagnosis: FSH above 25 IU/L on two tests four weeks apart, plus 4+ months of irregular or absent periods, plus low estradiol. NICE recommends HRT until at least the average age of natural menopause (51), regardless of whether symptoms feel severe, to protect bones, heart and brain over the long run. Worryingly, only about half of women with POI get the right treatment.
See also: Early menopause · Menopause (definition)
Progestin vs progestogen
Worth getting right. "Progestogen" = umbrella term for anything that acts like progesterone (includes natural progesterone AND synthetics). "Progestin" = a synthetic progestogen (medroxyprogesterone acetate / MPA, norethisterone, etc.). The WHI study used MPA (a progestin) and that's largely what got blamed for the breast cancer signal. Modern UK HRT uses micronized progesterone (body-identical, NOT a progestin) which appears to have a cleaner safety profile. The Mirena coil contains levonorgestrel, a progestin, but local delivery means very low systemic exposure.
See also: Micronized progesterone · WHI study (Women's Health Initiative)
R
Red clover
A phytoestrogen-containing herbal popular for hot flushes. Active ingredients: isoflavones, including some S-equol. Honest verdict: meta-analyses are mixed. A few trials show a small effect on hot flush frequency; many show no benefit over placebo. NICE doesn't recommend it. If you want to try it, 40 to 80 mg daily of standardized isoflavones, give it 12 weeks, then stop if no effect. Avoid if you have a history of hormone-sensitive cancer (theoretical risk, not proven).
See also: Black cohosh · Phytoestrogens
Resistance training
Lifting weights, non-negotiable in mid-life. Muscle mass drops about 10% per decade after menopause without intervention (sarcopenia). Muscle loss means slower metabolism, worse insulin sensitivity, weaker bones, more falls. Resistance training is the only intervention that reliably puts muscle back on. Twice a week, full body, progressive (heavier over time), proper form. You will not get "bulky". You will get strong, mobile, metabolically healthier, and significantly less likely to fracture a hip at 75.
See also: Creatine · Macronutrients · Sarcopenia
S
Sarcopenia
Age-related muscle loss. Starts in your 30s at 3 to 5% per decade, accelerates to roughly 10% per decade after menopause as estrogen and testosterone fall. Consequences: slower metabolism, weaker grip, slower walk, more falls, more fractures. Major predictor of how well you age. Levers: resistance training 2 to 4 times a week, protein 1.2 to 1.6 g/kg/day, creatine 3 to 5 g/day, vitamin D, adequate sleep. HRT helps. The dose-response is real, half-arsed gym sessions don't do it. Lift like you mean it.
See also: Creatine · Macronutrients · Resistance training
SERM (selective estrogen receptor modulator)
Drugs that act as estrogen on some tissues and anti-estrogen on others. Tamoxifen blocks estrogen in breast tissue (used for breast cancer) but acts estrogenic on the womb. Raloxifene (Evista) acts estrogenic on bone (used for osteoporosis when HRT isn't suitable) and anti-estrogenic on breast (reduces breast cancer risk). Ospemifene treats vaginal atrophy without systemic estrogen. Bazedoxifene is paired with conjugated estrogen in Duavee (alternative to traditional HRT for women who can't tolerate progestogens).
See also: Tibolone · Osteoporosis
Sleep apnoea
Recurrent stopping and starting of breathing during sleep. Risk in women rises 2 to 3-fold after menopause as falling estrogen affects upper airway tone and fat redistributes. Around 85% of cases in women go undiagnosed because the female pattern is less classically "loud snoring" and more daytime exhaustion, brain fog and waking unrefreshed. If you snore, wake up gasping, or your partner notices breathing pauses, ask for a sleep study. Treatment: CPAP or mandibular device, weight loss if relevant. Untreated, raises cardiovascular and dementia risk.
See also: Insomnia (peri)
SSRI
Selective serotonin reuptake inhibitor. Antidepressants like sertraline, citalopram, escitalopram, fluoxetine. Two uses in menopause: (1) For genuine depression, first-line when it's moderate-severe, alongside or instead of HRT. (2) Off-label for hot flushes in women who can't have HRT, moderate effect, around 50 to 60% reduction. Paroxetine (Brisdelle in the US) is the only one specifically approved for hot flushes. Side effects in mid-life: can blunt libido (already a problem), some weight gain. Not the right first answer for mild perimenopausal mood swings.
See also: Anxiety (peri) · Hot flushes
STRAW+10 framework
Stages of Reproductive Aging Workshop, updated 2011. The international medical framework for staging where a woman is in the menopause transition. Ten stages from late reproductive years through to late post-menopause, defined by cycle pattern, FSH levels and AMH. This is the system menopause clinics and researchers use; the Decodemeno quiz maps your answers to STRAW+10 stages.
See also: Greene Climacteric Scale · Perimenopause
SWAN study
Study of Women's Health Across the Nation. A landmark longitudinal study following 3,302 women through the menopause transition since 1996, including significant representation from Black, Hispanic, Chinese and Japanese American women. Key findings: hot flushes last on average 7.4 years (not the 2 to 3 years once taught), and roughly 11 years for Black women. The transition is more racially variable than previously assumed. SWAN data is behind a lot of what we now know about menopause as a process, not an event.
See also: KEEPS study · Hot flushes
T
Testosterone (in women)
Yes, women have testosterone, and it falls gradually with age (not at menopause itself). Plays a role in libido, energy, muscle, bone, mood. No UK female-specific testosterone product is licensed, so prescribing is off-label using a fingertip dose of a male testosterone gel (Tostran, Testogel) or imported Androfeme cream. Best evidence: low libido in post-menopausal women, after other causes (vaginal atrophy, sleep, relationship) have been addressed. Available privately and, increasingly, on the NHS via menopause clinics. Check levels before and after starting.
See also: DHEA · Libido changes
Thyroid (and meno)
Roughly 1 in 4 women develop thyroid issues at some point, and the perimenopausal years are a common time for it to surface. Symptoms massively overlap with perimenopause: fatigue, weight changes, low mood, hair thinning, brain fog. Worth a full panel at least once in your 40s: TSH, free T4, free T3, plus thyroid antibodies (TPO) to catch Hashimoto's. Hypothyroid is more common than hyper. The fix (levothyroxine) is simple and cheap; the diagnosis often gets missed because everything is blamed on "the menopause".
See also: Hyperthyroidism
Tibolone
A synthetic steroid (brand name Livial in the UK) that the body converts into substances with estrogenic, progestogenic and androgenic effects. Used as an HRT alternative for women who want some benefits without classical HRT. Helps hot flushes, bone density and libido. Concerns: small increased breast cancer risk in older women (Million Women Study), and not generally suitable to start over 60. Less popular now that transdermal estradiol plus micronized progesterone is the standard. Niche role.
See also: HRT (hormone replacement therapy) · SERM (selective estrogen receptor modulator)
Transdermal HRT
Estradiol delivered through the skin: patch (Estradot, Evorel), gel (Oestrogel, Sandrena), spray (Lenzetto). The NICE-preferred route, because it bypasses the liver, which means no increased risk of venous clots (unlike oral estrogen), no impact on triglycerides, no rise in SHBG (so testosterone stays available). For most women in 2026, transdermal estradiol plus oral micronized progesterone is the modern HRT default. Cheap on the NHS once you've found a working dose; takes 2 to 3 months to settle.
See also: HRT (hormone replacement therapy) · Estradiol (E2)
Triglycerides
Blood fats, a separate measure to cholesterol. Rise in perimenopause along with LDL. High triglycerides are driven mostly by sugar and alcohol, not dietary fat. Target: under 1.7 mmol/L fasting. Levers: cut liquid sugar (juice, fizzy drinks, fancy coffees), cut excess alcohol, oily fish 2 to 3 times a week, omega-3 supplement if needed. Oral HRT can push triglycerides up, which is one of several reasons transdermal is preferred. Routinely tested as part of a lipid panel.
See also: ApoB · HDL cholesterol · LDL cholesterol
U
UTI (recurrent)
Recurrent urinary tract infections, defined as 2 or more in 6 months, or 3 in a year. Affects up to 55% of post-menopausal women (versus 33% during reproductive years). Mechanism: estrogen-deficient vaginal tissue, altered vaginal microbiome (less Lactobacillus, more pathogenic bacteria), incomplete emptying. The single most effective preventer in mid-life: local vaginal estrogen, cuts recurrence rate by roughly two thirds. Cranberry tablets: weak evidence. D-mannose: moderate evidence. Prophylactic low-dose antibiotic: a last resort.
See also: Genitourinary syndrome of menopause (GSM) · Vaginal atrophy
UV protection
Most mid-life skin change blamed on "the menopause" is actually accumulated UV damage. The collagen loss IS real, around 30% in the first five years post-menopause, and estrogen does support skin thickness. But the deepest wrinkles, age spots and broken capillaries are sun. Mineral SPF 30 to 50 every morning year-round (zinc oxide, titanium dioxide), reapply if outside for hours. This protects the collagen you have left more than any expensive cream. Cheap, evidence-based, and reduces skin cancer risk too.
See also: Adipose tissue
V
Vaginal atrophy
The old name for the genital part of GSM (genitourinary syndrome of menopause). The vaginal lining thins, loses elasticity, dries out, pH rises, microbiome shifts, leading to dryness, burning, itching, painful sex, and tearing. Unlike hot flushes, vaginal atrophy is progressive, it gets worse, not better, with time post-menopause. Gold-standard treatment: local vaginal estrogen (cream, pessary, ring, tablet), safe long-term, near-zero systemic absorption. Now available without prescription in the UK as Gina (10 mcg estradiol pessary).
See also: Dyspareunia · Genitourinary syndrome of menopause (GSM)
Vasomotor symptoms (VMS)
The medical umbrella for hot flushes, night sweats and palpitations, anything driven by the hypothalamic thermoregulation glitch caused by falling estrogen. Affects roughly 80% of women in the transition. Severity ranges from mild and brief to debilitating and decade-long. The class of symptoms HRT treats most reliably (around 95% effective). Also the symptoms newer non-hormonal drugs (fezolinetant, soon elinzanetant) specifically target. Often the first thing women try to get help with, and the first thing dismissed by under-trained doctors.
See also: Fezolinetant · Hot flushes · Night sweats
Visceral adipose tissue
VAT. The deep belly fat that wraps around your organs (liver, pancreas, intestines). Post-menopausal women have nearly five times the risk of accumulating significant VAT compared with pre-menopausal women, and the redistribution happens quietly, even without overall weight gain. VAT is metabolically active and pro-inflammatory, raising risk of type 2 diabetes, cardiovascular disease, fatty liver and certain cancers. Best measured by waist circumference (target under 80 cm for women), DEXA, or MRI. Levers: resistance training, sleep, fiber, no liquid sugar.
See also: Abdominal fat shift · Insulin resistance
Vitamin D
Technically a hormone, not a vitamin. Critical for calcium absorption, bone health, immune function and probably mood. UK population is widely deficient because of latitude and lifestyle, NHS recommends 10 mcg (400 IU) daily for adults in winter; menopause guidance often goes higher, 1000 to 2000 IU year-round. Test if you can: target serum 25-hydroxyvitamin D above 75 nmol/L. Take with the largest meal of the day (fat-soluble). Pair with vitamin K2 for bone health. Cheap, safe at sensible doses.
See also: BMD (bone mineral density) · Osteoporosis
W
Weight gain (peri)
Most women gain 5 to 7 kg between ages 45 and 55, even with the same diet and exercise. Reasons: sarcopenia (less muscle = slower metabolism), insulin resistance, sleep loss (raises cortisol and hunger), and abdominal fat redistribution. The maddening bit: weight goes on around the middle, not where it used to. "Eat less, move more" is incomplete advice in mid-life. What works: prioritize protein (1.2 to 1.6 g/kg/day), resistance training, fix sleep, reduce ultra-processed food, alcohol moderation. Crash diets backfire, you lose muscle, not fat.
See also: Abdominal fat shift · Sarcopenia · Visceral adipose tissue
WHI study (Women's Health Initiative)
The 2002 trial that scared a generation off HRT. Tested ONE old formulation (oral conjugated equine estrogen plus medroxyprogesterone) in women whose AVERAGE age was 63, most well past the menopause transition. Reported a 26% relative increase in breast cancer (which sounds huge but was 8 cases per 10,000 women per year). The follow-up analysis showed: in younger women starting HRT within 10 years of menopause, the picture is very different, including a possible cardiovascular BENEFIT. Modern HRT (transdermal estradiol, micronized progesterone) was never tested in WHI.
See also: HRT (hormone replacement therapy) · KEEPS study
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