Perimenopause and menopause: a guide for partners

The majority of women will experience perimenopausal and menopausal symptoms that often impact on their physical and emotional health.

Relationships can be put under immense strain during this time and can be made more difficult by the fact that many couples don’t openly discuss menopause. It can be challenging, but it doesn’t have to be – armed with knowledge and advice, you can support each other through this time and towards a new chapter in your lives.

What is menopause?

Menopause is actually one year after a woman’s periods stop. It occurs when the ovaries stop producing eggs and as a result, levels of hormones oestrogen (oestradiol), progesterone and testosterone decline. During perimenopause, these hormones fluctuate so can be both high and low.

The low hormone levels last for ever. These hormones are also made in the brain and other tissues – the have important effects on every cell and organ in the body. 

There are four key stages:

Pre-menopause: the time before any menopausal symptoms occur.

Perimenopause: when menopausal symptoms begin due to hormone changes, but periods still happen (even if irregularly).

Menopause: when there has not been a period for 12 consecutive months.

Postmenopause: the time after there has not been a period for 12 consecutive months.

When do perimenopause and menopause happen?

The average age of menopause in the UK is 51 [1]. However, it can occur earlier or later than this – health conditions, medical treatment, genetics, ethnicity and social economic background can influence the age.

Menopause is described as early if it occurs before the age of 45. If it occurs before the age of 40, it’s called Premature Ovarian Insufficiency (POI).

Some medical treatments – such as having ovaries removed, breast cancer treatment, chemotherapy or radiotherapy – can lead to an early menopause.

Perimenopause, which starts when the first menopausal symptom occurs, can vary in length from a few months to around 10 years. Some women start to have these symptoms when they are in their early 40s, others can be younger.

Some women do not realise their symptoms are due to perimenopause – they may put them down to stress or their busy life. There is also not as much awareness of perimenopause as menopause so women can be surprised to learn their symptoms are due to perimenopause.

What symptoms might my partner experience?

During perimenopause and menopause, hormones – oestrogen (oestradiol), progesterone and testosterone – fluctuate and then decline. This change can result in a whole range of symptoms.

Some women have very few or even no symptoms and their periods simply stop happening. However, around 80% of all women experience several symptoms [2]. Around 25% of these women have severe symptoms [2].

Symptoms can include:

Changes to periods: they might become heavier than usual, although for some, they may get much lighter. Periods usually occur more irregularly before stopping altogether.

Hot flushes: these can come on suddenly at any time of day, spreading throughout the face, chest and body.

Night sweats: women can wake up drenched in sweat and need to change their pyjamas and bedding.

Mood changes: they might be irritable one minute and tearful the next. Mood changes may be more common if your partner suffered from premenstrual syndrome (PMS) or postnatal depression in the past.

Fatigue and poor sleep: your partner may be more tired during the day.

Joint pains and muscle aches: all three hormones are important in providing lubrication in the joints and preventing inflammation, so low levels can leave joints sore and muscles aching.

Brain fog: this is a collective term for symptoms such as memory lapses and poor concentration.

Lack of libido: Declining levels of the hormone testosterone can lead to a lack of interest in sex and lack of pleasure from it.

Vaginal symptoms: The tissues around the vagina can become thinner, drier and inflamed. The vagina also expands less easily during sex, which can make intercourse uncomfortable or painful.

Urinary symptoms: The lining of the bladder can thin, and some women have the urge to go to the toilet more often or have recurrent urinary tract infections.

Hair and skin changes: Skin may have reduced elasticity, fine lines and dryness. Some women find their skin becomes itchier, or they develop acne. Hair may become thinner and less glossy.

There can be other, often surprising, symptoms of perimenopause and menopause, including dry eyes, dizziness, altered sense of taste and smell, bleeding gums, and tinnitus.

How are perimenopause and menopause treated?

There are a range of treatments available to help manage symptoms, and in many cases, vastly improve your loved one’s quality of life. Nobody should wait until symptoms are unbearable before they seek help.

The most effective treatment is hormone replacement therapy (HRT), which works by replacing the hormones a woman’s body has stopped producing during the menopause. There are different doses and types – the three hormones oestrogen (oestradiol), progesterone and testosterone can all be prescribed.

In addition, lower levels of hormones are associated with an increased risk of developing other health conditions including osteoporosis (bone weakening disease) [3], cardiovascular disease (conditions affecting the heart and blood vessels) [4], type 2 diabetes [5], dementia and cognitive decline [6], auto-immune diseases [7] and some cancers [8], so speaking to a health professional is really important. They will be able to talk through available treatments to help your partner make an informed decision, based on their individual circumstances and preferences.

If you’d like to read more about the treatment of perimenopause and menopause, NICE (the National Institute for Health and Care Excellence) has released updated guidance. This emphasises the importance of an individualised approach and shared decision making when considering treatment options and choice for menopause care. Find it at nice.org.uk/guidance/ng23

How might menopause affect our relationship?

No man (or woman) is an island so if your partner experiences menopausal symptoms, they’re bound to have an impact on you too. This might be directly – if your partner’s night sweats wake you, for instance – or indirectly, say if your partner seems lower in their mood than usual.

Although most people associate menopause with flushes and hot sweats, these aren’t necessarily the symptoms that have the biggest impact on women. In a Newson Health survey of almost 6,000 women, an overwhelming 95% of respondents said they’d experienced a negative change in their mood and emotions, so you may notice your partner is more irritable, tearful or angry than usual [9].

Menopause also tends to coincide with a time of life where women are going through other transitions – children are growing up and may be leaving home, elderly parents may require care, and work may present new opportunities or even retirement. It can be a time for reflection and even reinvention – your partner might take on new hobbies or be thinking more about her future.

You might feel discombobulated by any changes your partner makes, especially if they come out of the blue, so it helps to understand that she might be embracing a new stage of her life.

How can I support my partner?

1. Learn about the menopause

Read up on the perimenopause and menopause so that you can have a greater understanding of what your partner may be going through. Offer to accompany her to any medical appointments – she might appreciate having someone to take notes or to just be there for her. Don’t be offended if she’d rather go alone though – just offering your support will be appreciated. You can find evidence-based information on everything perimenopause and menopause related at balance-menopause.com.

2. Be patient

If your partner does take HRT or receives alternative treatments, don’t expect it to be an instant magic “cure”. Treating menopause symptoms requires a holistic approach – she may want to make adjustments to her diet and exercise routine, or look into sleep and relaxation techniques. It can take time to get symptom relief and she may need to alter her treatment, for instance with a different dose or type of HRT. Also, keep in mind that although you may want to “fix” your partner’s problems, it’s not always helpful for a woman to feel she needs fixing – again it’s about being a stable presence.

3. Don’t take it personally

It can be hard to not take your partner’s mood swings personally – when someone is suffering, they can be difficult to be with and yet this is when they need their partner the most. Understand that her mood swings aren’t to do with you and that irritability is a common mood complaint for women during perimenopause [10]. Try not to snap back and try to ensure you have coping mechanisms in place for times when you may feel hurt.

4. Go with the flow

Many women feel overwhelmed during perimenopause and menopause and you might be surprised if she seems daunted by making decisions over seemingly trivial things. Don’t put too much pressure on her and offer to help. Some women struggle with self-confidence during this time and may not want to socialise. Or she may feel so tired she’s not able to keep up usual social engagements. Try to be her safe space – there’s a lot of pressure to be “on” at work or with friends and family – but she will appreciate it if she can be herself with you.

5. Factor in libido

Some women notice a change to their sex drive during perimenopause and menopause, and for some, less lubrication can mean sex becomes painful. Your partner may feel more self-conscious about her body, or feel shame that there is something wrong with her, and so avoid physical contact. Your reassurance can help – be sure to tell your partner you love her and don’t underestimate the power behind your words. Conversely, some women can feel liberated once their periods stop and find a confidence in this freedom.

6. Make time for each other

While it’s important to communicate with each other, accept that sometimes your partner might not want a big talk. Try to build in some short amounts of time where you can be together. Date nights can feel pressured – it can be more helpful to have a regular habit where, for instance, you might go for a 10-minute walk together in the evenings. Many people feel more free to talk when they are outdoors, walking side by side, rather than looking at each other. Some nights you might not even need to talk, but the time spent walking together, holding hands, can be an effective way of staying connected.

7. Be her champion

Remember, perimenopause and menopause symptoms can improve with treatment, including the right dose and type of HRT with testosterone. You can be your partner’s advocate by encouraging her to seek advice and treatment from a clinician who is experienced in hormones.

By having an understanding of what your partner is going through, you can support her through the physical and emotional changes of perimenopause and menopause.

References

1. Born L., Koren G., Lin E., Steiner M. (2008), ‘A new, female-specific irritability rating scale’, J Psychiatry Neurosci, 33(4) pp344-54.
2. NICE: CKS: Menopause
3. Woods NF, Mitchell ES. (2005), ‘Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives’, Am J Med. 118 Suppl 12B:14-24. Doi: 10.1016/j.amjmed.2005.09.031
4. Cheng CH, Chen LR, Chen KH. (2022), ‘Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover’, Int J Mol Sci. 23(3):1376. doi: 10.3390/ijms23031376
5. Iorga, A., Cunningham, C.M., Moazeni, S. et al. (2017), ‘The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy’, Biol Sex Differ 8, 33 https://doi.org/10.1186/s13293-017-0152-8
6. De Paoli, Monica et al. (2021), ‘The Role of Estrogen in Insulin Resistance’, The American Journal of Pathology, 191(9) pp1490 – 1498 https://doi.org/10.1016/j.ajpath.2021.05.011
7. Jett S., Malviya N., Schelbaum E., Jang G., Jahan E., Clancy K., Hristov H., Pahlajani S., Niotis K., Loeb-Zeitlin S., Havryliuk Y., Isaacson R., Brinton R.D. and Mosconi L. (2022), ‘Endogenous and Exogenous Estrogen Exposures: How Women’s Reproductive Health Can Drive Brain Aging and Inform Alzheimer’s Prevention’, Front. Aging Neurosci. 14:831807. doi: 10.3389/fnagi.2022.831807
8. Desai M.K., Brinton R.D. (2019), ‘Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan’, Front Endocrinol (Lausanne). 29;10:265. doi: 10.3389/fendo.2019.00265
9. Wu Z., Xiao C., Wang J. et al. (2024), ‘17β-estradiol in colorectal cancer: friend or foe?’, Cell Commun Signal 22 (367). https://doi.org/10.1186/s12964-024-01745-0
10. Experiences of the perimenopause and menopause, December 2022