Instant Genius - What we all need to know about menopause

Episode Date: October 31, 2025

Throughout our lives we all go through several significant periods of change – puberty, young adulthood, middle age, retirement. Each comes with its own quirks and challenges, but perhaps one of the most underdiscussed of these stages is menopause. The lowering of hormone levels and eventual cessation of ovulation caused by menopause can affect women’s mental and physical health, performance in the workplace and even social life. So why is talking about it still considered so taboo? In this episode, we’re joined by Dr Saleyha Ashan, a journalist, emergency medicine doctor and researcher based at the University of Cambridge. She tells us what she’s learned from her own life experiences as a woman and medical doctor, the many, varied ways that menopause affects women’s physical and mental health and gives us advice that can help us all navigate this natural period in life more successfully. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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talking about the most fascinating ideas in science and technology today. I'm Jason Goodyear, commissioning editor at BBC Science Focus. Throughout our lives, we all go through several significant periods of change. Puberty, young adulthood, middle age, retirement, each comes with its own quirks and challenges. But perhaps one of the most under-discussed of these stages is menopause. The lowering of hormone levels and eventual cessation of ovulation caused by menopause can affect women's mental and physical health, performance in the workplace, and even social life. So why is talking about it still considered so taboo?

In this episode, we're joined by Dr. Salehah Asan, a journalist, emergency medicine doctor and researcher based at the University of Cambridge. She tells us what she's learned from her own life experiences as a woman, and medical doctor, the many varied ways that menopause affects women's physical and mental health and gives us advice that can help us all navigate this natural period in life more successfully. So, Salaya, thank you so much for joining us. Pleasure. So today we're talking all about menopause. Yep. So let's start off with the basics. What exactly are we talking about when we mean menopause? So menopause is a natural biological phase in a woman's life where she comes to the end of the reproductive phase of her life.

So essentially, that is officially diagnosed when a woman has not had a period for 12 consecutive months and no other medical reason can explain it. And it's essentially the period where she is no longer reproductively. active, her body stops producing eggs and her estrogen levels and progesterine levels, which are the female hormones, go down. Yeah, so you mentioned there the lack of ovulation. But what about other common symptoms that accompany menopause? Sure. Gosh, okay, I'll tell you a little story. Now, I know in recent years there's been a lot on menopause in the news. Some huge campaigns by well-known people in the media, probably hitting that period of life themselves

and going through these strange signs and symptoms, not recognising themselves, you know, some impactful changes happening in their lives. So there's been some brilliant work done to bring this subject out into the mainstream. not that something that women sort of suffer and endure in silence on their own. And they brought it into the mainstream. And it became sort of the talk of the town, media, everyone was covering menopause. I was going through some symptoms myself a couple of years ago.

And I thought, oh, gosh, I'm exhausted. I feel like I've been, you know, climbed a mountain or something. and literally all I've done is just got out of bed and started my day. I was exhausted. I was a bit irritable. I was putting on weights. But I think that was probably because I was so tired. I wasn't moving as much as usual.

But the main thing was I felt like I'd been hit by a sledgehammer. And I had absolutely no energy whatsoever. So I just assumed, oh, that's menopause. I must be perimenopausal and I had the added complication of having a life of polycystic ovary syndrome which meant that my periods were very, very irregular

and turned up whenever they want huge long periods of time without actually having a period itself. So I just assumed what I was going through in the last couple of years was menopause. And I just phoned up my GP

And I went, I've got these symptoms, can I please have HRD? Because that was what was being put out there, hormone replacement therapy. It was, you know, women, if you're going through these symptoms and you're at this age, it's probably menopause. You know, you have a right to have HRT and GPs aren't prescribing it enough. Make sure you go to speak to them and get on it and it will do, you know, it was almost being. put out as the wonder cure. So I assumed that that's what I had. And I had a brilliant GP.

And it was also at the time when GPs were being slammed quite a bit and doctors were being slammed quite a bit for not being proactive enough in treating women with menopause that they weren't just, you know, that there were lots of hoops for women to go through before they could hit HRT. you know, which was leading to some women to sort of seek it online and in other places. But my GP said, okay, it could well be, but let's do some bloods.

Let's make sure, just let's just make sure, you know, let's be a bit thorough about this. And so she did a full set of bloods and lo and behold, some abnormalities came back. And long story short, turns out I have lupus. Right, yeah. So had I not had a GP, and this was two years ago when there was so much pressure on GPs from the media and from campaigners about HRT and the management of women. My GP could have just on the phone, and this was at the time where quite a lot of the consultations were happening over the phone. she just said, no, no, no, no, let's check this out properly. And, you know, if she hadn't, I would have had undiagnosed lupus,

which would have been doing me a lot of harm and untreated lupus. And I wouldn't have felt any better on HRT because that's not what it was. So I think what were the symptoms that I was going through? As I said, I was exhausted, that low energy. levels full of anxiety as well. I'm not, you know, I'm ex-military. I've worked in all sorts of places overseas in quite challenging testing settings,

in armed conflict settings, lots of adventure sports, you know, that I've done into climber and all that kind of stuff in my background. But I was now just nervous even getting in a taxi where someone else was driving. I mean, the anxiety levels were just, they were crippling. You know, at one point it was just bizarre. I wouldn't even let my partner drive. I had to drive everywhere because I just felt this bizarre anxiety of anyone doing any,

I needed to have control. And it was so debilitating. And I was getting annoyed and irritated. with things, the fact that the periods are even more irregular than ever, people can also get mood swings, sleep problems, and able to sleep. I had the opposite. I could go to bed for a week, but hot flushes, night sweats, we know all about all of that. You know, that's kind of like the, you know, the landmark symptoms that women have, but I didn't have that. Skin and hair becomes ever so dry. And I've experienced that myself. So I'm, I'm, I'm just lucky enough to be

having both things at the same time. So anyway, joint aches, headaches, poor concentration, this brain fog. And I have it. I do. It will probably happen during the course of this conversation with you that I'll be on a, on a flow with something, and then it will just be gone. And then I'll be like, where did it go? It was right there. So brain fog, uh, for, forgetfulness, mood swings, irritability, low mood, anxiety. Also, you know, the not so nice things as well, vaginal dryness, discomfort during sex, changes in libido. So it is a whole load of things.

It's a shopping basket full of not very nice things. And you begin to think, God, who am I? I don't even know who I am anymore. You know, and you begin to sort of think about who you are and who you were. And where has that person gone? And how did you get them back? Because they haven't gone anywhere. You're just dealing with some changes.

But I know that I was just going through periods of time where I didn't even recognise myself. And that can be really upsetting. So what sort of age range are we talking about for this? Okay. So the age range, I want to get this right. So it can happen. It can start to happen from as early as 45 and it can go up to 55 or even a bit longer. Oh, no, my mom didn't hit full menopause until her late 50s. And then you can have early onset menopause, which would be before 45. And that's called early menopause. But if it happens before the age of 40, it won't be called menopause. It will be called premature ovarian insufficiency. And that's POI. But basically it means that you're starting on the road to menopause. Doctors will look for other causes as well.

So it might take some time before they realize that it is a perimenopause. Whereas for me, I was at the age, but they just wanted to check it wasn't something else first. And I think that's absolutely right because it did end up being something else for me. but just don't assume it is that some of the other symptoms that you can get. And I had them like spikes in blood pressure and also palpitations. So obviously very important that those things are checked out not to be something else. When you need to build up your team to handle the growing chaos at work, use Indeed sponsor jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications and more.

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And you'll still be getting periods during this time. And remember, the menopause is when you've had 12 months of none. So paramount menopause, you'll still be having periods. They won't be regular, but they'll still come. They'll surprise you out of the blue when you're least expect. them. So yeah, it can be a bit annoying and it can last several years. So it's during this period that your your female hormones, estrogen and progesterone, are declining and these are, you know, these hormones are quite essential for our function, our, you know, our body. And they're

really important for things like bone health. They also, are reasons as to why we get some of those awful symptoms. So HRT helps to dampen some of those symptoms and help you to be you again almost as well. And there are different types of HRT. So that can be estrogen only or progesterine only or combined or you'll take one form, but you'll also take the other form as well. they've been as in estrogen but with progesterone as well.

And there's a whole load of types and ways that they are delivered into your body, whether tablets or gels or even pessories that you insert vaginally, you know, all sorts of things. It's really important to discuss this with your GP. and a bit like the contraceptive pill, different forms of the pill work better with different people. One type might suit you better than another. So it's really important to go through this journey of HRT, closely with your GP to see how you're doing on it.

Because it's a medication, people can get side effects. There's some estrogen-based HRT that, can cause a thickening of the womb lining, and that is a risk factor for cancer. So the way that the GP will counter that is to give progesterone as well, which reduces that risk. I remember being a medical student, and we were learning about HRT and the risks. And I still remember the notes that I made. And I remember being quite confused and a little bit alarmed at the time, thinking, quakey, women are kind of screwed because they go through this awful thing called menopause. It sounds horrendous.

And then when you try to help them with it with hormone replacement therapy, that's designed to sort of give you something worse. That's what I thought at the time as a medical student. Quiki, you know, your choices are going through all those awful symptoms or getting cancer. But what I think what was what we now know that some of those earlier studies about the cancer risks of HRT were quite old studies now and not relied on in the same way that, you know, me as a medical student was told, you know, is a balancing act between having hormone replacements therapy for a woman or her being given it and then having a really high risk of getting cancer. And this is why it's really important to go through everything with your GP when you're going on this journey because if you have a family history, a close family history of breast cancer, or you yourself have had breast cancer, you may not be a candidate for HRT, especially if you have had breast cancer because there are some studies that show that there has been,

you know, a link with HRT and breast cancer, particularly for. if you're already predisposed to it or have had it. So how about sort of lifestyle factors that women can take to manage some of these symptoms? I think so. There are some things like, you know, weight loss really helps, being active, doing the things, you know, remember the things that you liked to do just because you were a bit low of energy and you think, I really can't be bothered. Actually, if you fight that little bit harder and do those things,

it will help. The benefits of HRT of hormone replacement therapy usually outweigh the risks. And recent evidence says that the risks of serious side effects of HRT are very low. So if you've had blood clots before in the past, it's not to say you can't take HRT, but you've just got to be mindful of them. again, working closely with your GP, knowing what the symptoms of a blood clot might be, whether you get them in your legs

or whether you get them in your lungs. Being told what the risks are and then being able to make an informed decision yourself as a female patient, I think it's really important. I would tell everyone, you know, patient, you know, these are the risks, these are the benefits, these are the risks of not taking HRT if you're going through menopause

because you know you're losing bone density there's other things happening impacting your life so there are other negative things happening in your life and these are the benefits of HRT but again it comes with some risks we believe because of studies cardiovascular risks

blood clot risks or even small risks of cancer but then you balance and you decide and you can make an informed decision and it doesn't mean if you go on it you're on it forever you can come back off it if it's not working for you.

We've talked about an awful lot there so do you have any sort of closing thoughts things that you'd like to say about someone listening who perhaps is thinking they're going through the menopause or the peri-menopause and maybe having a bit of a hard time

it's a natural part of our lives it's just another stage. And I'm saying that, you know, it's just another stage. It's a hard stage. But then again, I remember when I passed into puberty, I thought that was horrendous. I was like, I don't want the periods. I, you know, I thought, my God, I'm going to be lumbered with this for the rest of my life. That wasn't easy, you know, going through.

that was horrible. I for me and you know it's not the most easiest experience for us when we're when we hit puberty for women and I'm not going to talk about men because men have their own challenges and then you go through the middly bit where you get used to it and now we're at the other end of it where we're saying goodbye to them and I think it's it's just about embracing the fact that this is just another part of the journey. It's just another it's just another it's not worse or better, just different section of it. You know, it's different section of the journey. And it comes with a few bits and pieces that we need to deal with. You know, we had to learn how to care for ourselves during periods, whether it was tampons or sanitary towels or learning how to

wear a bra or, you know, dealing with the horrendous cramps, all of that kind of thing. We had to learn how to deal with it and we did and we came through it. And now we've got to learn how to deal with these new things. that are coming along. And again, women have been going through this since time began. I have actually gained quite a lot of comfort through speaking to friends who are also going through it. And I get motivated by them.

I hear how they're doing things and what they're embracing. So speak to your friends, speak to family. Let's talk about it more, not suffer in silence. Talk about it with your partner. I'm really open with my partner. I said to him the other day, oh, I've got my period again. He went, are you still getting them?

I thought, you know what? I was really surprised that he even knew what it was. I thought, oh, you have been paying attention. Women's things and women, you know, what we go through is not his forte. You know, he's a sort of, you know, very upright, sort of conservative North African man. And I thought, quacky, you know about, you know, what I'm going through and you know that the periods will stop. So I was really impressed.

So talk about it. Talk about it with your partner. And talk about it with your peers and your friends. Because, you know, everyone will have a different approach to it. I've got my friend and she's, you know, she's going out there. I'm ex-military. I've got lots of ex-military friends. When she's going out and doing a big, long, huge walk, it kind of rubs off on me.

as well because I think, oh yeah, I want to go and do that too. But if you are getting unusual symptoms that are not you, don't just assume it's menopause. Don't just assume it's so important. If your blood pressure is spiking high, if your energy levels are just nowhere near where they used to be, absolutely go and get things checked out by your GP because it's a, we call it a differential diagnosis, it's one of a few things it could be. Let's make sure it's not something else. And that's the definition of perimenopause, menopause, 12 consecutive periods and all the symptoms that go with it, where there's no other medical reason for it.

Don't self-diagnose. Yes. This isn't something to self-diagnose. If you're going through some symptoms that you're not sure of what they are, you think that it might be menopause. or perimenopause, definitely start the journey with your GP. There's plenty of literature out there as well online. Have a read.

Have an informed conversation with your GP. Be open the fact that you think it's menopause, like I did. I'm really grateful that menopause is out there in public discourse and discussion. I found it so helpful. I think that we're better informed. and in turn we will be able to help those that are coming next. Thank you for listening to this episode of Instant Genius, brought to you from the team behind BBC Science Focus. That was Dr. Salaia Asan.

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