MENOPAUSE. It’s part of life, part of ageing, part of being a woman. All true. The best option for women is to keep a ‘this too shall pass’ or something similar to a ‘close your eyes and think of England’ kind of attitude while going through it. Not true. Nor wise. Or fair.

American actor Halle Berry’s famous words in a press conference in 2024 outside the Capitol Hill building, “I am in menopause, OK?” got the world’s attention. In the medical world, menopause has always just been a side note. Women have learnt to bear it; doctors are trained to ignore it. So let’s look at some facts. Whether it is peri- or post-menopause, brought on naturally with the passage of time, or suddenly due to medical interventions, it is a monumental biological transition. One of the many vital systems in the body is shutting down.

The system shutting down is, of course, the reproductive system, the one responsible for producing extremely vital hormones since birth, and this next part should be in all caps, directly related to not just reproduction but brain, heart, bone, and musculoskeletal health among others. How can this profound event not affect the mind and body?

Two hormones — oestrogen and progesterone — are depleted as women enter menopause. Let’s only discuss oestrogen for now, as it is the more vital of the two. And let’s start with one aspect of its role: oestrogen and the brain. Simply put, oestrogen or more accurately, estradiol, gives energy to the brain. When oestrogen is depleted, brain energy is depleted. According to research, by the time women reach post-menopause, almost 30 per cent of their brain energy has been depleted. Neurons slow down, potentially leading to brain fog, poor memory, word retrieval problems, low mood/ depression, heightened anxiety, and panic attacks, among other debilitating symptoms.

Women have learnt to bear it; doctors are trained to ignore it.

It’s a neuro-endocrine event in its full glory.

And before one attributes some of these symptoms to the emotions ignited by the depravity of our world leaders these days — a valid reason indeed for the frequent bouts of grief and bewilderment experienced by many regardless of gender — let’s take a moment to understand menopause as well, in the hope of bringing relief to some of us at least.

Unhelpfully, menopause does not follow a rigid timeline or fixed symptoms. It can manifest as anything from exhaustion, musculoskeletal pain, and poor sleep — which has its own serious repercussions — to widely experienced symptoms like hot flashes and night sweats. It can also cause metabolic changes and fat redistribution, urinary symptoms, painful intercourse, and an increased risk of type 2 diabetes and cardiovascular disease. Symptoms can sometimes be uncommon — like painfully itchy ears — or silent — like severe bone loss that leads to osteoporosis if not caught early. The list is as endless as is the correct diagnosis, while help remains elusive.

Of course, one must keep an eye on the usual suspects: lifestyle, diet, exercise, sleep, hydration — and stress, which deserves a special mention for making matters more muddled and insidious. Cortisol, a hormone the body produces during stressful events, exists in direct and opposite balance to the production of oestrogen. Cortisol increases, oestrogen decreases. Cortisol decreases, oestrogen increases. In menopause, oestrogen is dropping, and if, at this point, prolonged and escalating stress is thrown into the mix, it can lead to a perfect storm. Oestrogen is in free fall. The effect is neither minor nor fleeting.

So how to manage this? Is HRT (hormone replacement therapy), also called MHT (menopause hormone therapy), advisable and/ or available? Have they developed better solutions than what were available a few decades ago? Is breast cancer still associated with HRT? How can women protect their bones during this time? What about their cardiovascular health? Their brain health? These are the questions women should be asking their doctors. Shouldn’t menopause be at the centre of the overall clinical context, instead of each symptom being treated separately?

Doctors, too, need to arm themselves with the latest research instead of shooting in the dark — as in the case of Halle Berry, who was misdiagnosed with an STD when the real cause was menopause — or simply placating their patients. Yet, if we are sceptical of the old saying that every dark cloud has a silver lining, it has come true here: Halle Berry’s misdiagnosis led her to push for more federal funding for research and education on menopause, beginning with destigmatising public discussions on the topic. This was truly an excellent use of the platform available to her. Over to our Pakistani celebrities. Women need a voice. A voice that is heard.

The writer is a freelance contributor.

Published in Dawn, November 3rd, 2026