Of all the changes that come with menopause, this cluster of symptoms is the most under-discussed, the most likely to be dismissed, and the most treatable. It affects the majority of women after menopause, becomes worse over time without treatment, and yet only a small proportion of women ever receive care for it. Here is what it is and what can be done.

Not every woman can take menopause hormone therapy, and not every woman wants to. The good news is that there are several non-hormonal options with real evidence behind them. The less good news is that the menopause supplement industry has grown into a multi-billion pound market, and most of what is sold does not have the evidence its packaging implies. Here is how to separate what works from what does not.

Menopause hormone therapy (MHT), often called HRT, is one of the most misunderstood treatments in women's health. For two decades after the Women's Health Initiative study in 2002, MHT was widely feared, widely under-prescribed, and often withheld from women who would have benefited. The picture has changed considerably since then, with newer analyses, updated guidelines, and better understanding of how type, dose, timing, and route of administration affect the risk-benefit balance. Here is where the evidence sits today.

Hot flushes have become the shorthand for perimenopause, which is unfortunate because they are only one part of the picture and often not the first symptom. Many women spend years experiencing perimenopausal changes without realising what they are, partly because the wider list is rarely taught, and partly because the symptoms are easily attributed to stress, ageing, or 'just how life is right now'.

For a life stage that every woman who lives long enough will go through, menopause remains astonishingly under-taught. Most of us pick up fragments from mothers, sisters, friends, or the occasional article, and end up with a patchwork of information that only becomes useful once we start noticing changes ourselves. Here is the version worth having earlier.