Moving to a new country is exciting, but it comes with challenges—especially when paired with the journey through perimenopause or menopause. This stage of life is often unpredictable, bringing physical, emotional, and even social changes. And when you’re adjusting to a new culture in Germany, France, Spain, or Italy, finding support and information can be even more challenging.
Colette White is a gynaecologist from the UK specialising in menopause management. Now based in Bonn, Germany, she helps women navigate this stage both in her private practice and through online consultations across Europe. Here, she walks us through what perimenopause and menopause are, why symptoms may start sooner than you expect, and how best to manage this transition—wherever you are.
What Exactly is Menopause?
Simply put, menopause is a point in time: 12 months after your last period. From then on, you’re considered “postmenopausal” for the rest of your life. It’s a natural part of aging, with 100% of women experiencing it, though the timing varies. The average age in Europe and North America is 51, while Black and Hispanic women may experience it up to two years earlier, and women in India around age 47.
Some women, however, may enter menopause early due to surgery or medical treatments like chemotherapy. Menopause before age 40, known as early or premature menopause, often has a genetic component and may increase the risk of heart disease and osteoporosis, requiring careful management.
Why Does Menopause Happen?
There are various theories. One suggests that menopause frees us from childbearing so we can focus on helping future generations. Another is that menopause protects us from the risks of pregnancy later in life. In practical terms, we’re born with a finite number of eggs, which eventually run out. This egg release—along with related hormone production—drives our progesterone and estrogen levels. As egg supply dwindles, it becomes harder for the brain’s signals to prompt ovulation, causing hormone fluctuations and triggering symptoms. This process can start up to a decade before your last period, in a phase called ‘perimenopause’, which may last months or even years.
What is Perimenopause?
Perimenopause is the period leading up to menopause, marked by fluctuating hormone levels, especially estrogen and progesterone. In some months, you may not ovulate at all, resulting in low progesterone levels, while in others, the ovaries produce extremely high estrogen. This hormonal rollercoaster is what often causes perimenopausal symptoms, which can range widely and start as early as the late 30s.
Unlike conditions such as thyroid disease, perimenopause can’t be diagnosed with a simple hormone test, as hormone levels naturally vary throughout the month and even the day. Instead, diagnosis relies on a thorough history and symptom assessment. This is crucial, as fluctuating hormone levels mean that a single test could miss the variations causing your symptoms.
What Are the Symptoms?
Menopause symptoms affect all systems of the body because estrogen and progesterone receptors are found in every cell. Commonly discussed symptoms include hot flashes, mood swings, and changes in your menstrual cycle. But more than 40 potential symptoms have been linked to this phase of life, including:
– Joint and muscle pain (e.g., frozen shoulder)
– Hair changes (thinning, loss, or scalp itchiness)
– Skin and nail changes (dry, irritated skin, brittle nails)
– Tinnitus or hearing changes
– Digestive issues (bloating, reflux, constipation)
– Weight gain, especially around the abdomen
– Brain fog (difficulty concentrating, forgetfulness)
– Anxiety and low mood (often affecting previously unaffected women)
– Sleep disturbances (especially early waking and nighttime agitation)
– Low libido and vaginal dryness (causing discomfort during sex or frequent urinary infections)
Beyond immediate symptoms, postmenopausal changes increase the risk of heart disease and osteoporosis. Cholesterol levels often rise, and women tend to gain weight and experience shifts in blood sugar regulation, increasing diabetes risk.
What Treatments Are Available?
For years, hormone replacement therapy (HRT) was limited due to concerns about breast cancer and stroke. However, today’s body-identical hormones are much safer. Estrogen (as estradiol) is typically applied via skin patches, sprays, or gels, bypassing the liver to avoid clotting risks. For vaginal and urinary symptoms, vaginal creams or pessaries containing estradiol or estriol offer targeted relief.
Estrogen alone can thicken the uterine lining, so progesterone is used to balance this effect. Beyond this, body-identical progesterone is known to help with sleep and reduce anxiety, providing even broader benefits.
Lifestyle Tips for Managing Menopause
Whether or not you choose HRT, lifestyle adjustments can improve menopause symptoms and support long-term health:
1. Sleep: Aim for 8 hours. Avoid screens before bed, stick to a regular schedule, and limit caffeine and alcohol. A cool room, natural-fabric bedding, and supplements like magnesium and melatonin can aid rest. Good sleep is essential for brain health, memory, and metabolism, which are especially crucial during this transition.
2. Stress Management: Stress is often unavoidable, especially for women juggling work, family, or adjusting to life abroad. Practicing mindfulness, meditation, yoga, or cognitive behavioral therapy can help reduce stress and support hormonal balance, as stress hormones like cortisol can worsen menopausal symptoms.
3. Exercise: Weight-bearing exercises help maintain bone density and muscle mass, reducing osteoporosis risk and aiding sleep. Aim for at least 150 minutes per week, which can also lower your risk of breast cancer and promote a healthy weight.
4. Diet: A Mediterranean diet, rich in fresh vegetables, fruits, olive oils, nuts, and seeds, is highly beneficial. Ensure protein intake (1.5g per kg of body weight) to support muscle and bone health, and aim for 30g of fiber daily. Limit refined sugar and alcohol to reduce breast cancer risk, and incorporate fermented foods for gut health, as this can aid in hormone metabolism.
5. Social Connections: Building connections is vital, especially if you’re far from your home support network. Engage in local clubs, sports, or volunteer activities. Socialising is known to benefit mental health and can make a significant difference in coping with life changes, including menopause.
Finding Help When You Need It
Menopause is a uniquely individual experience, and its impact varies widely. If lifestyle adjustments don’t alleviate symptoms, know that safe, effective hormonal and non-hormonal treatments are available. Reach out for support; whether from local practitioners, online resources, or expat communities, there is help to make this transition easier—even in a new country.
Navigating menopause while adjusting to a new culture can feel daunting, but understanding what’s happening in your body and knowing your options can empower you to thrive through this phase—wherever you are.
Find out more about how Colette can support you via her website, or contact her by email: colettewhitemenocare@gmail.com
Read more useful articles and interviews on the MumAbroad blog
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