Twelve symptoms, forty articles, and no idea which thing to deal with first. This is the priority order — what to do in week one, what to treat before anything else, and what genuinely cannot wait. If you read one page on this site, this is a reasonable one.
Where we stand: Menova is an independent publication. We sell no hormones, supplements or tests, we are not your doctor, and this is general education, not medical advice.
Step 0 — the things that do not wait
Before anything else on this list, these go to a clinician now rather than being read about:
- Bleeding after twelve months without periods — any amount; see bleeding after menopause
- A new breast lump, or skin or nipple change — see breast changes in midlife
- Persistent bloating, most days for three weeks or more — see ovarian cysts in perimenopause
- Rectal bleeding, or a lasting change in bowel habit — see haemorrhoids and bowel changes
- A changing, bleeding or non-healing skin lesion — see checking your own skin in midlife
- An irregular pulse, or palpitations lasting a long time — see atrial fibrillation in midlife women
- Any thoughts of harming yourself — seek help immediately
Step 1 — start a record today
Two weeks of notes changes every appointment that follows, and it costs nothing.
Record: cycle dates and heaviness, hot flashes per day and per night, number of night wakings, and your top three symptoms scored out of five.
"Twelve hot flashes a day, waking four times a night, for eight months" gets a different consultation from "I'm not coping." Our free 30-day symptom tracker does this on paper, and how to track your cycle covers the detail.
Step 2 — get the blood tests that rule out the impostors
Before attributing anything to hormones. Every one of these produces exhaustion, fog and low mood, and every one is treatable:
- Full blood count and ferritin — see low ferritin in perimenopause
- Thyroid function — see perimenopause versus thyroid
- B12 and folate — see B12 deficiency in midlife
- HbA1c
- Vitamin D
Note what is not on that list: hormone panels. For women over 45, guidance generally advises against them for diagnosing the transition — see was that my last period.
Our fuller list is when menopause might not be the answer.
Step 3 — fix sleep first
If you do one thing for symptoms, do this one.
Almost everything else — mood, rage, cravings, brain fog, pain threshold, capacity for work — degrades on fragmented sleep, and night sweats fragment it for months before anyone connects the two.
Treating the night sweats is a mood intervention, a metabolic intervention and a safety intervention, not a comfort one. See night sweats in perimenopause and menopause insomnia.
And if you snore or wake unrefreshed despite enough hours, ask about sleep apnea — it rises sharply after menopause and is badly under-diagnosed; see sleep apnea after menopause.
Step 4 — treat the genitourinary symptoms early
The one that gets deferred and should not.
Hot flashes eventually settle for most women. Vaginal dryness, urinary urgency and recurrent infections get worse without treatment, and the tissue change becomes harder to reverse the longer it runs.
Local vaginal estrogen is low-dose, acts locally, and is suitable for many women who cannot take systemic hormones. It is under-offered and it is the treatment most likely to change daily life. See GSM and urinary changes and how to use vaginal estrogen.
Step 5 — start resistance training
Not because of how you look. Because bone loss is fastest in the years around menopause, muscle loss accelerates at the same time, and loading is the only thing that builds bone rather than slowing its loss.
Twice a week, progressively heavier. If you have never done it, that is normal and it is learnable in two or three sessions — see walking into a gym at 50, strength training in menopause, and muscle loss in midlife.
Add enough protein, which most women in this decade under-eat, and where breakfast is the usual gap — see how much protein you need.
Step 6 — book one appointment that covers the long game
Three numbers, one visit, and they cover most of what changes silently in this decade:
- Blood pressure — the highest-value measurement there is; see blood pressure and menopause
- A lipid panel — see cholesterol after menopause
- HbA1c
Mention pre-eclampsia or gestational diabetes in any pregnancy, and early menopause if it applies. Both are recognised markers of later cardiovascular risk and nobody asks about them. See health screening in your 50s.
Check your screening is up to date — cervical screening does not stop at menopause; see cervical screening after menopause.
Step 7 — decide about treatment, with real information
Now, rather than first — because the steps above make this conversation useful.
- Hormone therapy is the most effective treatment for vasomotor symptoms, and the risks are frequently misstated in both directions — see HRT risks and benefits and HRT and breast cancer risk in numbers
- Non-hormonal prescription options exist, including a class developed specifically for hot flashes — see non-hormonal prescription options
- CBT is in guidance and is rarely offered — see CBT for menopause
- Being refused is not the same as being ineligible — see what to do if your doctor says no
Prepare for the appointment with what actually happens at a menopause appointment and the free printable visit prep sheet.
Step 8 — the two cheap changes
- Reduce alcohol. It worsens sleep, hot flashes, mood, blood pressure and next-day anxiety, and its effect in midlife is larger than most women expect — see alcohol in midlife
- Contraception, if you might still conceive. Until twelve months after your last period if over 50, two years if under — see contraception in perimenopause
What not to do first
- Do not buy supplements before the blood tests. Most have weak evidence, and the money is better spent elsewhere — see what the supplement research says and how to tell whether a supplement is worth buying
- Do not pay for a private hormone panel to tell you what your symptoms already say
- Do not make a permanent decision about work during the worst months — see menopause and career decisions
- Do not buy hormones online without a prescription
The one-paragraph version
Start a record. Get ferritin, thyroid, B12, HbA1c and vitamin D checked. Treat the sleep. Treat the vaginal and urinary symptoms early, because they do not resolve on their own. Start lifting twice a week and eat more protein. Get blood pressure, lipids and HbA1c done in one visit, and mention any pregnancy complications. Then have the treatment conversation properly.
The free 2-minute Menova self-check organizes your symptoms into something you can take to that appointment — no account, not a diagnosis, and your answers never leave your device.
This article is general education, not medical advice. Report the Step 0 symptoms to a licensed clinician promptly. Treatment decisions belong with a clinician who knows your history.
Sources: NICE NG23 — Menopause, The Menopause Society, ACOG — The Menopause Years, and NHS — Menopause.