Brain fog, rage and libido: Two Kiwi menopause experts explain what’s really going on

During menopause, wildly fluctuating hormones can influence your mind and body without permission – sometimes with explosive results. Photo / Getty

What’s making me feel so angry? Should I break up with my partner? Is “brain fog” a real thing? Or am I just losing my mind?

It’s World Menopause Day and although the “m” word is no longer completely taboo, it can still be a hot mess for many women who don’t have the support or information they need. So, we went to the experts for some candid advice.

Dr Sylvia Rosevear is an Auckland-based obstetrician and gynaecologist who has just completed her term as president of the Australasian Menopause Society.

Sarah Connor founded the grassroots group Menopause Over Martinis and is a menopause speaker and workplace advocate.

I feel like I’m going crazy. Does menopause really cause brain fog?

Sylvia: Brain fog is well recognised and usually manifests as having trouble finding the right word. Some of that will be related to non-hormonal aspects of being in midlife, which can be a vulnerable time.

Many women experience some difficulty in cognitive performance that can cause distress but doesn’t always impact their day-to-day life. With dementia, you don’t just forget where your keys are – you don’t know what they’re for.

Sarah: Feeling crazy is a common complaint in perimenopause as our hormones fluctuate, on top of the daily demands of midlife – especially if we don’t understand the changes we’re going through or don’t have good support at work and home.

Not feeling like your usual self, not remembering your good friend’s name, going downstairs to get one thing and coming back with something else. It can be frustrating (I write a lot of things down). It’s a relief to know brain fog doesn’t last forever.

My relationship has become strained – we feel disconnected and I’m thinking about calling it quits.

Sylvia: One of the first symptoms of perimenopause [the transition stage] is “outrageous rage”, the feeling that you’re allowed to be really angry about something and you’re entitled to feel that way. A patient going through early menopause told me her husband said he can’t read her. One minute she’s sunshine, the next minute she’s thunder.

It’s probably a good idea to have some treatment for any menopause symptoms and then give it three months before making a decision. Relationships are always complex, and financial insecurity in itself is a health risk.

Sarah: Hormones are really powerful – they can influence your mind and your body without your permission and without warning, so it’s a really unpredictable time. Needing your own space more often is really common. You don’t want to stick with a situation that’s not healthy, but I’d also be factoring in the impact of peri/menopause on how you feel about yourself and others.

I’ve turned off sexually, too …

Sarah: That can be really challenging because one person has changed and one person hasn’t, which can cause all kinds of flow-on effects. Communication is the key, and both people understanding it’s not personal – even though it can look and feel like that – but is a very biological change.

Sylvia: Low libido may relate to relationship factors, general health factors, or possibly hormone factors. But it’s never due just to hormones and can’t be identified by measuring either oestrogen or testosterone.

Wellington-based menopause speaker and workplace advocate Sarah Connor: 'Hormones are really powerful – they can influence your mind and your body without your permission and without warning.' Photo / Nicola Edmonds

Given all the potential negatives – including loss of bone density, weight gain, higher risk of cardiovascular disease – is there anything good about going through menopause?

Sarah: Older friends tell me they’ve got more energy than they’ve ever had, and more clarity about what they want from life. One ditched her job and started a business. There’s also less tolerance for nonsense. And how great to have that money you don’t need to spend on period products every month!

Sylvia: Menopause is the permanent end of menstruation, occurring when the ovaries stop producing oestrogen and progesterone, typically between ages 45 and 55. It’s a time of reassessment some women find both empowering and liberating.

Are there cultural differences in the way menopause is viewed?

Sarah: In Māori culture, menopause is seen as a reset that comes with mana. It’s revered. In traditional times, it was the post-menopausal woman who did the karanga on the marae. Too often, the Western world views it with fear, shame and embarrassment rather than as a new and positive chapter in life.

There are some taboos across other cultures, too – some Asian and Pasifika communities aren’t comfortable talking about menopause. But in traditional Chinese medicine, it’s seen as a second spring. In the Arabic dictionary, they changed the definition of menopause from the age of despair to the age of renewal.

I feel a certain kind of grief about reaching menopause. Is that weird?

Sylvia: No, that’s normal and can sometimes be more pronounced in those who have not been able to have children or chosen not to, or women who are particularly conscious of ageing.

Sarah: The many changes to our minds and bodies can be very different from what we expected. There can be grief in that.

Obstetrician and gynaecologist Dr Sylvia Rosevear: 'Menopause is a time of reassessment. Some women find that both empowering and liberating.' Photo / Anna Kidman

What’s the deal with women losing their fertility in midlife while men can still father children in their 90s?

Sylvia: In some species of whales, the females go through menopause, too, and have been observed spending long periods teaching the young. The “grandmother hypothesis” comes from the thinking that women’s long post-menopausal lifespan evolved so they could focus on caring for their daughters’ offspring, but this is just a hypothesis and remains contentious.

Sarah: It does seem a bit out of sync, doesn’t it? But I’m seeing it as a positive. I don’t want to still be having babies when I’m 90. And, like Sylvia, I don’t think women were born to only reproduce and then become the carers of the next generation.

Is “male menopause” a real thing?

Sylvia: Men do experience a gradual decline in testosterone, but not the wild hormone fluctuations and sudden decrease that happens in women with estrogen loss. Sometimes referred to as “andropause”, it can cause symptoms in men such as fatigue, low libido and mood swings.

What support can I expect from my workplace?

Sarah: Everyone’s experience is different. It might be having the flexibility to work from home, starting or finishing later, or being able to work in a quieter, cooler space away from the hustle and bustle.

If you’re going into a long meeting, make sure there are frequent bathroom breaks. Someone who has heavy periods told me she takes a towel to sit on so she doesn’t have to worry about leaking on to her chair.

Also, be aware that it’s not solely up to your workplace. The Health and Safety at Work Act sees health and wellbeing as a joint responsibility.

Can I take sick leave for hot flushes or other menopause symptoms that are bothering me?

Sarah: The question would be, how does it impact your work? Insomnia is a big one. It can be difficult to concentrate if you’ve been awake all night. But if you’re having unpredictably heavy periods, or so many hot flushes you’re dripping in sweat and having to change your clothes 10 times a day, I’d recommend seeking medical advice.

Sylvia: The trouble is hot flushes can last a long time [an average of 7.4 years] and interfere with sleep very significantly. If your symptoms are severe, sick leave can be used to access medical appointments and get treatment.

Should I talk to my boss about what’s going on?

Sarah: If you have a good relationship and there’s an open, supportive, positive culture around what it is to be a human at all ages and all stages, then absolutely bring it up. Or talk to a different manager.

If peri/menopause is impacting your work, the risk is that it could be seen as just poor performance, so doing nothing could make the issue worse. However, some managers might be ill-equipped to have that conversation or even be quite dismissive, so talk to your health and wellbeing team.

Teenagers are taught about menopause at school in the UK. Why isn’t that happening here?

Sarah: Some external educators who go into schools will be making sure they include it, but at the moment, it’s not mandated. The Ministry of Education is hoping to add it to the curriculum in 2026, but possibly not until Year 13, which I think is out of context when you’re learning about periods in Years 5 and 6, so that would be a bit of a missed opportunity.

I don’t feel seen or heard by my GP and they aren’t up with the latest research. Now what?

Sarah: That’s a sign that you need to find another one! Unfortunately, antidepressants are still the go-to for some GPs ahead of hormone therapy, which is a real issue because it’s not treating the root cause.

If you’re in a practice that’s big enough, ring the receptionist and ask who would be the best fit. Consider a menopause clinic/specialist, in-person or online. If that’s not available or affordable, Sexual Wellbeing Aotearoa (formerly Family Planning) does menopause consultations.

Sylvia: The Australasian Menopause Society has patient information sheets on their website, and a list of doctors and practitioners who are members. Thankfully, there’s an increasing awareness among GPs that hormone therapy does not have the risks that were previously feared.

If hormone treatment isn’t for me, are there any alternatives that actually work?

Sylvia: Hormone therapy is the most effective treatment for many symptoms, including hot flushes, but there are other evidence-based medications: SSRIs and SNRIs for low mood, gabapentin for problems with sleep, and oxybutynin for genitourinary symptoms [such as vaginal burning/itching or pain during sex].

Sarah: We also need to consider self-care and lifestyle changes: regular exercise (especially weight-bearing), nutrition, sleep hygiene, managing stress.

There are things we can do every day, like exercising first thing in the morning with sunlight for vitamin D, eating enough protein and fresh produce, minimising sugar, processed foods, alcohol and caffeine (especially late in the day). Some people swear by supplements, others by mindfulness or yoga. Whatever works.

I’m suddenly suffering from insomnia, anxiety and low mood, but I don’t get hot flushes and my periods are fairly regular, so I’ve been told I can’t go on hormone therapy. What’s the criteria?

Sylvia: The AMY (Australian Women’s Midlife Years) study [published in The Lancet last month] says that if your periods are still regular but have become either a bit heavier or a bit lighter, then you are in perimenopause and can have cyclical MHT.

I’ve had a hysterectomy / my ovaries were damaged from treatment for cancer or removed. Will I still go through normal menopause?

Sylvia: On average, menopause will be a year or two earlier if a hysterectomy has taken place [the permanent end of menstruation typically occurs between 45 and 55]. If the ovaries are removed, which is known as surgical menopause, this can result in quite significant menopausal symptoms. Unless there’s a contraindication, such as ovarian or breast cancer, women younger than 45 can have MHT.

Can I get pregnant once my periods have stopped?

Sylvia: Yes. To no longer need contraception, you need two years of no periods if you reach menopause before 50, or one year of no periods after the age of 50.

• October 18 is World Menopause Day – this year’s theme is “lifestyle medicine”. A white paper reviewing the role of non-pharmacological interventions in menopausal health has been posted on the International Menopause Society website. For more information and resources, see the Ministry for Women’s new “Making Menopause Work” guide at women.govt.nz/menopause