DEEP DIVE
Menopause: How to
save your relationship
Without trying to fix her
If the woman in your life is between the ages of 36 and 55, put down whatever you're doing and read this now. The menopause conversation is finally going mainstream — there are more answers than ever on how to manage the hormonal rollercoaster taking your partner, and your relationship, for a ride.
Ahead: a simple three-step method — Sit. Listen. Believe — that's helped real couples get through it without losing each other.
© Katarina Zeravica
© Katarina Zeravica
Facing Facts: What Menopause Actually Is
And why doctors don't fully get it either
First, if you don't know much about menopause—or its forerunner perimenopause—you're not alone. This is not something men get taught about a lot. Or maybe ever.
And yet, this period in a woman's life is major, and impacts her body and mental and emotional well-being in drastic ways.
In a nutshell, menopause happens when a woman hasn't had her period in 12 months and her body can no longer naturally conceive. Perimenopause is the four to 12-year period before menopause when her hormones start to fluctuate and gradually decrease. The beginning and end of both perimenopause and menopause are different for every woman but usually happen between the ages of 36 and 55. Some of the most common symptoms include insomnia, brain fog, anxiety, hot flushes and mood swings, but this is just the tip of the iceberg.
There are approximately 13 million perimenopausal or postmenopausal women in the UK, and by 2035, there could be more than 4.61 million UK women aged 45 to 54.
Unsurprisingly, a 2025 survey in Wales found that men and younger people had the lowest knowledge of menopause. The US MATE surveys found that while most men noticed individual changes in their partner, such as sleeplessness (54%) and mood swings (47%), only 26% linked them to menopause, and just a quarter recognized forgetfulness as a symptom. Of those affected, 56% said the symptoms had hurt their relationship. More about this is in the graphic below.
Just one of these symptoms can have overwhelming effects on a person’s life…but all of them, and at the same time…yikes.
“When I was around 42 or 44, I was very anxious about losing my mental health,” recalled Dr Martina Herzog, author of The Female Art of Aging and menopause awareness advocate.
“From one day to the next, I wasn't able to remember very simple things. I'd go to the pantry. I didn't know why. I opened the fridge. I didn't know why. I saw my patients and of course I knew which patient it was but I couldn't remember the name of a particular medicine. And it wasn’t just once or twice a week, it was every single day. I was in an absolute panic.”
Neither women themselves nor the doctors treating them fully understand what the perimenopausal body is going through or why.
A Freedom of Information (FOI) request put to the UK's 33 medical schools by #MakeMenopauseMatter campaign founder Diane Danzebrink showed that a staggering 41% of those medical schools didn’t have mandatory menopause education. This means some doctors may leave university with absolutely no education in menopause at all.
Things are starting to change, but not fast enough. For example, we now know that brain fog is often one of the first and most severe symptoms of perimenopause, yet it's still not part of the mainstream conversation.
“Even today, every young [perimenopausal] woman I see tells me she needs to have an Alzheimer's test,” said Dr Herzog.
For Patricia Melendez (45), a human rights professional in London, many of the symptoms feel like a rollercoaster: “They've been psychological and emotional, like anxiety, feeling panicky and super emotional, with very big fluctuations.”
Constant daily shifts in hormone levels are exhausting, explained Dr Herzog, adding that the fluctuations cause most of the symptoms:
“It's not the loss of hormones itself, but the absolute highs and lows and never knowing what's going on next.”
So, you're forgiven for not knowing either and for stumbling through the dark as your partner struggles with what's happening to her life, but if you want to be a real support for her and give your relationship the best chance to make it through the wilderness, you need to put in the work.
A 2022 UK survey of 1,000 divorced women by the Family Law Menopause Project showed that seven in 10 women blamed menopause for the breakdown of their marriage, and that for almost eight out of every 10, perimenopause or menopause symptoms put a strain on their family life.
© Katarina Zeravica
© Katarina Zeravica
Although never having concerns about her relationship before entering perimenopause, Patricia suddenly found herself struggling.
“I was having a really tough time, really intrusive thinking or worrying about stuff, like my relationship. I've never had those worries before in my life,” she said.
With women generally initiating more than 60% of divorces in the UK, sweeping your frustrations under the rug and avoiding uncomfortable conversations are not recipes for an ever after of any kind, let alone a happy one.
Dr Martina Herzog is a medical practitioner, author and menopasue awareness advocate Photo © Dr Martina Herzog
Dr Martina Herzog is a medical practitioner, author and menopasue awareness advocate Photo © Dr Martina Herzog
Why men get it wrong
And how you can do better
Simon Salt is a certified menopause coach helping couples better navigate the menopause transition. Photo © Michelle Salt
Simon Salt is a certified menopause coach helping couples better navigate the menopause transition. Photo © Michelle Salt
For years, British-born marketing executive and photographer Simon Salt (63) and his Texan wife Michelle (52), struggled to make sense of why she was suddenly feeling so off kilter and their relationship seemed to be fraying at the edges.
Simon, who is now a certified menopause coach, says this gap in knowledge often leads to men filling in the blanks with their own, usually not very helpful, theories.
“About eight years ago when my wife went into perimenopause, neither of us had really heard of it and didn't really understand it. She was dismissed by four different doctors as not being old enough, or told it was diet and exercise. It was any one of a dozen different reasons, none of which were perimenopause. So, for four years, we kind of struggled with what was happening to our relationship,” he recalled.
“For me, as a man in the relationship, it was very much a case of, well, it's not her because the doctors are saying it's not her. Her labs are normal, so it must be me,” Simon explained.
The relationship is changing, so obviously I'm either doing or not doing or saying or not saying something that is impacting our relationship. And I need to fix that. But of course, there's nothing to be fixed. Nothing's broken,” he added.
When it was finally confirmed his wife was in perimenopause, it was a turning point for Simon’s marriage, but only because they decided it was going to be one.
“It's quite common during change for people to go down this route of fortune telling, of catastrophic thinking, all of those kinds of things where they start to see, well this is the end of the relationship, or maybe this is just how relationships get to after a number of years, and you just become roommates,” he explained.
Whatever's going on here can't be fixed with just a hormone pill and a cooling pillow, but while it's inevitable that during transitions of any kind something's got to give, if you play your cards right, it doesn't have to be your relationship.
Even so, a diagnosis wasn't a thunderbolt of enlightenment for Simon.
“Well, I thought what's that got to do with me? I had to really stop thinking about things happening to me, and start thinking about how things were happening to us. The way I was able to do that started with my wife sending me the odd article about perimenopause, and that snowballed to me reading more on my own and finding my own resources,” he said.
Until recently, a lot of the conversations on menopause for and by men have been stereotypical in a not-so-great way. You know the trope — a woman suddenly turning into a raging monster who hates everything, with the man needing a game-plan to dodge her bullets.
“None of that is useful,” cautioned Simon. “All it does is entrench stereotypes and allows men an out because it says, well, there's nothing you can really do about this. This is just how it is. This is what's happening to her. But that's just an excuse to not do the work,” he added.
Many men think menopause is something that only affects women Joe Warner argues that's exactly the problem.
"'When I saw my menopause doctor,” recalled Patricia, “I told her I feel bad for my husband, because of what it must be like to be with a person that is having such mood fluctuations, and she was like, what are you talking about? You're the one experiencing the symptoms? So, of course there should be empathy for him, but it made me think that at that particular moment, there I was really struggling with my fluctuating hormones but thinking about how this affects everybody else.”
This is why education is really important. You can't be empathetic about something you don't understand.
"'You're going to come to this from two different perspectives, always,” Simon advised. “A man can never understand the lived experience of a woman. Equally, a woman can't understand the male lived experience.”
Talk is not cheap
Why communication is the bridge
There's no renegotiation without communication, no matter how much you'd rather put it off until...the next time. It's not going to get any easier the longer you wait, but if you want your relationship to not just survive but continue to thrive, you need to open up.
“That first conversation is the hardest one to have. Especially when neither of you knows what's happening,” Simon admitted.
“Ask, but be prepared for the answer: 'I don't know',” he added, acknowledging that this can be infuriating.
“Well, if you don't know what's going on and I don't know what's going on, what's really going on? What's happening to our relationship? That's a huge hurdle to cross. And I think it's that very first conversation to have,” he said.
© Mircea Iancu/Pixabay
© Mircea Iancu/Pixabay
Where It Gets Hard: Intimacy and Renegotiation
As part of his menopause coaching practice, Simon has developed a three-step process to help couples communicate better so they can reconnect as partners on a journey they're on—together.
“One of the things I talk to couples about is Sit, Listen, Believe. First, sit down for a time-bound conversation. Don't just wait for your turn to talk, but really listen. And then the last part, believe,” he explained.
Certified menopause coach Simon Salt describes the Sit. Listen. Believe method to help couples communicate more effectively
An example he gives from his own relationship is realising that one of the symptoms of perimenopause can be 'meat ick', where the woman suddenly can't stand the thought, sight, or smell of meat.
“That changes the dynamic in the answer to the question, what's for dinner? Or why don't you want to cook dinner anymore?” Simon added.
Knowing it's an issue means you can renegotiate the situation and diffuse the conflict.
The S-word
This is especially the case when it comes to sex.
As Dr Herzog explained, when a woman's hormones change, her skin starts to get drier and thinner so sexual contact hurts. This means she can struggle to feel arousal and penetration can cause bleeding.
“At this stage, women start to feel invisible to the world, to men,” she said, adding that “Not a single woman has told me for herself, ‘I lost my libido’ or ‘I have problems with my urine.’ I always have to ask first.”
The good news, Dr Herzog added, is that treatment is relatively easy and possible for most women. A small dose of local estriol, also known as the 'skin' hormone, can revive her vulva, vagina, and anus and can make all the difference to getting your sex life back on track—if she wants it.
“For me, it's not important what the woman decides. But I think she has to have the right information for her decision. That's important,” she stressed.
Making changes
The more challenging news, according to Simon, is that this is only one side of the coin:
“It's not just physical, it's the emotional intimacy that declines as well. That all has to be renegotiated.”
And there it is, the holy grail of navigating through uncharted territory — renegotiation.
It's important to remember that relationships are work, advised Simon, and that if you want them to be successful, they have to evolve over time.
“You evolve together, hopefully, and you constantly see changes in the relationship as you age. Maybe children. Maybe aging parents. Those all have to be rediscussed, renegotiated. That means everything from intimacy to emotional and physical labour to priorities within the relationship,” he said.
Patricia noted that although she and her husband share the labour needed to keep their home functioning well, the intangible tasks still fall primarily to her.
“As the mom, at least in my case, I still carry the burden of emotional care: what are the children doing, or what we're going to do on holiday, so there's moments I'm like, this is too much, right? I have to care that everybody's taken care of, so when do I care for me?” she noted.
© Katarina Zeravica
© Katarina Zeravica
Perimenopause doesn't break relationships. But what it does do is reveal the cracks that were already there, and these can come as a big surprise to men because they haven't noticed them, because they've been papered over, said Simon.
Patricia recalled the first time she spoke openly about her symptoms outside her home: “I've been anxious in my life before, but with perimenopause it's like an ongoing anxiety and I don't know what's going on. But as people, as moms, you try to keep it all together, right? When I eventually told someone at work I was struggling with perimenopause he was like, you don't look it. It doesn't show. That made me think about how many of us women are going through these really significant changes in our lives but masking it.”
This unmasking might be overwhelming for men at first, but it doesn't have to be.
“I think that men have to understand that this isn't the end of anything. This is an opportunity to see something new coming out of their relationship,” Simon advised.
When to get outside help
If you've tried everything and you're still struggling to figure out a way forward, there's never any shame in asking for help.
For some couples, Simon said, couple counselling is appropriate and works. “I'm a big fan of individual therapy and then bringing it together where it works better,” he added.
He acknowledged however, that there's still resistance to therapy, which he believes is a missed opportunity for men to get the help they need during challenging times.
“There are two big barriers. One is stigma and the other is cost. The menopause transition set aside, men don't talk about anything else that's happening with their partner either. And they should be,” he advised.
Photo © Vera Arsic/Pexels
Photo © Vera Arsic/Pexels
Feel the fear,
prepare now
Why to start today
Fear of change is normal. Fear of rocking the boat. Fear of losing the relationship.
“It may all seem too much at times, but remember, this is a big change for her also,” advised Simon. “There’s fear of asking their partner to change after decades. Or asking them to take on physical or emotional labour. They also fear rejection,” he explained.
But, someone has to take the first step, so if you feel it can or should be you — do it.
Understanding that discovery is part of the process is important, agreed Patricia: “I'm very open and communicate with my husband about what's really going on. The good, the bad, and the ugly — everything.”
Perimenopause doesn't happen overnight but is a decade of evolution your relationship is going to go through.
“It's kind of like preparing for retirement. The earlier you start it, the more prepared you are when it happens. And I think that perimenopause is exactly the same,” said Simon.
If you're already struggling with how to move forward, finding a way to reconnect with your partner is the life-raft you're looking for.
“I think the only thing that holds relationships together is regular and deep communication that enables those cracks to be recognised and closed,” Simon advised.
He added: “You're going to have bad days when you get it wrong. And those bad days are going to make it seem like it's not worth doing. So you have to ask yourself, do I want this? Is it worth putting in the work?”
Take the menopause quiz
What is perimenopause?
Perimenopause is the stage when a woman has symptoms of menopause but her periods haven't stopped yet. Her periods become irregular, and this stage ends once she reaches menopause.
When has a woman officially reached menopause?
The NHS defines menopause as a woman not having had a period for 12 months, as long as she isn't using hormonal contraception. Hormonal contraception like the pill can affect her periods and mask her symptoms, which makes it harder to tell.
At what age does it usually happen?
It usually affects women between 45 and 55, but it can happen earlier. When it happens before 45 it's called early menopause, or premature ovarian insufficiency. It affects anyone who has periods.
What causes it?
Menopause is caused by a fall in a woman's hormone levels. It can also be brought on by surgery to remove her ovaries or womb, by cancer treatments such as chemotherapy, or by a genetic reason, and sometimes the cause is unknown.
What's usually the first sign?
The first sign is usually a change to her periods. They may come more or less often, and her bleeding may get heavier or lighter, until eventually her periods stop altogether.
What symptoms might she have?
Common symptoms include hot flushes, low mood, sleep problems and memory problems, along with anxiety, mood swings and brain fog. She may also have vaginal dryness that makes sex painful, more frequent urinary infections, weight gain around her stomach, and weakening bones. Her symptoms can start years before her periods stop and carry on afterwards, and they can have a big impact on your relationship and on her work.
Is there a test that can confirm it?
There's no routine test for perimenopause or menopause. A doctor may diagnose it based on her age and symptoms.
What treatments are available to her?
The main treatment is HRT (hormone replacement therapy). Oestrogen is the main hormone, and she can take it as tablets, patches, spray or gel. If she still has her womb, she'll also need progestogen to protect it, and testosterone can help some women with low libido. Non-hormonal options include cognitive behavioural therapy (CBT) and some medicines. The NHS notes there's very little evidence that herbal remedies like black cohosh work or are safe.
What else can help her feel better?
Lifestyle changes can make a real difference, and many are things you can do together:
- Keep to regular sleep routines.
- Eat a balanced diet with calcium-rich foods.
- Do weight-bearing exercise to protect her bones.
- Try relaxing activities like yoga.
- Avoid smoking and too much alcohol.
- For hot flushes, wear lightweight clothing and keep the bedroom cool.
The NHS also encourages women to talk to other people going through the same thing. Keep in mind that HRT is not a form of contraception.
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