Your body is telling you

Psychosomatics of menopause

Menopause is a natural stage when periods change and eventually stop because hormone levels fall. Hot flushes, poor sleep, mood swings, dryness and joint pain affect many women, while some hardly notice anything. If symptoms get in the way of life, see a gynecologist, and never put any bleeding after menopause down to menopause itself. The Ladder method adds questions about what this stage means to you.

Aizhan LiAuthor of the Ladder method
Updated 23 October 2026

When to see a doctor

Book a doctor’s appointment if you notice:

Periods come less or more often, lighter or heavier
Hot flushes and night sweats
Poor sleep, irritability, low mood, forgetfulness
Vaginal dryness and discomfort, pain during sex
A faster heartbeat, joint pain, headaches worse than usual
Symptoms get in the way of work, relationships and rest

If you have any bleeding after 12 months without periods, or your periods have become much heavier than before, see a gynecologist as soon as possible. Menopause is not an explanation for this.

Start with a gynecologist or general practitioner. Women in menopause are looked after by obstetrician-gynecologists, together with a general practitioner, endocrinologist and cardiologist if needed.

What medicine knows

Menopause, according to the clinical protocol of the Kazakhstan Ministry of Health (2020), is the permanent absence of periods for 12 months after the last one. Menopause at 46 to 54 is considered timely. The period before it, when cycles become irregular, starts at 40 to 45 and is called the menopausal transition. The NHS says menopause most often happens between the ages of 45 and 55.

The protocol names the early signs: hot flushes, chills, sweating, headaches, a faster heartbeat, irritability, weakness, restlessness, low mood, forgetfulness and lower sex drive. Later there may be vaginal dryness, pain during sex, urinary problems, dry skin and hair loss.

The NHS adds that symptoms differ a lot from woman to woman: from barely noticeable to ones that affect relationships, work and family. The first sign is usually a change in periods: they come more or less often, heavier or lighter. There may be sleep problems, mood swings, “brain fog” and weight gain.

A doctor can rate how severe the symptoms are with the Kupperman menopausal index, which scores hot flushes, sweating, insomnia, irritability, low mood, dizziness, joint pain and other complaints.

A doctor chooses the treatment. The protocol names menopausal hormone therapy, but it does not suit everyone: it has contraindications, such as a past breast cancer or bleeding of unclear origin. The protocol also advises seeing a psychotherapist to assess psychological and psychosomatic disorders.

Sources

In the Ladder method

In the Ladder method, menopause becomes a reason to look at what is changing for you along with your body: your role, your age, your place in the family. It is not an explanation of why the symptoms appear but a question to yourself: what are you saying goodbye to, and what are you ready to begin?

For some, the children have grown up and the house has gone quiet, and suddenly you have to find who to be when no one needs you every minute. For others, other people’s phrases ring at this age: “you’re not what you were,” “it’s too late at your age.” You can look at them one by one: whose are they, and are they true?

It helps many women to see that the second half of life can be a step toward a goal, not a descent. Symptoms and treatment stay with the gynecologist.

These are questions for reflection, not an explanation of what causes the condition and not a treatment.

Quick check: what may be behind it

Which of your old roles are you saying goodbye to now?
Whose words about your age do you still hear?
What can you finally allow yourself at this age?

Frequently asked questions

What is menopause and when does it start?

The protocol of the Kazakhstan Ministry of Health considers menopause at 46 to 54 timely, and the period of irregular cycles before it can start as early as 40 to 45. Menopause means 12 months in a row without periods. The NHS says menopause most often happens between the ages of 45 and 55.

Does menopause have a psychosomatic side?

Hot flushes and other symptoms come with falling hormone levels, a natural process. At the same time the protocol of the Kazakhstan Ministry of Health advises seeing a psychotherapist to assess psychological effects. In the Ladder method, menopause becomes a reason to talk to yourself about a change of role and age.

Can I get through menopause without pills?

That is for a doctor to decide based on your symptoms and health. Menopausal hormone therapy helps some women, but it does not suit everyone: it has contraindications. Questions from the Ladder method do not replace treatment.

See what is holding you back.

In 10 minutes, the Ladder shows past events, other people’s words and your fears on one map.

Take the free diagnosticFree · 10 minutes · on your phone