What I Wish Men Knew about Menopause

A few weeks ago, a male colleague of mine pulled me aside and told me he was hoping I’d see his wife in my clinic. He paused, and with a half-hearted smile, he said, “I hope you’ll give her whatever it is you’ve got to make her happy again.” He said it tongue-in-cheek, but what I read between the lines was pain. It occurred to me, embarrassingly for the first time, I’m afraid, that men are suffering too—right alongside us. And as is often the case when it comes to men and the suffering of the women they love, they feel helpless and unsure what to do. I am a big believer that knowledge is power, and when it comes to suffering, knowledge can go a long way toward relieving it. So, let’s begin at the beginning…

What is perimenopause?

Most of us (even men) have an idea about what menopause is, but we might as well begin by defining it. Medically speaking, menopause occurs when a woman has gone 12 full months since her last period. She is then deemed to be menopausal or “in menopause.” The average age in America for this—52. Her ovaries, the powerhouse of sex hormone production for the fertile years (like estrogen, progesterone, and even testosterone), are making less and less of these hormones. But this decline isn’t steady and gradual—it’s experienced as volatile shifts with high peaks and low troughs.

Although it’s common to think of the transition into menopause as flipping a switch, it typically takes place over the span of many years. The reality is that, just as a girl becomes a woman over many years, a woman transitions from her fertile years into menopause over many years, too. Perimenopause is aptly called puberty’s big sister. In fact, perimenopause—the period of hormonal upheaval (puberty in reverse, if you will) often begins 8 years before that final period takes place. It’s these years that can cause women a lot of grief. And let’s face it, it can cause everyone else some grief too. Men may feel like unnoticed collateral damage at this time. And women often feel so disjointed that they fail to notice how their own suffering may be impacting their relationships.

The first thing most women notice as they enter perimenopause is difficulty with sleep. That restorative, magical nighttime activity that their younger versions always took for granted now feels elusive—unattainable even. A partner’s snoring habit, which once was no big deal, may provoke late-night feelings of rage, not to mention resentment toward the peacefully snoring sleeper. With sleep deprivation comes brain fog, impaired working memory, and loss of emotional regulation. She may have symptoms of low estrogen (hot flashes, brain fog) one month and symptoms of high estrogen (breast tenderness, irritability) the next. For many women in early perimenopause, it’s the wild swings of hormone levels that wreak the most havoc.

Let’s linger a while longer on mood. I think it is incredibly important to assure men that none of this is their fault. And it’s not hers either. You’re not witnessing a fundamental change in who she is. You’re not witnessing a real-life Jekyll and Hyde phenomenon; you’re witnessing biology, playing out in real time, and in a body that is working very hard to keep everything afloat. Feelings of intense anxiety are extremely common as hormones swing like a massive pendulum inside her. That restless energy can present as irritability, distractedness, and even increased distance or lack of closeness.

Here’s the kicker (and where guys can really make a difference)—all of this hormonal volatility happens for women, in our culture, at the peak of personal responsibility. If perimenopause begins 8 years before menopause and the average age of menopause is 52, then the 40-somethings coming into leadership roles at work, parenting kids who have morphed into tweens and teens, and participating in the care of parents in their 70s and 80s—often all at the same time—are the very same people experiencing this barrage of symptoms. And this is where our guys can make a huge difference.

So, what can you actually do?

The stress of managing so much at once—the household logistics, the children’s schedules, the aging parents, the professional demands that don’t pause for anyone—falls disproportionately on women in midlife. Chronic stress, it turns out, is the archenemy of an already overtaxed hormonal system.

Taking things off her plate—genuinely, proactively, and without being asked—isn’t just kind. It is, in a very literal sense, therapeutic. Every item of the mental load you absorb is one less stressor taxing a system that is already working overtime. Notice what needs to be done and do it. Don’t make her manage you in addition to everything else.

Beyond the logistics, be intentional about time together. Here’s the brutal truth of midlife: emotional intimacy doesn’t happen by accident anymore. Between the careers, the kids, the parents, and the sheer physical exhaustion of perimenopause, connection has to be carved out deliberately. A walk. A dinner without phones. A conversation that has nothing to do with the calendar. These aren’t luxuries—they are, for many perimenopausal women, the foundation that everything else rests on.

And when she tells you how she’s feeling, validate before you solve. The instinct to fix is a loving one, but “that sounds really hard” before “have you tried…” is the difference between feeling seen and feeling told what to do. She doesn’t always need a solution. She needs to know you’re still with her.

What about sex?

I’d be doing this subject a disservice if I glossed over it, and I suspect it’s where many of you have been since the first paragraph. Let’s talk about it.

Sexual desire in women is deeply context-dependent—meaning, it’s complicated. The International Society for the Study of Women’s Sexual Health (ISSWSH) identifies low sexual desire, or Hypoactive Sexual Desire Disorder (HSDD), as one of the most common sexual concerns in midlife women. Part of this is hormonal: declining estrogen and testosterone reduce desire and can cause vaginal dryness and physical discomfort during sex, which creates a vicious and heartbreaking cycle. If sex hurts or simply doesn’t feel good anymore, the body, quite sensibly, stops wanting it. This is absolutely treatable (topical estrogen, lubricants, hormone therapy, and pelvic floor therapy have all been shown to help significantly), and it’s worth bringing up with her doctor.

But here is what I most want you to hear: a woman in perimenopause who seems less interested in sex is almost certainly not less interested in you. What she needs, more than ever, is to feel emotionally connected and genuinely relaxed before desire has a chance to emerge. And here is the paradox that nobody talks about enough: when a man steps up—takes pressure off, shows up at home, validates her feelings, creates real intimacy—he is directly improving their sex life. Not as a transaction, and not immediately—but by relieving her mental load and creating space for her to feel relaxed and connected. Pressure to be intimate, on the other hand, makes things worse. Trust me, she likely knows you’re interested. Aim for low-stakes physical affection instead—closeness without expectation—which keeps the connection alive while the biological piece is being addressed.

What should you realistically expect?

Hormone therapy, when appropriate, can be genuinely transformative—for mood, sleep, hot flashes, and sexual function. The Menopause Society supports its use for symptomatic women under 60 and within ten years of menopause onset, noting a favorable risk-benefit profile for most healthy women. But it takes time. Doses need adjusting. Formulations sometimes need to be switched. Women often wait months before they feel meaningfully better. The version of her that you remember is still in there; she is working her way back to herself, and that process can’t be rushed. What she needs from you during it is patience—the kind that keeps showing up.

I started writing this thinking I was writing it for the men in my patients’ lives. But the more I wrote, the more I realized I was writing it for all of us, ladies too—because the grief of feeling like a stranger to yourself is lonely enough without feeling like a stranger to the person you love most. Renowned couples psychologist, John Gottman, PhD, calls it turning toward. Not a grand gesture—just the daily, quiet choice to face each other instead of away. If someone sent you this article, that’s what they’re asking for. Please—forward it to the next man who needs it.

Further Reading

The Menopause Brain by Dr. Lisa Mosconi (Avery, 2024). Mosconi is a neuroscientist at Weill Cornell Medical College who has spent her career imaging what perimenopause actually does to the brain. It is accessible, fascinating, and the kind of book you’ll find yourself reading aloud to whoever is nearby. Recommended for both partners.

The Seven Principles for Making Marriage Work by Dr. John Gottman and Nan Silver. Gottman spent decades studying couples in his "Love Lab" at the University of Washington, and what he found is both humbling and hopeful: the marriages that survive are not the ones without conflict, but the ones where partners consistently turn toward each other instead of away. If you've read this far and you're wondering what turning toward actually looks like in practice, this is the book. Research-based, readable, and full of the kind of specific, actionable guidance that makes you want to hand it to your partner when you're done.

Sources

The Menopause Society. The Menopause Society Position Statement on Hormone Therapy (2022). menopause.org

The Menopause Society. Menopause Practice: A Clinician’s Guide, 6th ed.

International Society for the Study of Women’s Sexual Health (ISSWSH). Process of Care for the Identification of Sexual Concerns and Problems in Women (2019). isswsh.org

Glick ID, et al. ISSWSH Consensus Conference Summary on the Management of Hypoactive Sexual Desire Disorder. Sexual Medicine Reviews, 2017.

Mosconi L, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports, 2021.

Joffe H, et al. Estrogen, the serotonin-system, mood, and cognition: A review. Climacteric, 2020.