Menopause: What Is Actually Happening, and What Helps

Menopause is the point at which a woman has gone 12 consecutive months without a period, and it typically happens between 45 and 55. The years leading up to it, perimenopause, are when most symptoms start, because estrogen begins to fall and fluctuate. Hot flushes, disrupted sleep, anxiety, joint pain and brain fog are the most common, and they are physiological, not imagined.

What helps falls into 3 groups: sleep, diet and strength training, which have the strongest evidence and the widest effect; medical options including hormone therapy, which are a conversation with your doctor; and specific supplements, where the evidence varies enormously by ingredient and by product.

Perimenopause, menopause, postmenopause: what is the difference?

Perimenopause is the transition. Periods become irregular, estrogen starts to decline and fluctuate, and symptoms usually begin here. It can last several years.

Menopause is a single point in time: 12 consecutive months with no period. Typically between 45 and 55.

Postmenopause is everything after that, for the rest of life. New health considerations become relevant, including a higher risk of cardiovascular disease, osteoporosis and urinary tract infections, which is why this stage is worth planning for rather than simply passing through.

Why do menopause symptoms happen?

Almost all of them trace back to 1 thing: the ovaries produce less estrogen. Estrogen does far more in the body than reproduction, which is why its decline shows up in so many apparently unrelated places.

Estrogen receptors sit in nerve endings throughout the body, which is also why some women experience bladder changes, restless legs, pins and needles or tinnitus during this period.

What actually helps

In order of how much evidence sits behind them.

Strength training. This is the single most useful thing on the list. Muscle mass and bone density both decline after menopause, and resistance training is the only intervention that directly addresses both. Yoga and Pilates are gentler on joints and help with stiffness. Movement of any kind also releases endorphins, which helps with mood and sleep.

Sleep, protected deliberately. Falling estrogen and progesterone disrupt sleep directly, so the usual advice matters more now than it did at 35: consistent timing, less light from screens in the evening, and a cool room, which also helps with night sweats.

Steady blood sugar. When blood sugar drops it can trigger hot flushes and palpitations. Fiber levels it out. Protein, from animal or plant sources, matters more than it used to because maintaining muscle mass becomes harder.

People. This is not soft advice. Menopause often arrives at the same time as an empty nest and caring for aging parents, and isolation makes every symptom harder to carry. Knowing that other women are going through the same thing genuinely changes how it feels.

Medical options. Hormone therapy and other prescription treatments are effective for many women and are a conversation to have with your doctor, particularly if symptoms are disrupting your work or your sleep.

Supplements. Omega-3 fats, B vitamins and vitamin D all have roles here, in inflammation, mood and bone health respectively. Beyond those, the evidence varies enormously by ingredient, and by product within the same ingredient.

What the research says about Tongkat Ali for menopause

Tongkat Ali (Eurycoma longifolia) is best known as a men's supplement, which has meant the research in women is less well known than it should be. There is more of it than most people expect. Results in a trial are not a promise for any individual.

Quality of life. 138 women aged 40 to 55 with menopausal symptoms took either50 mg or 100 mg a day of standardized Tongkat Ali water extract for 3 months. At 100 mg, total MENQOL scores fell 33.9% from baseline by week 12 (P=0.049). MENQOL is the standard menopause quality of life questionnaire. The physical domain improved 36.4% (P=0.046) and the sexual domain 36.3% (P=0.043). This was a randomized, double-blind, placebo-controlled trial (Muniandy et al., 2025). 

Hot flushes. In 119 women aged 40 to 55 taking Physta® Tongkat Ali in combination with Kacip Fatimah (Labisia pumila) daily for 24 weeks, hot flush symptoms improved 65% by week 12 and 73% by week 24 from baseline, with a 15% improvement over placebo among women with high hot flush scores. Joint pain symptoms improved 68% at 12 weeks, and vitality rose 21% by 24 weeks, alongside improvements in hormone and lipid profiles (Chinnappan et al., 2020).

Strength and balance. In 31 women aged 45 to 59 taking 100 mg a day for 12 weeks alongside exercise, physical strength, balance and flexibility all improved significantly compared with placebo (Md. Yusof et al., 2009). Given what happens to muscle and bone after menopause, this matters more than it looks.

How it appears to work. Tongkat Ali is an adaptogen that acts on the adrenal glands, influencing the balance between testosterone and cortisol. Testosterone is not only a male hormone, and in women it contributes to libido, motivation and the maintenance of lean muscle. Laboratory work on Eurycoma root and its alkaloids has also found inhibition of phosphodiesterase-5, the enzyme that breaks down cyclic GMP, which mediates smooth muscle relaxation and blood flow (Choonong et al., 2022). That is test-tube work on the plant rather than a trial in people, so it points at a possible mechanism rather than a demonstrated effect. Separately, animal work has recorded reductions in FSH and LH, the hormones that rise as ovarian function declines (Chinnappan et al., 2020b).This imbalance in hormones is what triggers menopausal symptoms. From the two clinical studies of menopausal women, progesterone and bioavailable testosterone improved, explaining the calming effect from improved progesterone and increased strength and libido demonstrated in improved MENQOL.

One claim in circulation deserves a caveat. Work on hyaluronic acid, associated with skin suppleness, comes from a Biotropics-funded study conducted by SIRIM Berhad, the Standards and Industrial Research Institute of Malaysia, which is wholly owned by the Malaysian government. It has not been published, so we present it as in-house data rather than published evidence.

Why this research exists at all

Women have been under-researched for decades, partly because hormonal cycles introduce variables that researchers preferred to avoid. The result is a body of evidence that is thinner than it should be for half the population, in a field where women buy most of the supplements and make most of the health decisions for their families.

The menopause formulation described above was developed by an all-female research and development team at Biotropics, with a study protocol designed in collaboration with KGK Synergize in Canada, which also has an all-female leadership, and funding from the Malaysian government. That is worth saying plainly, because products designed for women by women, and tested properly, are still less common than they should be.

When to talk to a doctor

See your doctor if symptoms are disrupting your sleep, your work or your relationships, if you have unusual bleeding, or if you are considering hormone therapy. If you are on prescription medication or managing a health condition, check before starting any supplement.

Menopause is a significant change, physically and emotionally, and being supported through it matters. It is also, for many women, the beginning of something: energy returning, contraception and caregiving receding, and the freedom to live on their own terms.

Frequently asked questions

At what age does menopause usually start?

Menopause typically occurs between 45 and 55, defined as 12 consecutive months without a period. Perimenopause, when symptoms usually begin, can start several years earlier.

What is the difference between perimenopause and menopause?

Perimenopause is the transition, with irregular periods and fluctuating estrogen. Menopause is the single point 12 months after the last period. Everything after that is postmenopause.

Why do hot flushes happen?

Fluctuating estrogen destabilizes temperature regulation in the hypothalamus, which triggers the flush response.

Does Tongkat Ali help with menopause symptoms?

In a randomized, double-blind, placebo-controlled trial of 138 women aged 40 to 55, total menopause quality of life scores improved 33.9% over 12 weeks at 100 mg a day, with physical and sexual domain scores improving by around 36%.

Is Tongkat Ali not just for men?

It is best known for men's health, but it has been studied in women. Trials include 138 women with menopausal symptoms, 119 women for hot flushes, and 31 women aged 45 to 59 for physical strength and balance.

What dose was used in the women's trials?

50 mg and 100 mg were both studied. The menopause quality of life improvements were recorded at 100 mg a day. That is lower than the 200 mg used in most of the men's trials.

What is the single most useful thing I can do?

On the evidence, strength training. It addresses muscle and bone loss at the same time, and nothing in a capsule does that.