Menopause symptoms do not always arrive in ways women immediately recognise.
For advanced nurse practitioner Caroline Moore, some of the changes that can be overlooked include recurring urinary symptoms, loss of confidence, joint aches and pains, noise sensitivity and even the sensation of something crawling across the skin.
Alexander Clementine founder Alex Perry spoke with Caroline about the symptoms she sees in primary care, why women’s experiences are not always being connected, menopause and neurodivergence, the role understanding can play for partners and her biggest piece of advice for women beginning their menopause journey.
Does menopause have to be a negative stage of life?
When asked about the biggest misconception surrounding menopause, Caroline challenges the idea that it can only be a terrible period in a woman’s life.
She is careful not to minimise difficult symptoms. Caroline says they can be severe and frightening, particularly before someone understands what is happening.
But she also sees menopause as a potential point for reflection.
“It forces us to reflect on what we want going forward, and that sometimes can be a really positive thing.”
For Caroline, understanding what is happening and learning what can be done about it can change the experience.
She describes coaching as a way of turning knowledge into action and says this stage can lead some women to look differently at what they want from the next part of their lives.
“I think that that can be quite liberating for some people.”
Which menopause symptoms are women most likely to overlook?
Caroline initially points to urinary and vaginal symptoms.
She describes women experiencing repeated UTI-type symptoms or burning when passing urine, without necessarily connecting those experiences with changes occurring around menopause.
But Caroline also raises a less obvious change:
“Big one, loss of confidence.”
She says menopause does not always present as the symptoms people might immediately expect.
In her experience, some women who have spent their careers working confidently in demanding professional environments begin to feel very different.
“People just don’t feel like themselves.”
Caroline describes women feeling less confident, sometimes feeling invisible, reducing their working hours or quietly leaving roles rather than making a dramatic decision to stop.
She also talks about the wider pressures many women may be experiencing at the same time — careers, children and older parents among them — rather than viewing menopause in isolation.
What is one of the most unusual menopause symptoms Caroline sees?
Caroline gives two particularly unexpected examples.
The first is exacerbation of noise sensitivity, including misophonia, especially in neurodivergent women.
She describes women suddenly finding sounds such as chewing, crunching or even a partner breathing much harder to tolerate.
The second is formication.
“It’s like ants crawling on your skin.”
Caroline describes women experiencing a crawling sensation around their scalp that can make them feel as though they have nits.
“A lot of people… have it, but hadn’t really associated it with the menopause.”
For Caroline, this is one of the more unusual symptoms women may experience without immediately making the connection.
Are menopause symptoms still being treated separately rather than as part of a bigger picture?
Caroline’s answer is unequivocal:
“Oh, definitely, definitely.”
This is one of the reasons she became interested in menopause coaching.
“People weren’t connecting the dots.”
One example she gives is women repeatedly seeking help for joint aches and pains over a period of years without reaching an explanation for why they are experiencing them.
She also discusses chronic stress, depression and anxiety, particularly in relation to women’s health and neurodivergence.
Caroline’s concern is that some women return to healthcare settings repeatedly with different problems without the overall pattern being recognised.
“These women are being missed.”
For her, the result can be growing frustration and the feeling that nobody is listening.
What does Caroline want neurodivergent women approaching menopause to know?
Neurodivergence is a particular area of interest for Caroline.
When Alex asks what she would tell someone who already knows they are neurodivergent and is approaching perimenopause or menopause, her first advice is simple:
“I think just be kind to yourself.”
Caroline believes understanding your own neurotype can help.
“Understanding your neurotype really helps.”
She emphasises that people with autism or ADHD are not all the same. Different people have different sensitivities and find different things difficult.
For Caroline, knowing yourself — including your triggers and sensitivities — can help you identify tools that work for you when things become harder to manage.
“It’s about knowing yourself.”
What if someone reaches menopause without knowing they are neurodivergent?
Caroline also discusses women who may not already know they are neurodivergent.
She talks particularly about ADHD and the relationship she sees between fluctuating oestrogen and dopamine.
In Caroline’s description, things someone previously managed can suddenly become much more difficult.
She talks about task initiation becoming harder, losing things such as your phone more frequently and feeling increasingly frustrated with yourself.
That can create negative self-talk.
“It’s not you.”
For Caroline, understanding why something has become more difficult can help someone respond differently to themselves.
“Knowledge is power, isn’t it?”
But she also makes an important distinction: knowledge alone is not everything. Having tools that allow someone to turn that knowledge into action matters too.
What does Caroline say about supporting dopamine?
In the context of ADHD, Caroline talks about finding healthy ways of supporting the behaviours and activities that make someone feel good.
She mentions:
- exercise
- nutritious food
- good sleep and giving yourself permission to have down time
- nervous-system regulation
- understanding what gives you pleasure
She contrasts these with unhealthy dopamine-seeking behaviours such as alcohol, drugs and risky behaviour.
Her wider point is that what someone finds difficult will depend on the individual.
“It’s so complicated with ADHD, and I suppose it depends on what the individuals are finding difficult in particular.”
Again, Caroline returns to understanding the individual rather than assuming everyone will experience the same thing.
What should men understand about menopause?
Caroline’s message to men is primarily about understanding.
“Learning as much as you can.”
She says that if men understand more about what may be happening, it can help them support the women around them — whether that is a wife, mother or daughter.
“That understanding sometimes can just mean everything, really.”
Her answer is less about having the perfect response and more about knowing enough to better understand what the person close to you may be experiencing.
What is Caroline’s biggest piece of advice for someone starting menopause?
Caroline does not hesitate when Alex asks for her single biggest piece of advice:
“Start exercising.”
She specifically includes both strength and cardiovascular exercise.
“Not just strength, but aerobic activity as well.”
It is the clearest and most concise answer in the entire interview — and the point Caroline chooses to leave women with at the end of the conversation.
Understanding what is happening
A consistent theme runs through Caroline’s interview: understanding can change how someone responds to what they are experiencing.
That can mean recognising that confidence changes deserve attention. Considering whether symptoms that appear separate might be connected. Understanding your own neurotype and sensitivities. Or simply learning enough about menopause to better support someone close to you.
For Caroline, knowledge is most useful when it can then be turned into practical action.
Or, as she puts it:
“Knowledge is power, isn’t it?”
About Caroline Moore
Caroline Moore is an advanced nurse practitioner working in primary care with a special interest in women’s health and menopause.
She previously spent ten years working in oncology before moving into primary care. After seeing how difficult it was to provide women with adequate menopause support within short appointments, Caroline became increasingly interested in approaches that went beyond treatment options alone.
She has since established her own menopause coaching and workplace consultancy service, Beyond The Fog, using evidence-based information and coaching to support women through this stage of life.
This interview forms part of Alexander Clementine’s Expert Conversations, speaking directly with people working across menopause and women’s health about the questions women are asking.
