As a hormone therapist, Suzanne speaks daily with women who notice that menopause increasingly affects their sleep, mood, energy, and daily functioning. In this column, she shares anonymised stories from her practice to provide recognition and to illustrate the factors that may play a role.
In my practice, I see women who, deep down, know that their symptoms have a cause but don’t know where to start. This was also the case with Maaike, a 44-year-old woman who approached me for an initial consultation.
During our first meeting, she sat somewhat tensely in her chair, which she immediately acknowledged. She had slept poorly, perhaps because she was nervous about the appointment. Not because she didn’t want to come, but because she had so much hope riding on it. She had already tried many things to feel better, with little to no success. As a result, there was not only hope but also fear of yet another disappointment.
Maaike no longer recognised herself. She had always been an energetic, stable woman, someone who could handle her work, family, and social commitments well. But over the past year, that had slowly changed. It started with her digestive system. A bloated feeling that wouldn’t go away. Trousers that suddenly felt tight by the end of the day. Alternating between diarrhoea and constipation. And there was always that unease in her stomach.
What made her especially insecure was the fear of going out. What if she got cramps? Or sudden diarrhoea? Just the thought of it caused tension. As a result, she started doing less and less, even though she was used to leading an active life.
Mentally, she also noticed changes. She was less tolerant of stimuli, became irritated more quickly, and had a shorter temper, especially at home. This visibly pained her. Her husband noticed that she snapped more often, and her children reacted to it as well. One particular moment with her son stayed with her. It became a wake-up call. He had forgotten to empty the dishwasher, which was his daily chore. Maaike lashed out at him so harshly that he ran upstairs crying. She was terribly shocked by herself and his reaction.
Additionally, her menstrual cycles had changed drastically in a short time. They had become much heavier and lasted longer. She now planned her schedule around them because she knew she could barely function on those days.
“It’s just taking over my life,” she said.
What struck me about Maaike was that she wasn’t just struggling with her stomach or her menstrual cycles. She mainly felt like she was losing herself. I hear this more often, and it deserves attention.
In her story, I heard signals that could indicate a hormonal imbalance, particularly relatively high oestrogen levels compared to progesterone. This is also known as oestrogen dominance, which is common during perimenopause. It can affect menstrual cycles, mood, irritability, and water retention.
What stood out with Maaike was that her symptoms were interconnected. Her digestive system was unsettled, her menstrual cycles had become much heavier, and mentally, she felt more easily overstimulated. Everything seemed to overlap.
The interaction between the gut and hormones likely also played a role. The gut microbiome helps process and eliminate oestrogens. Conversely, hormonal changes can also affect gut function. When this balance is disrupted, it can be felt in multiple areas.
To better understand what was happening with Maaike, we conducted additional blood tests and stool analysis. The results aligned with what I had suspected during our conversation. Her body seemed to struggle with breaking down and eliminating oestrogens. Additionally, her gut microbiome was significantly out of balance, and it turned out she had difficulty tolerating wheat.
Finally, something clicked. She had felt all along that something wasn’t right but couldn’t pinpoint it. “So it’s not just in my head,” she said.
For Maaike, the tension surrounding her symptoms amplified their daily impact. She became increasingly alert to her stomach, her menstrual cycles took a toll on her body, and she started overthinking everything.
This uncertainty had a significant impact. If you’re afraid your stomach might act up at any moment, you naturally start planning ahead. Can I use the loo there? What if I get cramps? What if I suddenly have diarrhoea? For Maaike, this led to her doing less and less.
At home, the strain was also significant. She wanted to be a good mother and partner but noticed she was snapping more often than she was used to. This made her sad and insecure—not just because her family reacted to it, but mainly because she didn’t recognise herself in those reactions.
Diet also played a role. Not as a standalone cause, but as part of the foundation. Maaike was used to fixed eating patterns, whereas variety can be important for gut health to nourish different gut bacteria and intake a wider range of nutrients.
With symptoms like these, it’s not just about hormones. Gut health, diet, stress, recovery, and feeling safe in your own body also deserve attention.
We started by gradually supporting her body. We began with the basics: her diet. This didn’t mean everything had to change overnight. For Maaike, small, manageable adjustments were important—changes that reduced the strain on her body while providing more nourishment. Since the tests showed she had difficulty tolerating wheat, we took that into account as well.
We also focused on supporting her liver so her body could process and eliminate hormones more effectively. Additionally, we worked on restoring her gut balance. The first few weeks were a period of trial and adjustment for her. You really have to discover a new way of eating. It’s not always easy. Often, you’ve been eating and doing the same things for years.
I often see women who eat the same breakfast every morning for years. Often yoghurt with fruit, nuts, seeds, and grains. Absolutely healthy, but variety in diet remains important. It nourishes different gut bacteria and helps you absorb a wider range of nutrients.
For Maaike, we didn’t just look at what she should avoid but also at what she could add. This made the approach more practical and sustainable.
At her next consultation, eight weeks after the intake, Maaike came in with a different energy. She admitted that the therapy wasn’t easy. It required attention, planning, and getting used to making different choices. But she also noticed that the results were significant.
After about three or four weeks, she began to notice real changes. Her digestive system calmed down, she felt better in her own skin, and she was able to reclaim more of her old life. Even her last menstrual cycle was less intense. At the same time, she remained realistic: now she had to wait and see how the next one would go.
Often, improvement happens relatively quickly, while full recovery takes longer. That’s why we scheduled another evaluation after three months.
What I found beautiful about this process was not just the physical improvement but also how Maaike gradually reconnected with herself. She moved from frustration and helplessness to greater trust in her body.
Feeling safe and confident in your own body is important for your brain and nervous system. If someone is constantly afraid of symptoms, tension, or losing control, the body often remains on high alert. For Maaike, a sense of calm gradually returned.
What we want other women to know is that symptoms like these deserve to be taken seriously. A bloated stomach, diarrhoea, constipation, heavy menstrual cycles, irritability, and fatigue may seem unrelated, but they can also be interconnected.
This doesn’t mean there’s a single simple cause. For Maaike, hormones, gut health, diet, menstrual cycles, stress, and insecurity all played a role. It was precisely this combination that made her symptoms increasingly impact her daily life.
It can help to look beyond a single symptom. Not just: why is my stomach unsettled? But also: how am I sleeping, how am I recovering, how does my body respond to food, how are my menstrual cycles, and how much stress have I been carrying for a long time?
These signals can reveal a lot about what’s happening in your body and daily life. Trousers that feel tight by the end of the day. Not daring to go out spontaneously. Snapping at your family more often. Planning your schedule around your menstrual cycle. These aren’t just minor inconveniences when they start to dictate your life.
What helps varies from woman to woman. If symptoms persist or you don’t know where to start, you can read more about dietary and lifestyle tips for each symptom on SeeMe-nopause. This can help you take the first steps and better determine where you might need extra support.
A symptom is often not just a symptom. Sometimes, your body has been signalling for a long time that something is out of balance. Instead of pushing harder, it helps to explore what is needed.
This case study shows how menopause symptoms, digestive issues, menstrual cycles, mood, and stress can be interconnected. The approach is always personal, and not every woman needs the same solution.
If you want to take action yourself, you can read more about dietary and lifestyle tips for each symptom on SeeMe-nopause. Think of tips for digestive issues, heavy menstrual cycles, fatigue, irritability, or poor sleep. If you also want to know which treatments, medications, or supplements might be suitable, a doctor can help you. During an intake, you’ll also receive a free dietary and lifestyle guide with practical tips for each symptom cluster.
This article is based on the practical experiences of a specialist. To protect the patient’s privacy, the name and identifiable details have been changed. The information in this article is intended for educational purposes and does not replace personalised medical advice.
