A Man’s Guide to Menopause
How to Stand Beside the Woman You Love
Menopause is not just a women’s issue. It is a family issue. A relationship issue. A community issue that reaches far beyond biology. It shapes marriages, friendships, intimacy, trust, patience, and the everyday ways we stay connected to each other as we grow older together.
Yet most men know almost nothing about it. And that is not their fault. No one taught them. Many women themselves walk into perimenopause completely unprepared for what this transition does to their bodies and minds. So how could their partners, husbands, brothers, sons, or closest friends possibly be ready to understand it too?
Menopause Is More Than Hot Flashes
One of the biggest myths is that menopause means a few hot flashes and no more periods. The reality is far bigger and more powerful to understand.
Menopause is the culmination of a years-long transition called perimenopause, when three major hormones, estrogen, progesterone, and testosterone shift in ways that affect nearly every organ system in a woman’s body.
Estrogen does far more than regulate periods. Its receptors are spread throughout the brain, bones, muscles, blood vessels, bladder, immune system, and skin. Estrogen keeps blood vessels flexible, helps manage inflammation, preserves bone strength, supports metabolism, and protects memory and mood. When estrogen swings wildly and then drops abruptly due to the ovaries stopping their function, every system must adapt to its absence.
Progesterone is just as important. It steadies the second half of the menstrual cycle, supports restful sleep, and calms the nervous system. As ovulation becomes unpredictable in the years before menopause, progesterone fades and fluctuates. Many women say they feel wired but exhausted, tired yet unable to get true, restorative sleep, because the hormone that once settled their system is slipping away.
Testosterone matters for women too. Though we often think of it as the male hormone, women make it in both the ovaries and adrenal glands. It supports muscle mass, bone strength, sexual desire, and steady energy. Unlike estrogen and progesterone, testosterone does not vanish at menopause. It declines steadily with age, very similar to how it does in men.
The difference is that women start with far lower levels than men. When they lose ovarian estrogen and progesterone suddenly while testosterone continues its gradual decline, the combined impact can feel dramatic. A woman might feel the loss of stamina, muscle tone, and sexual vitality more sharply, layered with poor sleep, brain fog, weight shifts, and a sense that her entire body has changed almost overnight.
In men, testosterone falls gently, about one percent each year from midlife onward. If men lost most of their testosterone in just a few short years, no one would dismiss it with, “Just get through it.” Yet that is exactly what women have been told for generations about one of the steepest hormonal changes the human body can face.
This Is Not Weakness, It Is Physiology
When women say they do not feel like themselves, they mean it. Their brains, bones, metabolism, and relationships are adjusting to a radical hormonal recalibration.
The brain’s sleep centers must find a new balance. Memory and mood pathways shift without estrogen’s protection. Bones lose density rapidly. Blood vessels adapt to higher inflammation and cholesterol. The weight gain around the middle is not about willpower. It is about real metabolic changes driven by hormone loss.
None of this is a personal failing. It is biology. And yet too many women are still told to keep quiet and push through alone. Many are handed antidepressants instead of real hormone care, sleep support, or evidence-based treatment that could help them reclaim themselves.
A Time of Reckoning
Menopause can be a time of reckoning for many couples. It often shines a bright light on parts of a relationship that have been on autopilot for years. It can reveal unspoken needs, unaddressed tension, or distance that has grown quietly while life carried on.
This is not always a crisis. For many couples, this is an invitation. It is a chance to pause, to learn, and to say, “What do we need now? What does intimacy look like in this new season? What does support really look like when one partner’s entire physiology is shifting under her feet?”
What I See in My Exam Room
In my clinical practice, some of the most meaningful patient visits I have are when a partner comes with her. He sits beside her not to speak for her but to truly listen and ask what steps they can take together to help her feel like her best self again.
I see the relief on her face when she realizes she does not have to fight for every answer alone. I see the calm in the room when he asks thoughtful questions and shows he wants to understand the science and the reality of what her body is going through. He does not want her to suffer in silence. He wants her well. That is all either of them wants: for her to feel like herself and for them to find each other fully again.
I remind them of something true every day. The last third of a relationship can be the best third. When couples walk through this transition together, with real science, better medicine, open communication, and compassion, the closeness that comes next can be deeper and stronger than what came before. I see it in my practice every single day.
What the Science Tells Us
We know that starting modern hormone therapy within ten years of menopause can protect bone density, reduce fracture risk, improve sleep, ease hot flashes and night sweats, and protect vaginal and sexual health.
Body-identical hormones today are not what older studies once made people fear. When prescribed thoughtfully and monitored well, they are safer, better tolerated, and can preserve health and vitality for years. This is not about fighting aging for vanity’s sake. It is real preventive care that protects bones, the brain, the heart, the metabolism, and the quality of relationships that hold a family together.
How to Stand Beside Her
Believe Her
Her exhaustion is real. The changes in her body, mood, sleep, and desire are real. Listen first. She needs to know that she does not have to convince you.
Learn With Her
Start with The New Menopause. Learn what estrogen, progesterone, and testosterone do. Understand why appropriate hormone therapy is not about vanity but about protecting her brain, her bones, her heart, her sleep, and the connection you share.
Protect Her Peace
Perimenopause and menopause do not happen in isolation. They arrive during the busiest years: teenagers, aging parents, and career demands. Stress makes every symptom worse. Lighten her load. Make her sleep sacred. Make her time to move her body non-negotiable.
Talk About Intimacy
If sex has changed, say so. Ask. Shame grows in silence. Many solutions exist: local vaginal estrogen, lubricants, pelvic floor therapy, full hormone therapy, honest conversation, and couples counseling if you need it. You can rebuild intimacy, but it begins with honesty.
Keep Showing Up
She is still herself. Stand beside her while she finds her way back to feeling whole. Be the reason she knows she does not have to fade quietly.
What You Will See Here
If you stay here, you will see what I stand for every single day. You will not see me tearing down other voices for sport. You will see me lifting up credible science, real experts, and women who refuse to be silenced. You will see me making space for the people who love us, especially men, who want to know better and do better too.
Your Next Step
Menopause has never just been her burden. It is a season of life that demands real science, real compassion, and partners who stay when it is hardest.
Pick up The New Menopause. Sit beside her and learn what her body is really doing. Go to appointments with her if she wants you there. Offer to take something off her plate when she is too tired to ask. Hold her hand when she feels invisible and remind her every chance you get: she is not fading. She is transforming.
The last third can be the best third. We no longer expect women to navigate this journey alone. We stand together now, and we are just getting started.
What a wonderful post. I think you hit every necessary point perfectly. In my regular column here on sub stack, I write about menopause for men. It’s my mission to educate men on how they can support their partner/wife through their menopause journey, and why it’s important to understand what’s going on. I recall the difficult journey my mom had when she went through menopause when I was just a boy. She was treated with lithium when what she really needed was estrogen. Women often get treated like second class citizens and through my own journey I realize that’s sadly true even in the field of medicine.
I’m in the unique position of having been treated for advanced prostate cancer with androgen deprivation drugs that decimated my testosterone to less than 1 % of what is normal and lived with hot flashes, chills, muscle aches, brain fog, memory loss, anxiety, depression, hair, loss, weight gain, and yes, even loss of libido for well over a year. I’ve lived menopause or as I like to call it “manopause”.
Best wishes on your journey to help women live their best lives.
Oh goodness! This explains so much, even as a woman entering menopause, I along with my family would have benefited so much from this and made “our” transition so much more endurable!
25 years ago!!
I remember saying to them, “you think this is bad, you oughta be on tha inside”!
Thank you for sharing all that you are doing to help us all live vibrantly!