The Menopause Clinician

HRT is highly effective for many menopause symptoms.

But some women cannot use it.

Some choose not to.

And some need additional help despite HRT.

Non-hormonal management is not one tablet. The right option depends on the symptom you are actually trying to improve.

A major 2026 update is that NICE now recommends fezolinetant for moderate to severe hot flushes/night sweats when HRT is unsuitable. � It is available on NHS now

: non hormonal menopause treatment | fezolinetant UK | alternatives to HRT | hot flush treatment.

I’ve had a number of women ask me recently:

“Can antihistamines help PMDD or premenstrual symptoms?”

There is a possible mechanism worth exploring.

And importantly, this isn’t simply about “antihistamines” as one group. The discussion includes H1 and H2 histamine blockers, which act on different receptors and may have different effects.

Histamine interacts with mast cells, the nervous system and reproductive hormones, and hormonal changes may influence histamine activity across the menstrual cycle.

But a possible mechanism is not the same as a proven treatment.

Right now, H1 or H2 blockers are not an established PMDD treatment pathway.

What we need is better data:

Which symptoms improve? Which women respond? Which receptor pathway matters? When in the cycle? And what are the risks?

This is where surveys, symptom tracking, clinical audit and proper research are needed.

Observation → data → research → evidence → treatment pathway.

Have you seen H1 or H2 blockers being recommended for PMDD or premenstrual symptoms?

PMDDResearch

HIGH PROTEIN is everywhere at the moment.
But does high protein automatically mean healthy? No.

Protein is important.

Especially for women as we get older — for muscle, strength, recovery and helping us feel fuller.

But I think we have become a little obsessed with one word on the front of a packet:

PROTEIN.

Protein bars.
Protein yoghurts.
Protein cereal.
Protein puddings.
Protein snacks.

And now we have proteinmaxxing.

But nutrition is not just about how many grams of protein you can fit into your day.

When I look at food, I also want to know:

Are you getting enough fibre?
Are you eating enough fruit and vegetables?
What is your gut and bowel health like?
Are you drinking enough water?
Are you actually moving your body?

Because you can eat a very “high protein” diet and still miss some of the basics.

And please remember — putting extra protein into a processed food does not suddenly make that food healthy.

That doesn’t mean you can never eat it.

I eat convenient foods too.

It just means look beyond the big HIGH PROTEIN label on the front.

Turn the packet over.

Look at what else is in it.

And look at your whole diet, not one snack.

One thing I think we are definitely forgetting in this protein obsession is fibre.

Fibre matters for your bowel health, your gut health and your overall health — and many people still do not get enough.

And movement matters too.

You cannot protein your way out of a lifestyle where you barely move, your diet has little variety and your bowel is struggling.

Protein is important.
But so is fibre.
So is movement.
So is variety.
So is balance.

Health was never meant to be about maxxing one nutrient.

Have you noticed yourself buying something just because it says HIGH PROTEIN on the front?

“Ferritin face” is trending — but low ferritin is not just about how you look.

Dark circles, pale skin and hair shedding may make someone wonder about iron deficiency, but they are only part of the picture.

Low iron stores can also sit alongside symptoms such as:

Fatigue
Low energy
Poor concentration
Brain fog
Headaches
Dizziness
Restless legs
Sleep disturbance
Feeling more irritable, anxious or emotionally unsettled

The important point is this:

A face cannot diagnose low ferritin — and neither can a symptom list.

If symptoms raise the possibility of iron deficiency, the next step is appropriate assessment and blood tests.

And if ferritin is low, my clinical question is not simply:

“How do we increase it?”

It is:

“Why is it low?”

Heavy periods?
Low dietary iron intake?
Poor absorption?
Blood loss?
Another underlying reason?

That matters, because treating the number without understanding the cause can mean missing the bigger picture.

And please don’t go from dark circles, tiredness or hair loss straight to buying iron supplements.

Notice the clues. Investigate appropriately. Find the cause. Then treat.

Do you struggle with low Ferritin or low Haemoglobin?

HairLossWomen Fatigue BrainFog WomensHealth BloodTests

🩸 Your Haemoglobin Is Normal… But What About Your Ferritin?

Many women tell me, “My blood tests are normal, but I still feel tired.”

Think of it this way: haemoglobin is your current account, while ferritin is your savings account.

Haemoglobin helps carry oxygen around your body every day, while ferritin reflects your stored iron reserves. When those reserves start running low, you may begin noticing symptoms even when your haemoglobin appears normal.

Iron plays an important role in energy, brain function, muscles and overall wellbeing.

So if you’re constantly tired, don’t just think about haemoglobin. Understanding the bigger picture matters.

💬 Have you ever had your ferritin levels checked?

Fatigue IronLevels Perimenopause MenopauseHealth VeeThePharmacist

A woman does not suddenly develop ADHD at 45.
So why can life suddenly become unmanageable at 45?

For many women, ADHD was missed earlier because it did not always look like the stereotype.

She may have been successful, organised and high-functioning — but behind that were constant reminders, overpreparing, perfectionism, last-minute urgency, masking and huge amounts of mental effort just to keep everything together.

Then midlife arrives.

Periods change. Sleep becomes less reliable. Brain fog appears. Emotional regulation feels harder. Responsibilities increase.

And the strategies that worked for years may no longer be enough.

That does not mean menopause causes ADHD.

ADHD is a neurodevelopmental condition, so the timeline matters.

Was poor focus, forgetfulness, procrastination or disorganisation present in childhood or earlier adulthood?

Or are these difficulties genuinely new?

And if they are new — what changed at the same time?

Perimenopause?
Poor sleep?
Anxiety or depression?
Burnout?
Medication?
Iron, B12, thyroid or another medical problem?

This is why in my clinic I look at onset, pattern and timeframe, not just a symptom checklist.

Sometimes that leads to an ADHD assessment.

Sometimes it points towards menopause, emotional health, sleep, another medical cause, further investigation or referral.

And sometimes more than one thing is happening at the same time.

If you are struggling with poor focus, brain fog, overwhelm, forgetfulness or emotional regulation, start by asking:

When did this begin, what was there before, and what else changed?

Save or share this with a woman trying to understand ADHD and perimenopause.

🧠 Does your brain feel overloaded lately?

Walking into a room and forgetting why you went there, forgetting someone’s name, missing a message you meant to send, or struggling to organise your day… it isn’t always just about memory.

Think of your brain like a desk overloaded with laptops, books, bills, stationery and paperwork. Eventually, there’s no space left, and you can’t find what you need.

Your brain can feel the same way.

Work, family responsibilities, emotional stress, poor sleep and hormonal fluctuations can all add to your mental load. Other factors such as iron or vitamin deficiencies and thyroid problems may also contribute to cognitive symptoms.

That’s why brain fog isn’t always just forgetting things. It can affect focus, planning, organisation and your ability to get things done.

Sometimes your brain doesn’t need more pressure. It needs you to unload, organise and understand what’s contributing to the problem.

💜 Make the lists. Prioritise what matters. Take things one task at a time, and seek professional advice if your symptoms are new, persistent or concerning.

HormonalHealth BrainHealth WomensHealth ExecutiveFunction MenopauseSupport VeeThePharmacist