Medications have chemicals in them. The chemicals have special shapes to them that makes them fit into specific places. The chemicals slotting into those places makes the thing we want the medication to do happen.
Over time, the shapes of chemicals change. We know after a certain amount of time a certain amount of the medication will have changed shape. The new shape doesn’t work the same way the old shape did – it probably won’t fit into the right slot, and it might go into a different slot and cause something bad to happen.
Expiration is when enough of a medication has changed shape that either wont have the right effect any more or will have a bad effect.
As for what causes it (less ELI5): heat and light both contribute to medications breaking down, because they’re both sources of energy. Energy can kick-start. chemical reactions that otherwise would not occur, even if overall the reaction is energetically favorable (“activation energy” is still needed for reactions that release more energy than they consume). Restricting the contact the chemicals have with air also helps, because some stuff in air can react with the molecules that are the active ingredient in medicine (water vapor, oxygen, etc).
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