Menopause
The natural end of menstruation — symptoms are manageable, and long-term health needs proactive attention.
Overview
Menopause is defined as 12 consecutive months without a period, typically around age 51 in the UK. The transition (perimenopause) can last 4–10 years, with vasomotor, mood, sleep, sexual and cognitive symptoms. Hormone replacement therapy (HRT) is the most effective treatment; for most women under 60, benefits outweigh risks.
Symptoms
- • Hot flushes, night sweats
- • Irregular then absent periods
- • Sleep disturbance, fatigue
- • Mood changes, anxiety, low mood, brain fog
- • Vaginal dryness, discomfort during sex, urinary urgency, recurrent UTIs
- • Joint and muscle aches, palpitations
Risk factors
- • Age — natural menopause average 51
- • Smoking (1–2 years earlier)
- • Family history of early menopause
- • Autoimmune disease, certain genetic syndromes
Causes
- • Ovarian follicular depletion and falling oestrogen
- • Premature ovarian insufficiency (<40 years)
- • Surgical (bilateral oophorectomy), chemotherapy or radiotherapy-induced
🚨 Red flags — seek urgent care
- • Postmenopausal bleeding — investigate to exclude endometrial cancer
- • Severe mood symptoms with suicidality
- • Genitourinary symptoms with mass or bleeding
When to seek care
- • Symptoms affecting quality of life
- • Periods stopping before 45 — exclude POI
- • Any postmenopausal bleeding
- • Discuss bone and cardiovascular health proactively
Diagnosis
- • Clinical diagnosis in women over 45 — bloods not usually needed
- • FSH twice (4–6 weeks apart) if under 45 or atypical presentation
- • AMH if assessing ovarian reserve
- • Exclude alternative causes: thyroid, anaemia, depression
Treatment
- • HRT: transdermal oestrogen (patch/gel) ± progestogen if uterus present; vaginal oestrogen for genitourinary symptoms
- • Testosterone for low libido (off-label, specialist initiation)
- • Non-hormonal: SSRIs/SNRIs (venlafaxine, paroxetine), gabapentin, clonidine for vasomotor symptoms
- • CBT for vasomotor, sleep and mood symptoms
- • Lifestyle: regular exercise, healthy weight, reduce alcohol/caffeine, cool sleep environment
- • Bone protection: weight-bearing exercise, calcium/vitamin D, DEXA if risk factors
Prevention
- • Not preventable — but symptom impact and long-term risk are modifiable
- • Maintain cardiometabolic health and bone density
Complications
- • Osteoporosis and fragility fracture
- • Cardiovascular disease
- • Urogenital atrophy: dyspareunia, recurrent UTI
- • Premature menopause: higher risk of cognitive and cardiovascular disease without HRT
Prognosis
Most symptoms improve within 4–7 years; some persist longer. With appropriate management, women live healthy, active lives for decades after menopause.
Education & self-care
Menopause is a natural life stage, not an illness — but symptoms deserve treatment and long-term bone and heart health deserve attention.
Frequently asked questions
Is HRT safe?
For most women under 60, benefits outweigh risks. Risks are individual — discuss with your GP or menopause specialist.
Will HRT cause breast cancer?
Combined HRT carries a small additional risk after several years; oestrogen-only HRT does not increase risk.
How long can I stay on HRT?
There is no arbitrary stop date. Continue while benefits outweigh risks, with periodic review.