Menopause Content Supplied by NHS Choices

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

Periods usually start to become less frequent over a few months or years before they stop altogether. Sometimes they can stop suddenly.

The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.

However, around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.

Symptoms of the menopause

Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.

Common symptoms include:

Menopausal symptoms can begin months or even years before your periods stop and last around four years after your last period, although some women experience them for much longer.

Read more about the symptoms of the menopause.

When to see your GP

It's worth talking to your GP if you have menopausal symptoms that are troubling you or if you're experiencing symptoms of the menopause before 45 years of age.

Your GP can usually confirm whether you are menopausal based on your symptoms, but a blood test to measure your hormone levels may be carried out if you're aged 40 to 45.

Blood tests may also be carried out to help diagnose suspected premature menopause if you're under 40 and have menopausal symptoms.

Read more about how your GP can help during the menopause.

Treatments for menopausal symptoms

Your GP can offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day life, including:

Your GP can refer you to a menopause specialist if your symptoms don't improve after trying treatment or if you're unable to take HRT.

Read more about treating the menopause.

What causes the menopause

The menopause is caused by a change in the balance of the body's sex hormones, which occurs as you get older.

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Premature or early menopause can occur at any age, and in many cases, there's no clear cause.

Sometimes it's caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying medical condition, such as Down's syndrome or Addison's disease.

Symptoms of the menopause

Most women will experience some symptoms around the menopause. The duration and severity of these symptoms varies from woman to woman.

Symptoms usually start a few months or years before your periods stop, known as the perimenopause, and can persist for some time afterwards.

On average, most symptoms last around four years from your last period. However, around 1 in every 10 women experience them for up to 12 years.

If you experience the menopause suddenly rather than gradually - for example, as a result of cancer treatment - your symptoms may be worse.

Changes to your periods

The first sign of the menopause is usually a change in the normal pattern of your periods.

You may start having either unusually light or heavy periods.

The frequency of your periods may also be affected. You may have one every two or three weeks, or you may not have one for months at a time.

Eventually, you'll stop having periods altogether.

Common menopausal symptoms

About 8 in every 10 women will have additional symptoms for some time before and after their periods stop.

These can have a significant impact on daily life for some women.

Common symptoms include:

The menopause can also increase your risk of developing certain other problems, such as weak bones (osteoporosis).

See your GP if you're finding your symptoms particularly troublesome, as treatments are available. Read about how to manage symptoms of the menopause.

Treating symptoms of the menopause

Not all women want treatment to relieve symptoms of the menopause, but treatments are available if you find the symptoms particularly troublesome.

The main treatment for menopausal symptoms is hormone replacement therapy (HRT), although other treatments are also available for some of the symptoms.

Hormone replacement therapy (HRT)

HRT involves taking oestrogen to replace the decline in your body's own levels around the time of the menopause. This can relieve many of the associated symptoms.

HRT has been out of favour since the early 2000s because of a link with breast cancer, but new guidelines from the National Institute for Health and Care Excellence (NICE) say that HRT is effective and should be offered to women with menopausal symptoms, after discussing the risks and benefits.

There are two main types of HRT:

  • combined HRT (oestrogen and progestogen) - for women with menopausal symptoms who still have their womb (oestrogen taken on its own can otherwise increase your risk of womb cancer)
  • oestrogen-only HRT - for women who have had their womb removed in a hysterectomy

HRT is available as tablets, skin patches, a gel to rub into the skin or implants.

HRT is extremely effective at relieving menopausal symptoms, especially hot flushes and night sweats, but there are a number of side effects, including breast tenderness, headaches and vaginal bleeding. It's also associated with an increased risk of blood clots and breast cancer in some women.

HRT is not advisable for some women, such as those who have had certain types of breast cancer or are at high risk of getting breast cancer.

Your GP can give you more information about the risks and benefits of HRT to help you decide whether or not you want to take it.

Read more about HRT.

Hot flushes and night sweats

If you experience hot flushes and night sweats as a result of the menopause, simple measures may sometimes help, such as:

  • wearing light clothing
  • keeping your bedroom cool at night
  • taking a cool shower, using a fan or having a cold drink
  • trying to reduce your stress levels
  • avoiding potential triggers, such as spicy food, caffeine, smoking and alcohol
  • taking regular exercise and losing weight if you're overweight

If the flushes and sweats are frequent or severe, your GP may suggest taking HRT.

If HRT isn't suitable for you, or you would prefer not to have it, your GP may recommend other medications that can help, such as clonidine (a high blood pressure medicine) or certain antidepressants.

These medications can cause unpleasant side effects, so it's important to discuss the risks and benefits with your doctor before starting treatment.

Mood changes

Some women experience mood swings, low mood and anxiety around the time of the menopause.

Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as yoga and tai chi may help. Medication and other treatments are also available, including HRT and cognitive behavioural therapy (CBT).

CBT is a type of talking therapy that can improve low mood and feelings of anxiety. Your GP may be able to refer you for CBT on the NHS, or recommend self-help options such as online CBT courses. Read more about online mental health services.

Antidepressants may help if you've been diagnosed with depression.

Reduced sexual desire

It's common for women to lose interest in sex around the time of the menopause, but HRT can often help with this. If HRT isn't effective, you might be offered a testosterone supplement.

Testosterone is the male sex hormone, but it can help to restore sex drive in menopausal women. It's not currently licensed for use in women, although it can be prescribed by a doctor if they think it might help.

Possible side effects of testosterone supplements include acne and unwanted hair growth.

Read more about loss of libido and female sexual problems.

Vaginal dryness and discomfort

If your vagina becomes dry, painful or itchy as a result of the menopause, your GP can prescribe oestrogen treatment that's put directly into your vagina as a pessary, cream or vaginal ring.

This can safely be used alongside HRT.

You'll usually need to use vaginal oestrogen indefinitely, as your symptoms are likely to return when treatment stops. However, side effects are very rare.

You can also use over-the-counter vaginal moisturisers or lubricants in addition to, or instead of, vaginal oestrogen.

Read more about vaginal dryness and sex after the menopause.

Weak bones

Women who have been through the menopause are at an increased risk of developing osteoporosis (weak bones) as a result of the lower level of oestrogen in the body.

You can reduce your chances of developing osteoporosis by:

  • taking HRT - HRT can help to prevent osteoporosis, although this effect doesn't tend to last after treatment stops
  • exercising regularly - including weight-bearing and resistance exercises
  • eating a healthy diet that includes plenty of fruit, vegetables and sources of calcium, such as low-fat milk and yoghurt
  • getting some sunlight - sunlight on your skin triggers the production of vitamin D, which can help to keep your bones strong
  • stopping smoking and cutting down on alcohol
  • taking calcium and/or vitamin D supplements if you don't feel you're getting enough of these - discuss this with your GP

Read more about menopause and bone health and preventing osteoporosis.

Premature menopause

Premature menopause, also known as premature ovarian insufficiency, is when a woman experiences the menopause before the age of 40.

The two main treatments for early menopause are HRT and the combined contraceptive pill, as they both contain oestrogen and progestogen.

These treatments can help to relieve troublesome menopausal symptoms and reduce the risk of problems such as osteoporosis.

Your doctor will normally recommend continuing treatment until at least around the time of natural menopause (45 to 55 years of age).

Follow-up appointments

If you're having treatment for your menopausal symptoms, you'll need to return to your GP for a follow-up review after three months, and once a year after that.

During your reviews, your GP may:

  • make sure your symptoms are under control
  • ask about any side effects and bleeding patterns
  • check your weight and blood pressure
  • review the type of HRT you're taking and make any necessary changes
  • discuss when you could stop treatment and how this could be done

Many women will need treatment for a few years, until most of their menopausal symptoms have passed.

'There's a lot of help out there'

Pat found a few simple lifestyle changes made her menopause symptoms easier to manage.

Pat was 44 when she realised she had started missing a few periods. "It didn't bother me at first, as I lead quite a stressful life," she says. "But after a while, I also started getting really bad PMT when I did have a period. It was awful."

Pat decided to keep a diary charting her periods and how she felt generally. She kept it for six months. Looking back at it, she suspected that she was starting to go through the menopause. She went to her GP and discussed the best course of action.

"My GP is a woman, so I felt comfortable discussing things with her," she says. "At that point, I didn't feel I needed any medication. I just wanted information about what was happening to me and how I could manage it."

Soon afterwards, Pat began to experience hot flushes. "They're awful," she shudders. "Lots of women think they're having a panic attack when they have their first one, and I can see why. I certainly did. I get a feeling of intense pressure in my upper chest, then my face starts to feel like it's on fire. Then my face and upper chest turn red. Some women also get palpitations, though luckily I don't.

"The attacks come on at any time. I work in a shop, so it's very embarrassing when one comes on as I'm talking to a customer. Luckily, there are lots of women where I work, many of a certain age, and we all support each other."

Pat's currently considering whether to try hormone replacement therapy (HRT). "If my symptoms get worse, I'll certainly give it a go," she says. "I want to read up on it and make sure I know all my options. At the moment, however, I've made some small changes which make a big difference. For example, I never used to eat breakfast, as I have three kids and a husband to sort out! But now I make sure I have a cereal bar, at least. I have a proper lunch with brown bread to keep my blood sugar levels steady as well."

Menopause is a fact of life, says Pat, and she's determined to manage her condition. "I have bad days," she admits. "It's difficult for my husband sometimes, as well. He says he never knows whether I'm going to wake up nice or nasty. But there's no need for women to suffer menopausal symptoms in silence, like our mothers and grandmothers did. Educate yourself and you'll find there's a lot of help out there."

'The night sweats really got to me'

Barbara Hunt, a retired civil servant from Canterbury, Kent, has had many ups and downs with the menopause and HRT.

"I was 51 when I had my first hot flush. My periods had been erratic for six months, so I realised I was approaching the menopause. Then the flushes started with a vengeance.

"My GP immediately suggested HRT. This was when it was being hailed as a wonder drug. I started with patches. I still had periods, but at least the flushes went away.

"After four years, I heard about its possible side effects and stopped taking it. The flushes returned and I got night sweats too. Heat would engulf me, then disappear as quickly as it had arrived. The night sweats really got to me. I was waking every half an hour and became so short of sleep that going back on HRT seemed my only option.

"I started taking it again and, to my relief, the flushes and sweats are a thing of the past. I'm now trying to wean myself off the patches by cutting a third off them each time. Having gone on HRT, it seems to be such a job to get off it and I sometimes wonder whether, if I'd never taken it, the flushes might be over by now."


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