Menopause: Your Questions Answered

Menopause is defined as the point at which a woman has not had a period for twelve consecutive months, marking the end of the reproductive years. The average age in the UK is 51, though early menopause, before 45, affects around 5% of women, and premature ovarian insufficiency, before 40, affects around 1%. After menopause, the postmenopausal years bring their own hormonal environment and associated health considerations.

For many women, the most difficult symptoms occur during perimenopause, the transition leading up to menopause, but symptoms can continue for several years after the final period. Understanding what menopause involves, what treatment options exist, and what the longer-term health picture looks like gives women a much stronger foundation for navigating this phase.

What menopause does in the body

Oestrogen has receptors throughout the body, not only in the reproductive system but in the brain, bones, heart, skin, and urinary tract. When oestrogen levels fall permanently at menopause, the effects are correspondingly wide-ranging. Hot flushes and night sweats, driven by oestrogen's role in thermoregulation, affect around 75% of menopausal women and can last for years. Vaginal dryness, reduced elasticity of the urogenital tissues, and changes in bladder function are extremely common and often underreported, partly from embarrassment.

Longer-term, the loss of oestrogen increases the risk of osteoporosis, as oestrogen plays a key role in maintaining bone density. It also affects cardiovascular risk, cholesterol profile, and cognitive function over time. These longer-term considerations are part of why HRT has been increasingly recognised as having benefits beyond symptom management.

"Menopause is not the end of anything. It is a hormonal transition that, like all transitions, benefits from good information and the right support."

HRT: what it is and what the evidence says

Hormone replacement therapy replaces the oestrogen and, where relevant, progesterone that the body is no longer producing in adequate quantities. Modern HRT has evolved considerably from earlier formulations, and the risk profile is now understood to be much more favourable than was believed following a large study in the early 2000s that caused widespread alarm and led many women to stop treatment unnecessarily.

Current evidence suggests that for most women under 60 who start HRT within ten years of menopause, the benefits outweigh the risks. HRT effectively reduces hot flushes, improves sleep, supports mood, maintains bone density, and improves quality of life for the majority of women who use it. The small increased risk of breast cancer associated with combined HRT is lower than that associated with drinking a glass of wine a day, and does not apply to oestrogen-only HRT for women who have had a hysterectomy.

There are different types, doses, and routes of administration. Transdermal oestrogen, applied as a patch, gel, or spray, has a more favourable risk profile than oral oestrogen for most women. The decision about whether and how to use HRT is a personal one, made in conversation with a knowledgeable GP or menopause specialist.

Non-hormonal approaches

For women who cannot or choose not to use HRT, there are other approaches that may help with specific symptoms. Cognitive behavioural therapy has reasonable evidence for improving hot flushes and sleep. Some antidepressants and certain other medications may be offered for flushes where HRT is not appropriate. Lifestyle measures, including regular exercise, reducing alcohol and caffeine, and maintaining a healthy weight, are associated with less severe symptoms for some women. Certain supplements and herbal preparations are widely used, though evidence varies considerably and some interact with medications.

Menopause is well worth taking seriously as a health event. The options available to support wellbeing through this transition are considerable, and accessing them doesn't require putting up with symptoms that affect everyday life.