Menopause is defined as the absence of menstruation for 12 consecutive months.

In the United Kingdom, the average age for menopause is 51, with a typical age range of 45 to 55 years. Menopause occurring between ages 40 and 45 is termed Early Menopause, while menopause before age 40 is referred to as Premature Ovarian Insufficiency (POI).

For most women, menopause is a natural phase of life. Death is ‘a natural part of life’  but there are good and bad ways for it to happen! Some women may experience surgical menopause when their ovaries are surgically removed or undergo menopause as a result of pelvic radiation or chemotherapy. Symptoms can be especially challenging for those who experience surgical menopause.

Symptoms can manifest many years before menopause itself; this phase is known as perimenopause. During this time, women may notice changes in their menstrual cycles, such as lighter or heavier bleeding and shorter or longer cycles. These changes, along with accompanying symptoms, are typically sufficient for diagnosis and warrant support.

The experience of menopause varies from person to person. Some women have minimal symptoms, with their periods simply ceasing. After 12 months without menstruation, they are considered postmenopausal.

However, the majority of women will experience symptoms, with approximately 80% encountering one or more of them, and around 25% facing severe symptoms. Changes in menstrual patterns often precede the cessation of periods, and symptoms may commence during this time, lasting from months to years, with an average duration of 7-8 years. Some women may continue to experience symptoms for decades.

Oestrogen receptors are present throughout the body. Reduced oestrogen levels that occur post-menopause can lead to a wide range of symptoms, including:

  • Anxiety
  • Breast tenderness
  • Decreased confidence/ imposter feelings
  • Dry skin, dry eyes, or dry mouth
  • Fatigue
  • Hair loss
  • Headaches or worsening migraines
  • Hot flushes
  • Irritability or anger
  • Itchy skin
  • Low libido
  • Low mood
  • Muscle and joint pains
  • Night sweats
  • Pain during intercourse
  • Palpitations
  • Poor memory
  • Sleep disturbances.
  • Tearfulness
  • Urinary symptoms, such as frequent urination or recurrent urinary tract infections
  • Vaginal dryness
  • Weight gain

This list is not exhaustive but encompasses the various symptoms that can affect women during menopause.

You can monitor your symptoms using the Menopause Symptom Checker.

For women aged 45 or older with typical symptoms, no blood tests are necessary to diagnose menopause. These women may be advised to undergo blood tests to rule out other common conditions in their age group, such as anemia, underactive thyroid function, or iron deficiency. Blood tests may also be recommended as part of a routine health check to assess cholesterol levels and screen for pre-diabetes.

For women under the age of 45, hormone blood tests are usually suggested, although they can be unreliable during perimenopause.

This is an opportunity to pause and evaluate your lifestyle choices. The decisions you make now will impact your long-term health and your quality of life in the postmenopausal years. Here are some steps you can take:

Strive to incorporate a variety of colourful foods into your diet. The British Heart Foundation offers guidance on this topic. Additionally, ensure an adequate intake of calcium for bone health, and supplement with a daily dose of 10 micrograms of vitamin D.

Weight Management
Be mindful of weight gain during menopause, as changes in metabolism due to reduced bone and muscle mass are common. Keeping a food diary can help you better understand your eating habits.

Aim for at least 150 minutes of moderate-intensity exercise per week, or 75 minutes of vigorous-intensity exercise per week, distributed throughout the week. Include strength-training activities targeting major muscle groups at least twice a week. Regular exercise offers mental health benefits, reduces stress, lowers blood pressure, and lowers the future risk of breast cancer.

Many women find that alcohol can trigger or worsen hot flushes. Limit alcohol intake to government-recommended levels of 14 units per week, with at least two alcohol-free days. Be aware that alcohol contributes to unwanted weight gain.

Women who smoke are more likely to experience early menopause and more severe hot flushes and night sweats. Reduce the number of cigarettes smoked and aim to quit completely.

Stress Management
Self-care is crucial during this phase of life. Explore relaxation techniques such as yoga, meditation, nature walks, spending time with loved ones, or any activity that helps you unwind.

Address sleep disturbances caused by night sweats, anxiety, itchy skin, vaginal dryness, or the need to urinate. Strive for 7-8 hours of sleep per night, maintain a consistent routine, avoid caffeine and alcohol before bedtime, establish a bedtime routine, and keep electronic devices out of the bedroom.

If you find it challenging to implement these changes, don’t hesitate to seek help. If symptoms are significantly affecting your quality of life, consult a healthcare professional for tailored advice. Every woman’s experience of menopause is unique, and knowledge is key.

In menopause, the ovaries cease to produce hormones, resulting in persistently low hormone levels unless they are replaced. Hormone Replacement Therapy involves the replacement of one or more hormones, including estrogen, progesterone, and testosterone.

The type of oestrogen used in HRT is 17 beta-estradiol, derived from the yam root. It shares an identical biological structure with naturally produced estrogen and can be administered via patches, gels, sprays, or oral tablets.

Women with a uterus who use oestrogen replacement also require progestogen. When taken alone, estrogen can cause the uterine lining to thicken, increasing the risk of abnormalities and cancer. Progestogen prevents this by keeping the uterine lining thin. Natural progesterone (Utrogestan in the UK) is available as an oral capsule and is derived from the yam root. It is used in Body Identical HRT. The Mirena coil is another option, releasing progestogen into the uterus to prevent uterine lining thickening and can remain in place for 5 years before replacement. Other progestogens are available in combined patches or tablets.

Some women may continue to experience low libido, reduced arousal, and unsatisfactory sexual experiences despite adequate oestrogen replacement. For these women, a trial of testosterone may be beneficial. While there are no testosterone products licensed for use in women in the UK, menopause specialists and some GPs/ ANP’s are willing to prescribe testosterone cream or gel off-label under supervision.

Local vaginal oestrogen
Symptoms like vaginal dryness, pain during intercourse, vulvar and vaginal soreness, recurrent urinary tract infections, and increased urinary frequency can be relieved with local vaginal oestrogen treatment. It can be used alone or in conjunction with HRT, available as a pessary, cream, gel, or a vaginal ring that remains in place for 90 days.

We are born with our lifetime’s worth of eggs and follicles in our ovaries; they are used over our lifetime and reduce in number with  age until (a) we have none left, (b) we stop ovulating and (c) stop having periods.  The average age of menopause is 51 in the UK.

The menopause is a diagnosis made 1 year after your last period. It is a hormone deficiency and can be addressed.

What affects the onset of menopause?

  • A family history of early menopause
  • Smoking
  • Early onset of periods
  • Alcohol and drugs can cause earlier menopause
  • Race can have an impact on menopause – Hispanic and African-Caribbean women may have earlier menopause than that of Japanese and Chinese women who appear to have a later menopause, in general. 
  • Gynaecological surgery can cause a surgical menopause – hysterectomy with oophorectomy (removal of womb and ovaries) will lead to an instant surgical menopause.

Some Key Facts...

50% of women and 20% of men will sustain osteoporotic bone fractures in their lifetime.  ​

One third of the UK population is over the age of 50.

80% of women have moderate to severe physical menopause symptoms and suffer from them on average for five years; 30% of women suffer for 10 years; and 35% of women have no physical symptoms.

In the 1900’s the age of menopause was 45 years old and life expectancy was 45 years old. In 2020, the average age of menopause is 51, but life expectancy is 82. More than 30% of a woman’s life is postmenopausal.

What next?

Book an appointment with us at the Hormone Health Clinic and we can provide advice and support on what you may need and what would be suitable for you.  We will send you a medical history questionnaire, a symptom survey and then book an up to hour long appointment to discuss all this with you and outline your choices.