Menopause
Also known as Climacteric, Change of life
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is menopause?
Menopause is the point 12 months after the final menstrual period, marking the end of reproductive years. The perimenopausal transition beforehand often lasts several years and produces most symptoms. It is a natural stage rather than a disease, but symptoms can be substantial and treatable, and bone and cardiovascular health warrant attention afterwards.
Causes
- Depletion of ovarian follicles with age
- Falling oestrogen and progesterone production
- Surgical removal of the ovaries
- Chemotherapy or pelvic radiotherapy
- Primary ovarian insufficiency before age 40
Symptoms
- Hot flushes and night sweats
- Irregular periods during the transition
- Sleep disturbance
- Mood changes, anxiety and irritability
- Vaginal dryness and discomfort during sex
- Reduced libido
- Difficulty concentrating and memory lapses
- Joint aches
Risk factors
- Age, typically between 45 and 55
- Smoking, which brings menopause earlier
- Family history of early menopause
- Previous ovarian surgery
- Cancer treatment
Diagnosis
- Clinical diagnosis from symptoms and menstrual pattern in women over 45
- FSH testing in younger women or where the picture is unclear
- Thyroid function testing to exclude mimics
- Assessment of bone and cardiovascular risk
- Exclusion of pregnancy where relevant
Treatment
- Hormone replacement therapy for troublesome symptoms
- Vaginal oestrogen for genitourinary symptoms, usable long term
- Non hormonal options such as SSRIs for hot flushes
- Cognitive behavioural therapy for flushes and sleep
- Weight bearing exercise and adequate calcium and vitamin D
- Smoking cessation and cardiovascular risk management
Self care
- Dress in layers and keep the bedroom cool
- Identify flush triggers such as alcohol, caffeine and spicy food
- Exercise regularly, including weight bearing activity for bone health
- Ensure adequate calcium and vitamin D
- Use vaginal moisturisers or lubricants for dryness
- Practise pelvic floor exercises
- Prioritise sleep and manage stress
When to see a doctor
Book an appointment if:
- Symptoms affecting sleep, work or relationships
- To discuss whether hormone replacement therapy suits you
- Vaginal dryness or pain during sex
- Low mood or anxiety around the transition
- Periods stopping before age 45
- Concerns about bone or heart health
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Menopause is a natural stage and is not prevented
- Bone loss is reduced by weight bearing exercise, calcium and vitamin D
- Cardiovascular risk is reduced by activity, not smoking and blood pressure control
- Vaginal symptoms are prevented long term by local oestrogen
- Stopping smoking delays menopause onset slightly
Outlook
Vasomotor symptoms last around seven years on average, though a substantial minority experience them for a decade or more. Genitourinary symptoms tend to persist and worsen without treatment but respond very well to vaginal oestrogen. The main long term considerations are bone density and cardiovascular health, both of which are modifiable.
Common questions
Is hormone replacement therapy safe?
For most healthy women under 60 or within 10 years of menopause, benefits generally outweigh risks. Risk varies with type, route and personal history, so decisions are individualised with a clinician rather than made from headlines.
How long do symptoms last?
On average around 7 years, though a substantial minority experience hot flushes for a decade or more. Genitourinary symptoms tend to persist and worsen without treatment.
Why does bone health matter at menopause?
Oestrogen protects bone, and its loss accelerates bone density decline in the years around menopause. This is when osteoporosis risk rises, making exercise, nutrition and risk assessment important.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.