Menopause

Menopause is when you stop having periods, which usually happens between the ages of 45 and 55. For a small number of women, menopause occurs earlier. If it happens before you are 40 it’s called premature menopause (or premature ovarian insufficiency).

Menopause happens when your ovaries stop producing a hormone called oestrogen and no longer release eggs. For some time before this – it could be for a few months or for several years – your periods may become less regular as your oestrogen levels fall. This is called perimenopause. 

Symptoms 

During perimenopause you might have symptoms such as hot flushes, night sweats, joint and muscle pain, vaginal dryness, mood changes and a lack of interest in sex.

Menopause affects every woman differently. You may have no symptoms at all, or they might be brief and short-lived. For some women they are severe and distressing.

You can still get menopause symptoms if you have had a hysterectomy (an operation to remove your womb). Other natural changes as you age can be intensified by menopause. For example, you may lose some muscle strength and have a higher risk of conditions such as osteoporosis and heart disease. 

Working with you 

Your healthcare professionals should talk with you about menopause. They should explain any tests, treatments or support you should be offered so that you can decide together what is best for you. Your family or carer can be involved in helping to make decisions, but only if you agree. 

Diagnosing menopause 

If menopausal symptoms are affecting your day-to-day life you should see your gynaecologist. Your gynaecologist should be able to tell if you are in perimenopause or menopause based on your age, symptoms and how often you have periods. If you are taking any hormonal treatments (for example, to treat heavy periods) it can be more difficult to know when you have reached menopause.

You may be offered a blood test but only if: 

• you are between 40 and 45 and have menopausal symptoms, including changes in your menstrual cycle (how often you have periods) 

• you are under 40 and your gynaecologist suspects you are in menopause 

The blood test measures a hormone called FSH (follicle-stimulating hormone). FSH is found in higher levels in menopause. 

Treating menopausal symptoms 

For women who seek help for their menopausal symptoms, HRT (hormone replacement therapy) is the most commonly prescribed treatment. HRT helps to relieve symptoms by replacing oestrogen levels that naturally fall in menopause. You can take HRT as tablets or through a patch or gel on your skin.

If HRT is suitable for you and you are interested in taking it, your gynaecologist should discuss the benefits and risks with you, both in the short term (the next 5 years) and in the future, before you decide to start it. 

You should also be given information about:

• non-hormonal treatments, for example a drug called clonidine
• other types of treatments, such as cognitive behavioural therapy (CBT), a type of

psychological therapy that helps people to manage the way they think and feel. 

Another type of treatment is called bioidentical or compounded hormones, but these are unregulated and it is not known whether they are safe or effective. 

Benefits and risks of HRT 

NICE looked at the risks of the following conditions in women taking HRT compared with women of menopausal age in the general population. Your gynaecologist  should explain that the risks of the conditions described below vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women. 

-Blood clots (venous thromboembolism) 

HRT tablets (but not patches or gels) are linked with a higher risk of developing a blood clot. If you are already at higher risk of blood clots (for example, you are obese) and you are considering HRT, you may be offered patches or gel rather than tablets. If you have a strong family history of blood clots or if there’s another reason why you are at high risk of blood clots, you may be referred to a haematologist (a doctor who specialises in blood conditions) before considering HRT. 

-Heart disease and stroke (cardiovascular disease) 

Studies show that:

• If you start HRT before you’re 60 it does not increase your risk of cardiovascular disease.
• HRT does not affect your risk of dying from cardiovascular disease.
• HRT tablets (but not patches or gels) slightly raise the risk of stroke. However, it is important to remember that the risk of stroke in women under 60 is very low.

If you’re already at higher risk of cardiovascular disease it may still be possible for you to take HRT but it will depend on your individual circumstances. Your gynaecologist can give you more information. 

-Breast cancer 

Studies show that for women around menopausal age:

• Oestrogen-only HRT causes little or no change in the risk of breast cancer.
• HRT that contains oestrogen and progestogen may increase breast cancer risk. This risk may be higher if you take HRT for longer but falls again when you stop taking HRT. 

-Type 2 diabetes 

HRT does not increase your risk of developing type 2 diabetes. If you already have type 2 diabetes, HRT is unlikely to have a negative effect on your blood sugar control. When deciding if HRT is suitable for you, your gynaecologist  should take into account

any health problems related to your diabetes and may ask a specialist for advice before offering you HRT. 

-Osteoporosis 

When your ovaries stop making oestrogen your bones become thinner and you have a higher risk of osteoporosis, where your bones break more easily. You should be given advice about bone health and osteoporosis at your first appointment and again when reviewing your treatment. Your gynaecologist should explain that for women around menopausal age the risk of breaking a bone is low, and HRT reduces this risk further. This benefit only lasts while you are taking HRT but it may last longer if you have taken HRT for a long time. 

-Loss of muscle strength 

You may lose muscle strength as you reach menopause, and HRT may improve this.

However, it is also important to carry on with daily activities and exercise, which will help you to stay as strong and fit as possible. 

-Dementia 

It is currently unknown whether HRT affects the risk of developing dementia. NICE has recommended more research about this. 

Starting HRT 

Your gynaecologist should tell you what to expect when you start taking HRT. It’s common to have some vaginal bleeding in the first 3 months (for women who have a womb). If you have any unexpected bleeding in the first 3 months, tell your gynaecologist at your first review appointment. If it happens after the first 3 months tell your gynaecologist straightaway. 

Stopping HRT 

When you are thinking about stopping HRT you can either stop immediately or gradually reduce your dose. Your gynaecologist should give you more advice about this. You may have some menopausal symptoms again after stopping HRT, although they may return less quickly if you stop gradually. 

Reviewing your care

You may be having different treatments or therapies to help your menopausal symptoms. To see whether treatment is helping you should be offered review appointments every 3 months to start with. If you are not having any problems, you should then have appointments once a year. You should be offered an earlier review if you need it, for example if treatment no longer seems to be working or is causing side effects. It is also important to keep going to all your routine health screening appointments (for example, breast and cervical screening). 

Hope you found this information helpful.