Menopause is a natural biological process that marks the end of a woman’s reproductive years. It typically occurs between the ages of 45 and 55, with the average age being 51. By the age of 54, 80% of women will have stopped their periods.

During menopause, a woman’s ovaries gradually produce less oestrogen and progesterone, the hormones responsible for regulating the menstrual cycle and supporting fertility. As a result, menstruation becomes less frequent and eventually stops altogether. Menopause is considered complete when a woman has gone through 12 consecutive months without a period.


The transition leading up to menopause is called perimenopause, which can last for several years before menopause is reached. Perimenopause is marked by hormonal fluctuations and changes in menstrual cycles. This phase varies for individuals but can last months or years. Periods may become less frequent, heavier or lighter. For some women they can stop suddenly. Women may also experience various symptoms during this time.


Menopause is a highly individual experience. Not all women will experience the same symptoms, and the severity and duration can vary. The average duration of symptoms is 7 years. Up to 25% of women will have no symptoms.

There are oestrogen receptors throughout the body meaning the symptoms of menopause are widespread. They include hot flushes, night sweats, brain fog, forgetfulness, weight gain, hair loss, palpitations, headaches, insomnia, itchy skin, joint pain, fatigue, irritability and mood changes.

You can use the Balance app to track your symptoms.

Menopause and sexual health

Menopause can have a significant impact on sexual health and function. The delicate tissues of the vulva and vagina are very sensitive to decreased levels of oestrogen. This can lead to vaginal dryness and thinning of the vagina walls (vaginal atrophy), and changes in the pH balance of the vagina. These changes can lead to vulval soreness and itch, discomfort during sexual intercourse and increased urinary tract infections and incontinence.

Fluctuating hormone levels, coupled with other physical and emotional factors, can affect libido. Some women may experience a decrease in libido whilst others may have an increase or no significant change.

Menopause can bring about physical changes such as weight gain and changes in body shape which may affect self-esteem, body image and intimate relationships. Open communication with partners about the physical and emotional changes experienced during menopause can help maintain a healthy and satisfying relationship.

Various treatment options are available. These include over-the-counter vaginal lubricants and moisturisers such as YES and SYLK to alleviate discomfort and dryness. Localised HRT in the form of oestrogen creams and pessaries can also help to restore vaginal health and improve sexual function and urinary symptoms.

Menopause and mental health

Menopause signifies a significant life transition, associated with the end of fertility and shift into a new phase of life. This often coincides with children leaving home and caring for ageing parents. This phase of life can evoke a range of emotions and prompt reflection on identity, purpose, and the ageing process which may impact on mental health.

Even if you have never suffered from mental health issues before, fluctuating hormone levels during the menopause can bring about mood swings, irritability, anxiety or low mood. Sleep disruptions can also lead to increased fatigue and irritability and overall, negatively impact on mood. It’s important to remember that while menopause can contribute to mental health challenges, not all women experience significant psychological symptoms.


There is no right way to manage the menopause. Options include lifestyle changes, complementary therapies, over the counter supplements and hormone replacement therapy (HRT). On average, women live more than 1/3 of their lives after menopause. Maintaining a healthy lifestyle, including regular exercise and eating well, will reduce symptoms and contribute to overall mental and

physical well-being during this stage of life and beyond. For more information about the non-HRT options please see the links below:

Alternatives to HRT

Complementary and Alternative Therapies

Living well through your perimenopause

Hormone Replacement Therapy

HRT stands for Hormone Replacement Therapy. It works by replacing the hormones that are declining during this time, primarily oestrogen. For women who still have a womb progesterone is given alongside the oestrogen. The progesterone is unlikely to help the symptoms, but it does protect against cancer of the womb which can occur if oestrogen is given alone. Progesterone is not needed if women have had a hysterectomy or if they have the Mirena coil.

There are many different forms of HRT. We can discuss the various options with you, we prefer to prescribe the ‘gold standard’ preparation which is generally considered the safest regime. This uses oestrogen through the skin (transdermal) as a patch, gel or spray alongside micronized progesterone which is a natural form of progesterone and best taken at bedtime as it can make you feel sleepy.

For women needing progesterone there are two different regimes used depending on whether the last period was within the past 12 months. Simply put if the last menstrual period was <12 months ago HRT is given cyclically and there will be a monthly bleed. For women whose last menstrual period was >12 months ago HRT is given continuously and there should be no bleeding.

Risks vs Benefits

The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks. The benefits of HRT usually outweigh the risks for most women especially if <60 years. There is no absolute age limit on when to stop HRT. A yearly review is recommended to review your individual risks

against the benefits. The benefits of HRT are in reduction of symptoms and maintenance of bone density and reduced osteoporotic fractures.

  • Breast cancer
    If you are under the age of 50 and take HRT, there is no extra risk of breast cancer. You still have the same risk of breast cancer as the rest of the population. Over the age of 50, there is little or no increased risk of breast cancer if you take oestrogen-only HRT. Combined HRT can be associated with a small increase in the risk of breast cancer especially if using an older form of HRT like combined tablets or combined patches. The increased risk is related to how long you take HRT, and it falls after you stop taking it. Because of the risk of breast cancer, it’s especially important to attend all your breast cancer screening appointments if you’re taking HRT.
  • Blood Clots
    There is no increased risk of blood clots from HRT given through the skin. Taking HRT tablets can increase your risk of blood clots – but this risk is still small.
  • Heart disease and strokes
    HRT does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age and may reduce your risk. Taking HRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.


Testosterone is a hormone commonly associated with males, but it is also present in females, although in smaller amounts. Levels of testosterone in women decline between the ages of 20 and 40. By menopause the levels have plateaued out and are stable.

Testosterone is produced by the adrenal glands and the ovaries in women. Testosterone plays various roles in a woman’s body, including contributing to libido, muscle strength, bone health, and overall well-being. Low testosterone levels can lead to symptoms such as reduced libido, fatigue, reduced muscle strength, and mood changes. These symptoms can overlap with menopausal symptoms, making it challenging to attribute them solely to testosterone decline.

It’s important to note that testosterone replacement therapy is not a standard treatment for menopausal symptoms. While testosterone replacement therapy may be considered in certain cases, it is not a routine part of menopause management. We follow the NICE Menopause Guideline (NG23) and the BMS (British Menopause Society) guidance which recommends that testosterone is only used for low libido and only once other options have been exhausted.

Conventional HRT should be given before testosterone supplementation is considered. Randomised clinical trials of testosterone to date have not demonstrated the beneficial effects of testosterone therapy for cognition, mood, energy and musculoskeletal health. Testosterone supplementation could lead to potentially irreversible side effects including enlarged clitoris, deepening of the voice and male pattern baldness.


HRT is not a contraceptive; Women continue to require contraception

during the perimenopause. A woman is considered potentially fertile for two years after her last menstrual period if she is aged under 50 years and for one year after her last menstrual period if she is aged over 50 years.

For many women oestrogen HRT alongside the Mirena coil is an optimal combination. Alternatively, the progestogen-only contraceptive pill can be given to women who are taking combined HRT (oestrogen and progesterone). Contraception is no longer needed once a woman turns 55.


For more information about the menopause, the following sites are an

excellent resource. Please take time to look through these before

booking an appointment.

We would also strongly advise that you watch the following short video about menopause and HRT.

Making an appointment

Ahead of your appointment please use the Patient Pod in reception. It is necessary to know your BMI and blood pressure in order for us to make an informed decision about your menopause management.

Screening and health checks

Being post-menopausal can increase your risk of other health conditions, so it is important to attend your regular cancer screenings such as cervical and breast.

Other health changes post-menopause can include bone or joint issues like osteoporosis and arthritis, cardiovascular disease, diabetes and urinary tract infections. Please do take advantage of the NHS Health Check.

HRT pre payment certificate

From 1 April 2023, women prescribed HRT – the main treatment for menopause symptoms – will have access to a new scheme enabling access to a year’s worth of menopause prescription items for the cost of 2 single prescription charges (currently £18.70).