What is the menopause?

The menopause is a natural stage in a woman’s life when periods permanently stop. The menopause is generally confirmed when a woman has not had a period for 12 months. 

The menopause is caused by a reduction in the levels of the hormones oestrogen and progesterone produced by the ovaries. This decline coincides with a decline in the number of eggs in the ovaries, which are gradually depleted throughout a woman’s life. The transition to menopause seems to occur when the number of eggs falls below a certain threshold.

With fewer eggs, the ovaries produce less oestrogen and progesterone. This process begins years before periods completely stop. The decline in oestrogen levels is thought to be responsible for menopausal symptoms. 

When does the menopause happen?

In the UK, the mean age for the natural menopause is 51. It generally occurs between the ages of 45 and 55. Early menopause is defined as occurring before the age of 45. Premature menopause is defined as occurring before the age of 40.

Sometimes chemotherapy or radiation can damage the ovaries and cause the menopause to occur. Women who have both ovaries removed during a hysterectomy will immediately go through the menopause after the surgery.

Lifestyle advice

General healthy living advice is important to follow for women experiencing menopausal symptoms:

• Regular exercise
• Sleep hygiene
• Reducing stress and relaxation techniques

Improving sleep hygiene, taking regular exercise, and reducing stress levels can help women who experience sleep disturbance and mood changes (e.g anxiety) around the time of the menopause.

Postmenopausal women are at an increased risk of osteoporosis. You can reduce this risk by:

• Performing regular weight-bearing exercises
• Eating a healthy diet that includes plenty of calcium
• Getting enough sunlight (or supplementing with Vitamin D if not)

More information is available on the Royal Osteoporosis Society website.

Hot Flushes

Hot flushes are the most common menopausal symptom and some women can be severely affected. Some tips to help include:

• Wearing cotton clothing rather than man-made fibres
• Wearing loose clothing with thinner layers rather than thicker layers
• Keeping your bedroom cool at night
• Avoiding possible triggers of flushes such as caffeine, alcohol, and spicy foods
• Losing weight (if you are overweight)

Hormone Replacement Therapy (HRT)

HRT are medicines used to treat menopausal symptoms. They may also be used to help prevent osteoporosis in postmenopausal women. HRT can be very effective at relieving symptoms but are associated with some risks.

The two main hormones used in HRT are oestrogen and progestogen. Progestogens are synthetic versions of the natural hormone progesterone. Patients taking HRT either take a combination of both hormones or just take oestrogen.

Taking oestrogen replaces the oestrogen lost during the menopause. This helps to relieve menopausal symptoms. However, an increase in oestrogen levels can cause an overgrowth of the womb lining (endometrium). This increases the risk of developing womb cancer. 

Taking progestogen alongside oestrogen protects against the increased risk of womb cancer.

Types of HRT

• Oestrogen-only HRT does not contain a progestogen. Due to the risk of womb cancer associated with oestrogen, it is generally only used by women who have had their womb removed.
• Combined HRT contains both oestrogen and progestogen. There are two types of combined HRT:
• Continuous combined HRT. This involves taking both hormones together every day.
• Cyclical HRT, also known as sequential HRT. This involves taking oestrogen every day and then adding progestogen alongside it for around the last 14 days of the menstrual cycle. This normally produces a monthly bleed.

In general, continuous combined HRT is used by women who are postmenopausal (no period for over 1 year). Cyclical HRT is used by women who still have periods but suffer from menopausal symptoms. Oestrogen-only HRT is generally used by women who have had their womb removed.

Menopausal hormone therapy is available as:

• Vaginal pessaries
• Vaginal creams
• Vaginal rings
• HRT Tablets
• Skin patches
• Gels

Our doctors are able to prescribe a number of HRT products on our website:

• Elleste Duet
• Elleste Duet Conti
• Elleste Solo
• Livial
• Premarin
• Premique
• Kliovance
• Trisequens
• Provera
• Evorel Conti patches

Risks of HRT

Before starting therapy women should be aware of the potential risks of HRT. Women taking HRT report the following diseases more often than women who do not take HRT:

• Endometrial cancer
• Ovarian cancer
• Heart disease
• Stroke
• Blood clots (venous thromboembolism)
• Breast cancer

The patient information leaflet for each HRT product contains more information about the risks of that particular product. These leaflets can be searched for here.

Women taking HRT should be regularly checked by their doctor to monitor treatment and side effects. The NHS website contains information on the symptoms of blood clots, breast cancer, endometrial cancer and stroke as well as information on the risks of HRT.

Non-HRT Medication

A number of non-HRT medicines can be prescribed for menopausal symptoms. A class of medicines called SSRIs are typically used as antidepressants but are sometimes prescribed to help hot flushes and night sweats.
Vaginal moisturisers are commonly prescribed to improve symptoms of vaginal dryness and itching. One example of a product used is ReplensMD.

Symptoms of the menopause

Most women will experience some symptoms around the time of the menopause. Symptoms can begin months and years before periods stop because of the gradual hormonal decline that leads up to the menopause.  

The earliest symptom many women notice is changes to their periods. They may become more or less frequent and not as regular as previously. They may also become unusually light or heavy.

The NHS website suggests that around 80% of women will have other symptoms before and after their periods stop. Symptoms can resolve in 2-5 years but for some people they can continue longer. We have listed a number of symptoms below:

• Hot flushes/hot flashes
• Night sweats
• Palpitations
• Joint stiffness and aches
• Headaches
• Insomnia
• Weight gain and bloating
• Depression
• Mood changes
• Breast pain
• Libido changes
• Difficulty concentrating and forgetfulness (may arise from sleep problems)

The most commonly reported symptoms are hot flushes and night sweats. Around 75% of women report suffering from these symptoms and 25% of these are severely affected.

Other symptoms can affect the bladder and the vagina but, in general, tend to occur later and sometimes years after the final period:

• Vaginal dryness, pain and/or itching
• Discomfort during sex
• Needing to urinate more often
• Discomfort urinating
• Recurring urinary tract infections (UTIs)

What happens during the menopause?

The menopause occurs when a woman permanently stops having her period. Around this time hormone levels of oestrogen and progesterone decrease and can cause menopausal symptoms such as changes to periods, hot flushes, night sweats, mood changes and vaginal dryness.  

Menopausal symptoms can begin months or years before the final period and symptoms can persist for years afterwards.

What is the menopause age?

For most women, the menopause begins between the ages of 45 and 55. The mean age of the natural menopause in the UK is 51. If the menopause begins before the age of 45, it is classed as early menopause.

What are the side effects of HRT?

Side effects can differ between different HRT medicines but some common side effects of HRT include:

• Breast pain or tenderness
• Headaches
• Vaginal bleeding
• Nausea
• Stomach pain

HRT can have rare, serious side effects such as increasing the risk of certain cancers. Further information can be found here.

Do you gain weight on HRT?

Research has shown that women can gain weight during the menopause. However, the manufacturers of some HRT products do list weight gain as a side effect of treatment. This can be a common side effect of some products and an uncommon side effect of others.

How long does it take for hormone therapy to work?

The full effects of HRT can take up to three months to show but some women may notice benefits within a few weeks of starting therapy.

How does a woman feel during menopause? 

The menopause can be accompanied by symptoms that affect a woman’s quality of life. The physical symptoms like hot flushes and night sweats can cause psychological distress. Other symptoms can occur such as low mood, anxiety, and irritability. The menopause matters website offers information and support for women affected by the menopause.

What is the best HRT to take?

The type of HRT a patient should take depends on a number of factors, and the best HRT for one patient may not be the best for another patient. You should have a discussion with your doctor to decide whether HRT is suitable for you and which type of HRT is best to take. 

How long do HRT side effects last?

Some of the common side effects of HRT like nausea, headaches and breast pain should improve within the first 3 months of treatment. If these side effects are severe or persist after 3 months you should stop HRT and discuss with your doctor.