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Menopause

The menopause: an overview

The average age for the menopause in the UK is 51 with a range from 45-55 and it heralds a number of changes to physiological mechanisms due to associated hormonal changes – principally reduction in oestrogen.

The average life expectancy for women is now 86 which means nearly 40 years in a postmenopausal state. Whilst some women may get very little in the way of symptoms and for others symptoms that they do notice are manageable most women will notice some change and there is a significant impact on long-term health. On average symptoms last for 4 years from the last period but for some the duration is much longer. Symptoms typically start before periods stop and this is called the perimenopause.

Possible effects of the menopause

Effects of the peri-menopause/menopause include:

  • Irregular bleeding
  • Hot flushes
  • Night sweats
  • Disrupted sleep
  • Poor concentration
  • Impact on short term memory
  • Vaginal dryness
  • Reduced sex drive (libido)
  • Mood change
  • Changes in skin and hair quality
  • Changes in collagen (affecting pelvic floor tone, urinary incontinence)
  • Impact on bladder function (the bladder lining is estrogen sensitive)
  • Osteoporosis (thinning of the bones) and increased risk of fracture
  • Increase in cardiovascular disease
  • Loss of muscle strength

Hormone replacement therapy (HRT)

Deciding whether to use HRT is a complex decision but many of the effects of the menopause can be prevented with the potential to improve day to day quality of life and long-term health.

There are a number of different ways of taking HRT including tablets, patches or topical gels. The combination of hormones and which route will work best is a very individual decision with each having different pros and cons. There are also a number of individual risk factors (e.g. your weight, whether you smoke and your personal or family medical history).

Risks of HRT

Risks of HRT include:

Breast Cancer:

  • Oestrogen-only HRT causes little or no difference 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

Heart disease and stroke:

  • 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
  • VTE (venous thromboembolism – blood clots in leg or lung): HRT tablets (but not patches or gels) are linked with a higher risk of developing a blood clot

During a consultation a comprehensive assessment is made, what options are available and which treatment is likely to give the most benefit are discussed and if appropriate a prescription for treatment provided.