Menopause / Hormone Replacement Therapy

What is the menopause?

The word menopause comes from the Greek words “men” for month and “pausis” for stop, so the menopause happens when a woman stops having her monthly period.

When does the menopause happen?

The menopause usually occurs between the ages of 45 and 55, with an average of 51 in the UK.

However around 1:100 women experience menopause before age 40. This is known as premature menopause or premature ovarian insufficiency.

What is happening inside?

As a woman grows older, her ovaries produce less of the female sex hormones oestrogen and progesterone, and eventually the ovaries stop producing eggs and the woman stops menstruating.

An early menopause can be triggered by surgery to remove the ovaries, chemotherapy, auto-immune disease or genetic problems.

Although a hysterectomy will stop a woman’s periods, she will only become menopausal if her ovaries are also removed.

Symptoms

As a woman’s hormone levels fall, she may experience several symptoms such as:

  • hot flushes and night sweats
  • difficulty sleeping
  • low mood and anxiety
  • joint pains
  • headaches
  • low sex drive

Symptoms can start several years before the menopause (this is called peri-menopause) and may continue for some time afterwards.

After the menopause, many women develop vaginal dryness or itch and pain with sex. Changes in the skin lining the urethra (the tube leading into the bladder) can also make a woman more prone to recurrent bladder infections (cystitis). Longer term, bones can become less dense and this can lead to osteoporosis (thin bones) which increases the risk of bone fractures, especially of the hip, forearm and spine.

Further information on the menopause and symptoms may be found at:
  • NHS Website
  • Menopause matters (this is an independent website for both the public and health professionals with easy-to-follow links to different menopause related topics)
  • Rock my menopause (this is the public-facing campaign of the Primary Care Women’s Health Forum and was featured on BBC Breakfast TV in 2019. It has several useful factsheets on the menopause and HRT and aims to raise awareness)

Diagnosis

The menopause can only be diagnosed reliably in retrospect as the term refers to the date of a woman’s last period. One year after her last menstrual period, a woman can be classed as post-menopausal (and any vaginal bleeding thereafter should be reported to your doctor).

A working diagnosis of menopause can usually be made confidently if a woman of menopausal age (45 to 55) has stopped having periods and is suffering typical menopause symptoms.

After the menopause, when the ovarian production of hormones has ceased, there is a rise in FSH (follicle stimulating hormone) levels which persist thereafter. An FSH level above 30 on two occasions six weeks apart may sometimes be used to diagnose the menopause, for example if a woman has stopped having periods and is under the usual menopausal age or if the woman is using the progestogen only pill or the IUS for contraception and would like to know when she could safely stop.

As a rough guide, a woman can stop using contraception two years after her last period if she was under 50 at the time, or for one year if she was over 50. If in doubt it is usually safe to abandon contraception after age 55.

Blood tests are not usually necessary to diagnose the menopause and can be unreliable during the perimenopause when periods and menopause symptoms can come and go.

Selfcare and more information

Lifestyle and over-the-counter remedies

  • Keeping healthy at this stage of life is clearly important. There is good evidence that regular physical exercise can help you to manage the hot flushes and is good for your mental health and general fitness.
  • Wearing natural fibres if possible and layering your clothes may be helpful.
  • Having the bedroom window open or a fan on overnight may help you to manage the night sweats.
  • Avoiding too much caffeine and alcohol is also a good idea.
  • There is a strong link between stress and hot flushes, so anything you can do to manage your stress levels will help.
    • Please click here for further information on managing stress.
    • TALKWORKS can offer treatment and support for anyone in Devon (excluding Plymouth) who is going through the menopause to help them to feel better again.
  • Some women try over the counter menopause products such as vitamin supplements or herbal preparations. Unfortunately, there is little convincing evidence that they are effective.

If your symptoms are significantly affecting you, please talk to your GP.

For vaginal dryness and painful sex, it may help to use a vaginal lubricant. You can find more information on this here, this site has a useful section on treatments and a checklist of symptoms you can print out to show to your GP.

There are several preparations your GP can prescribe for you to help with these problems.

Medication

Hormone Replacement Therapy (HRT)

HRT can be very helpful for managing menopause symptoms, particularly hot flushes and night sweats.

Premature menopause

HRT is usually advised if you have a premature menopause, to protect you from developing osteoporosis. There is some evidence it may also provide some cardiovascular protection.

The Daisy Network is a charity offering information, advice and support for women going through an early menopause.

Types of HRT

HRT contains synthetic oestrogen (usually derived from natural plant or phyto- oestrogens) to replace the oestrogen no longer produced by your ovaries.

If you have had a hysterectomy, you can use oestrogen-only HRT.

However most women will also need to take a progestogen (a synthetic form of progesterone) to protect the lining of the womb from overgrowing (endometrial hypertrophy) as this is a risk factor for endometrial cancer and taking a progestogen for at least 10 days each month is protective. Unfortunately, progestogens can cause side effects for some women (oily skin, bloating, headaches) and when taken cyclically (for 10-14 days each month) will usually result in a bleed like a period.

After the age of 54, or at least 12 months from your last natural period, it is possible to have continuous combined HRT (oestrogen and progestogen taken daily). This is designed to avoid a monthly bleed.

Oestrogen can be given as a tablet, patch or gel. Patches and gels may be advised if you have a problem with absorption from the gut, or if you are at higher risk of a blood clot.

Progestogens can be given as a tablet, combined with oestrogen in a patch, vaginally as a pessary or inside the womb as an intra-uterine system (IUS).

Risks of HRT

HRT does carry some extra health risks, however. The most important of these is the increased risk of blood clots. There is also an increase in breast cancer with combined (oestrogen and progestogen) HRT.

For further information on the risk and benefits of HRT please click here.

The decision to start HRT requires careful consideration of your individual risks and benefits. It is a joint decision between you and your doctor.

Further information on treatment may be found at:

Testosterone

Please click here for further information regarding testosterone.

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

What support is available?

Follow the links below to find support and further information: