Obstetrician and Gynaecologist

The Menopause

In the UK, the average age for a woman to reach the menopause is 51 years. The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.  Periods usually start to become less frequent over a few months or years before they stop altogether, however sometimes they can stop suddenly. The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's oestrogen levels decline.

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

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 (eg your weight, whether you smoke and your personal or family medical history).

Apart from HRT there are other medical and complementary therapies that can help with symptoms. These can include:

cognitive behavioural therapy (CBT) – a type of talking therapy that can help with low mood and anxiety

eating a healthy, balanced diet and exercising regularly – maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms

Risks of HRT include:

Breast Cancer:

Estrogen only HRT causes little or no difference in the risk of breast cancer.

HRT that contains estrogen 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.

See NICE guideline on HRT (

Additional information can be found from the NHS Choices website