What is the menopause, and what are the treatment options?
The point at which menstruation has stopped for twelve consecutive months, marking the end of ovarian function — and most of what people describe as "the menopause" is actually perimenopause, the transition before it, which can last years and is when symptoms are usually worst.
The stages:
Perimenopause, when hormone levels fluctuate erratically — frequently more disruptive than the steady low levels afterwards, because the variability is what produces symptoms. It commonly begins in the mid-forties and can start earlier.
Menopause, the retrospective diagnosis at twelve months.
Postmenopause, afterwards.
Early menopause before 45, and premature ovarian insufficiency before 40, both of which need different management and specific attention to bone and cardiovascular health.
The symptoms, which are wider than commonly recognised: hot flushes and night sweats; sleep disruption; mood changes, anxiety and irritability; brain fog and memory difficulty, which is genuinely distressing and frequently dismissed; joint aches; genitourinary symptoms — vaginal dryness, discomfort, urinary urgency and recurrent infections, which are common, progressive without treatment and very under-reported; changes in libido; palpitations; and skin and hair changes.
How it is diagnosed. In women over 45, clinically, on symptoms — blood tests are generally unhelpful because levels fluctuate day to day. Testing is used in younger women.
The treatment options:
Hormone replacement therapy, which is the most effective treatment for vasomotor symptoms. Understanding of its risks changed substantially after early reporting of a major trial was widely misinterpreted, leading to a sharp fall in use and, in the assessment of many clinicians, considerable avoidable suffering. Current guidance supports it for most women under 60 or within ten years of menopause, with risks and benefits varying by preparation, route and individual history.
Vaginal oestrogen, which is local, carries minimal systemic absorption, and can generally be used long term — including by many women who cannot take systemic HRT.
Non-hormonal medication for those who cannot or prefer not to use HRT.
CBT, with evidence for flushes and mood.
Exercise, sleep and weight-bearing activity for bone.
General information, not medical advice.