Menopause & HRT

The menopause is a natural stage of life, but that does not mean you have to simply put up with symptoms that are affecting how you live. For some women the transition passes quietly; for others it brings changes that disrupt sleep, mood, work and relationships. Help is available, and there is more choice than many women realise.

What is happening

The menopause is the point at which periods stop permanently, usually confirmed after twelve months without a period. The years of hormonal change leading up to it are called the perimenopause, and this is often when symptoms are at their most unpredictable.

Most women reach the menopause in their late forties or early fifties, though it can happen earlier — either naturally or following surgery or medical treatment.

Symptoms you might notice

Symptoms vary enormously from woman to woman. Commonly reported changes include:

• Hot flushes and night sweats
• Disturbed sleep and fatigue
• Low mood, anxiety or irritability
• Difficulty with memory and concentration
• Vaginal dryness and discomfort during sex
• Reduced libido
• Urinary symptoms, including recurrent infections
• Joint aches and changes in skin or hair

How it is assessed

For most women over forty-five, the menopause is diagnosed from symptoms alone and blood tests are not needed. If you are younger, or the picture is less clear, hormone tests may be helpful.

Just as importantly, an assessment means looking at the whole picture — your symptoms, your medical history, any family history, and what matters most to you. Some symptoms attributed to the menopause turn out to have another cause, which is worth identifying.

Treatment options

There is no single right answer, and doing nothing is a legitimate choice if symptoms are manageable. Options that may be discussed include:

• Hormone replacement therapy (HRT), in various forms including tablets, patches, gels and sprays
• Vaginal oestrogen, which treats local symptoms and can be used by many women who cannot take systemic HRT
• Non-hormonal prescription medicines
• Lifestyle approaches, including exercise, sleep and alcohol
• Talking therapies, particularly for mood and anxiety symptoms

What about the risks?

HRT has been the subject of a great deal of confusing and sometimes alarming coverage. The honest position is that the balance of benefit and risk depends on your age, your health, the type of HRT and how long it is used — which is precisely why it is worth a proper conversation rather than a headline.

My aim is to set out what is known clearly, including the uncertainties, so you can make a decision that feels right to you.