What is the menopause?

Menopause is officially defined as one year after your last period. The time leading up to this — when hormone levels start to fluctuate and symptoms may begin — is known as the perimenopause.

After menopause, you are considered to be in the postmenopausal stage.

Everyone’s experience is different, and symptoms can start several years before menopause and continue afterwards. If your symptoms are affecting your quality of life, support and treatment options are available.

When does the menopause start?

The average age of menopause in the UK is 51, but this can vary widely from person to person.

Most women start noticing perimenopausal symptoms (the transition phase before menopause) in their 40s. These symptoms can last for an average of four years, but some may experience changes earlier or later.

If menopause occurs:

• Before age 40, it’s known as Premature Ovarian Insufficiency (POI)

• Between ages 40 and 45, it’s considered early menopause

If you're experiencing symptoms at any age that are affecting your wellbeing, it's important to seek support—there are options available to help you feel better.

What are common menopause symptoms?

During perimenopause and menopause, levels of oestradiol (a form of estrogen) start to fluctuate and eventually fall. Because we have oestradiol receptors throughout the body, these hormonal changes can lead to a wide range of symptoms.

Physical symptoms may include:

• Changes in periods

• Hot flushes and night sweats

• Headaches or migraines

• Acne

• Heart palpitations

• Low libido

• Vaginal dryness or discomfort

• Joint and muscle pain

Psychological symptoms can include:

• Low mood or mood swings

• Anxiety or depression

• Brain fog or difficulty concentrating

• Insomnia or disrupted sleep

Symptoms can vary widely in type and severity from person to person. Some may experience just a few mild symptoms, while others find they significantly affect daily life. Support and treatment options are available to help manage them effectively and we will discuss these.

How is menopause diagnosed?

We will discuss your symptoms and what you have been experiencing which will guide whether we need to do any investigations. Generally, if you are age 45 or over, the diagnosis is usually clinical and investigations may not be needed.

If you are age 40-45, we may perform hormonal blood tests to confirm, again depending on your symptoms.

If you are under 40, you will need to have blood tests.

How can I manage symptoms?

There are several ways to manage menopause symptoms, and lifestyle plays a big role. Regular exercise—both cardiovascular and strength training—along with a balanced diet, avoiding smoking, and limiting alcohol can all help improve your overall wellbeing and ease symptoms.

Some people also find non-hormonal supplements helpful, though the evidence supporting them is limited.

For many, Hormone Replacement Therapy (HRT) is an effective treatment to relieve a wide range of menopause-related symptoms.

During your consultation, we’ll talk through your symptoms, lifestyle, and preferences to create a personalised plan that works for you.

What is HRT?

Hormone Replacement Therapy (HRT) is a treatment that provides oestradiol (a type of estrogen) to help relieve symptoms of perimenopause and menopause.

If you still have a uterus, progesterone is also required to protect the womb lining. If you’ve had a hysterectomy, oestradiol alone is usually suitable—unless the surgery was due to endometriosis, in which case progesterone may still be recommended.

I also prescribe:

• Vaginal oestrogen and treatments for genitourinary syndrome of menopause (GSM)

• Testosterone if needed, particularly for low libido

There’s no set time to start HRT—it’s a personal decision. If your symptoms are affecting your quality of life, HRT can be an effective way to manage them.

There are different types of HRT, including both synthetic and body-identical hormones (which closely match your body’s natural hormones). During your consultation, we’ll discuss the best option for you.