Menopause: Symptoms, Hormone Therapy & Long-Term Wellbeing

Common Symptoms

HRT: Benefits and Risks

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

1. Menopause. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK507826

References

Sources cited on this page. PubMed links open the original abstract.

1. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975–4011. PMID 26136398 · doi:10.1210/jc.2015-2236

Perimenopause versus menopause – the hormonal transition explained

Menopause – defined as 12 consecutive months without a menstrual period – is a single point in time, not a prolonged state. The years before (perimenopause) and after (post-menopause) span a decade or more of hormonal change:

• Perimenopause: Begins on average 4–6 years before the final period (average age of menopause in UK women is 51). FSH rises as ovarian reserve declines and the pituitary works harder to stimulate failing follicles. Oestrogen fluctuates erratically – sometimes very high (causing heavy bleeding, breast tenderness, migraines), sometimes low (causing hot flashes, poor sleep, vaginal dryness). These fluctuations make symptoms unpredictable and can be more debilitating than post-menopausal symptoms.
• Post-menopause: Oestrogen stabilises at a consistently low level. Hot flashes typically peak in the first 1–2 years and gradually reduce over 3–7 years, though 10–15% of women have persistent symptoms beyond a decade. Genitourinary syndrome of menopause (GSM) – vaginal dryness, dyspareunia, urinary urgency – tends to worsen progressively without treatment.

Blood tests and when they're needed

For most women over 45 with typical symptoms (vasomotor symptoms, menstrual changes), menopause is a clinical diagnosis – blood tests are not routinely required. However, FSH testing is appropriate in:

• Women under 40 with possible premature ovarian insufficiency (POI) – a separate condition requiring different management (higher-dose HRT continued until average menopause age of 51, plus bone density monitoring)
• Women aged 40–45 where the diagnosis is uncertain
• Women on combined hormonal contraception (where periods may be suppressed, masking the menopause transition) – after stopping contraception, FSH can be checked
• Women post-hysterectomy (where the absence of periods does not confirm menopause)

FSH above 30 IU/L on two occasions (at least 6 weeks apart) in a woman with amenorrhoea for 12 months or more confirms menopause. Note: FSH fluctuates significantly in perimenopause – a single result can be misleading and does not exclude perimenopause if below 30.

Genitourinary syndrome of menopause – undertreated but treatable

Unlike vasomotor symptoms (hot flashes, night sweats) which often self-resolve over years, GSM does not improve without treatment – it progressively worsens. GSM encompasses vaginal atrophy (thinning, dryness), dyspareunia, vulval irritation, and urinary symptoms (urgency, frequency, recurrent UTIs). It affects approximately 50% of post-menopausal women but only 25% receive treatment, largely due to under-reporting. Local vaginal oestrogen (topical oestradiol cream, pessary, or ring) is highly effective, does not significantly increase systemic oestrogen levels, and is safe even in women with a history of breast cancer where systemic HRT is contraindicated.