Overview
Menopause is the natural biological process marking the end of menstrual cycles, defined as 12 consecutive months without a period. In the UK the average age is 51. The perimenopause (transition phase, usually 4 to 8 years before the final period) is when symptoms typically begin. Symptoms vary enormously in severity and duration. Effective treatments exist.
How common is it?
Menopause is a usual stage of reproductive ageing. It most often occurs between ages 45 and 55, but can happen earlier. The symptoms and their impact vary widely.
Causes and risk factors
The ovaries produce progressively less oestrogen and progesterone as egg supply declines, causing the hypothalamic-pituitary axis to register an absence of negative feedback and FSH to rise.
Common risk factors
- Natural menopause: age-related follicular depletion (average age 51)
- Premature ovarian insufficiency (POI): loss of normal ovarian function before age 40
- Surgical menopause: bilateral oophorectomy (most abrupt onset)
- Medical: chemotherapy, radiotherapy, certain GnRH agonists
- Genetic: Turner syndrome, Fragile X premutation
Symptoms
- Hot flushes and night sweats (vasomotor symptoms)
- Sleep disturbance
- Mood changes: anxiety, low mood, irritability
- Brain fog and memory difficulties
- Vaginal dryness and dyspareunia (genitourinary syndrome of menopause)
- Reduced libido
- Urinary symptoms: urgency, frequency, recurrent UTIs
- Joint aches
- Irregular periods (perimenopause)
- Long-term: increased cardiovascular risk, osteoporosis
When to see a doctor
Seek advice if symptoms affect daily life or menopause may be starting before age 45. Any vaginal bleeding after 12 months without periods needs prompt assessment, even spotting; discuss unexpected bleeding on HRT too. Treatment is chosen according to diagnosis, medical history and preferences.
Diagnosis
In people aged 45 or over with typical symptoms, diagnosis is usually clinical without hormone tests. FSH testing may help at ages 40 to 45 or when premature ovarian insufficiency is suspected under 40. POI assessment usually uses two elevated FSH results 4 to 6 weeks apart, interpreted with symptoms and hormone use.
Treatments
Hormone replacement therapy (HRT)
HRT is effective for menopausal symptoms and helps protect bone health. Choice of hormone, route and progestogen depends on personal risks and whether the womb is present. Discuss benefits and risks individually; body-identical does not mean risk-free.
Vaginal oestrogen
Low-dose vaginal oestrogen can help vaginal and urinary symptoms, with little absorption into the bloodstream. After breast cancer, non-hormonal options are usually tried first; persistent symptoms need an individual discussion, involving the cancer team particularly with aromatase inhibitors.
Non-hormonal pharmacological options
Non-hormonal medicines can be considered when HRT is unsuitable, according to symptoms and medical history. Fezolinetant is an option for moderate-to-severe hot flushes, with access depending on local criteria. It can cause liver injury and requires liver blood tests before and during treatment.
CBT for menopause
Cognitive behavioural therapy adapted for menopause (CBT-M) is evidence-based for mood, sleep, and hot flush perception. Recommended in NICE guidelines.
Self-care and lifestyle
- Regular weight-bearing exercise for bone density; aerobic exercise for cardiovascular protection
- Reduce alcohol and caffeine (triggers hot flushes)
- Avoid triggers: spicy food, hot drinks, hot environment
- Maintain healthy weight (overweight worsens hot flushes)
- Mindfulness and CBT-based approaches help with mood and sleep
Prevention
Menopause cannot be prevented. Care focuses on symptoms and long-term health, including bone health. For early or premature menopause, discuss hormone replacement and how long to continue it with your clinician; avoid promises that HRT will prevent cardiovascular disease.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to urgent-care guidance, diagnosis, treatment, frequency, symptoms, risk factors. This update covers the named sections; a full review of the remaining guide is pending.