Menopause: Symptoms and treatment options

Gynaecologist Professor Jay Chatterjee discusses the wide range of options available to manage menopause symptoms.

Older woman with daughter

Although its symptoms are often unwanted, a range of modern, effective treatment options mean that menopause need not be disruptive to a woman’s daily life. We spoke to Professor Jay Chatterjee, Consultant Gynaecological Surgeon, to find out more.

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What is menopause?

Menopause occurs when hormone levels lower and your periods stop as a result. Although menopause is often used as a catch-all term, it specifically refers to the day on which it’s been 12 months since your last period.

Perimenopause is the transition period leading up to menopause, where your periods become irregular and begin to stop. You may also experience symptoms like hot flashes and vaginal dryness.

Postmenopause is the period after the menopause has officially occurred.

Menopause is a natural event that occurs as part of biological aging. However, in some cases, menopause may occur prematurely or be induced through cancer treatments, such as chemotherapy, or through surgery.

Also explore our insights on women experiencing menopause in their 40s.

What age does menopause start?

Perimenopause usually begins between the ages of 45 and 55. In the UK, the average age for reaching menopause is 51.

What is early menopause?

If menopause occurs before the age of 40, it is known as early menopause or premature ovarian insufficiency (POI).

Early menopause can occur as a result of surgery (involving removal of the ovaries), cancer treatments like chemotherapy, or an underlying health condition.

If you have surgery which involves the removal of the ovaries, such as a hysterectomy, you will reach menopause immediately. This is known specifically as surgical menopause.

What is perimenopause?

Perimenopause is the transition period before menopause, where your ovaries gradually begin to slow down and stop producing eggs regularly.

Perimenopause can last from months to years – although, on average, perimenopause lasts around four years. During this time, you may experience an irregular menstrual cycle and menopause-like symptoms such hot flashes, insomnia, and vaginal dryness.

You can still become pregnant during perimenopause, so it is important to continue using contraception if you wish to avoid pregnancy.

Perimenopause ends when your period has stopped for twelve months.

What is postmenopause?

Postmenopause refers to the time period after you haven’t had your period in twelve months and lasts for the rest of your life.

The symptoms of menopause may or may not stop once you officially reach postmenopause. However, symptoms can last for up to seven years in around 50% of women and for up to 12 years in 10% of women.

Postmenopausal women are at increased risk of osteoporosis and heart disease due to lowered oestrogen levels. However, these risks can be reduced through lifestyle changes and/or hormone replacement therapy (HRT).

How long does menopause last?

Menopause refers specifically to the day on which you haven’t had a period in 12 months – therefore, it technically only lasts for one day.

Perimenopause lasts for four years on average. Postmenopause lasts for the rest of a woman’s life, although symptoms can last for up to 12 years on an average.

Menopause symptoms

Menopause can cause a wide range of symptoms. Some women may experience severe symptoms that impact their day-to-day life, while others will have mild symptoms.

The physical symptoms of menopause include:

  • heart palpitations
  • insomnia or poor sleep
  • fatigue
  • hot flushes and night sweats
  • dizziness and fainting
  • headaches
  • muscle and joint pain
  • vaginal dryness
  • increased thrush and UTIs
  • thinning hair
  • dry, itchy skin
  • tinnitus
  • dry mouth and eyes

As well as physical symptoms, many women also experience psychological symptoms, too. These include:

  • low mood and depression
  • anxiety
  • memory problems
  • panic attacks
  • difficulty concentrating
  • irritability
  • crying spells
  • mood swings
  • brain fog
  • loss of interest in sex

Blood tests for menopause

Menopause can usually be diagnosed based on symptoms alone. However, there are some diagnostic tests that can be carried out to confirm levels of FSH.

Follicle-stimulating hormone (FSH) stimulates the ovaries to release eggs (ovulation). During perimenopause, when fewer eggs are released, your body produces more FSH to try and encourage ovulation. Therefore, blood tests that show elevated levels of FSH can be a positive indicator of menopause and is inversely related to the level of oestradiol.

Blood tests for thyroid-stimulating hormone (TSH) may be used to rule out hypothyroidism, as the symptoms closely resemble those of menopause.

What are the signs of coming to the end of menopause?

You can estimate when you’ll officially reach menopause by keeping track of the monthly periods that you have missed.

You might also see your menopausal symptoms stabilise or improve with time – for example, your sleep may improve, or you find you have fewer hot flashes.

Treatments for menopause

Hormone replacement therapy (HRT)

The main treatment for symptoms of menopause is hormone replacement therapy (HRT), which is used to replenish the declining levels of hormones (oestrogen and progesterone). Taking HRT should improve almost all symptoms of menopause.

Low levels of oestrogen can increase your risk of developing osteoporosis, heart disease, type 2 diabetes, dementia, depression, and bowel cancer. HRT can also help reduce the risk of these conditions developing in the future.

There are different ways in which you can take HRT, including tablets, skin patches, creams and gels, and implants. Women who have a low sex drive as a result of the menopause may also be offered testosterone gel or cream.

HRT may not be suitable for all menopausal women. If you have had breast cancer or blood clots in the past, you may be advised not to take HRT as it can increase the risk of these conditions reoccurring.

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Treatment for hot flashes

Women who cannot take HRT may be prescribed clonidine (a blood pressure medication), gabapentin (a seizure medication), or a new drug called Veoza (Fezolinetant) to improve their hot flashes.

MonaLisa Touch® for vaginal dryness

The hormone oestrogen is important in keeping the vagina healthy and lubricated. It also encourages the presence of ‘good’ bacteria that protect against infections.

During menopause, when oestrogen levels begin to lower, many women experience vaginal dryness. Vaginal dryness, also known as vaginal atrophy, occurs when the tissue lining of the vagina becomes thinner and drier.

MonaLisa Touch® is a non-hormonal, chemical-free treatment to address vaginal dryness. It may be a good option for women who can’t (or would prefer not to) use oestrogen-based therapies.

MonaLisa Touch® works by delivering fractional CO2 laser energy to the tissue of the vaginal wall, which stimulates the production of collagen and new blood vessels and restores proper balance to the mucous membrane. The procedure requires no anaesthesia, takes just a few minutes to complete, and allows patients to go home the same day.

More about MonaLisa Touch® >

About the consultant

Professor Jay Chatterjee is a senior Consultant Gynae-oncologist at the Royal Surrey County Hospital NHS Foundation Trust (Guildford) – associated with the renowned St Luke's Cancer Centre – and sees patients at the Cromwell Hospital.

Professor Chatterjee provides all aspect of surgical gynaecological and gynaecological-oncological care. He is internationally known for his surgical expertise in advanced open abdominal and laparoscopic/robotic operative skills. He is presently working to develop genomic, proteomic and immunomic characterisation of tumours, so that novel therapies can be applied as part of personalised cancer care to improve survival from gynaecological cancers.

Known for his patient-centred focus, Professor Chatterjee employs the most up-to-date clinical techniques in order to ensure that he can provide the utmost in patient care.

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