Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
Next review due February 2021

The menopause is the time when a woman stops having periods, and she’s no longer able to get pregnant. It’s common to have symptoms such as hot flushes, night sweats and mood changes when you go through the menopause.

Menopause is a natural stage of life. The average age for women to reach the menopause in the UK is 51, but this can vary widely.

An older woman smiling

About the menopause

The menopause happens when your ovaries run out of eggs, or stop producing eggs. Your ovaries also make the hormone oestrogen. So when they stop working, there’s a drop in your blood level of this hormone. This change disrupts your periods and causes the symptoms of the menopause.

If you’re going through the menopause and are having troublesome symptoms, there’s a lot you can do to help yourself. And treatments are available which will help ease your symptoms; so if you’re concerned, speak to your pharmacist or GP.

When does the menopause happen?

You’re said to have reached the menopause if you haven’t had a period for at least a year.

The menopause usually happens gradually. For a few years before the menopause, your periods may become irregular, happening more or less often than they used to. You may also have slightly heavier periods. This stage is called the perimenopause (or menopausal transition) and can last for about four years or sometimes longer.

You can still become pregnant while going through the perimenopause, so you need to keep using contraception if you don’t want to get pregnant. Doctors usually recommend stopping contraception at 55, because most women are in the menopause by this age.

Premature and early menopause

When the menopause happens before the age of 40, it's called premature menopause. Premature means it’s much earlier than might be expected. When the menopause happens between 40 and 45, it’s called an early menopause.

Your menopause can be naturally premature or early because your ovaries stop working. But it can also happen if you’ve had one or both of your ovaries removed as part of a hysterectomy (an operation to remove your womb). See our section on causes of menopause below.

Signs and symptoms of the menopause

Most women develop symptoms at some point during the menopause. Some find their symptoms don’t cause them too much trouble. However, around one in four women will have more significant symptoms.

The timing of the start of symptoms varies widely. Your symptoms may begin up to six years before your periods stop, or your symptoms may not start until after your last period.

Symptoms typically go on for about four years after your periods stop. But every woman is different. One in two women has symptoms for seven years. For around one in 10 women their symptoms carry on for up to 12 years.

If you’re going through the menopause, you may have some of the following signs and symptoms.

  • Irregular periods – you may get your periods more frequently or further spaced apart, before they stop completely. You may bleed more heavily. Having irregular periods is often an early sign of the approaching menopause.
  • Hot flushes and night sweats – during a hot flush, your head, face and neck can become very hot for several minutes. At the same time, you may have heart palpitations and feel anxious or irritable. When flushes happen during the night, they’re known as night sweats.
  • Difficulty sleeping (insomnia) – you may find it hard to sleep because of the night sweats. This lack of sleep may cause you to feel tired during the day.
  • Changes in your mood (eg feeling irritable, depressed or anxious) – lack of sleep can make these symptoms worse. You may also have difficulty in concentrating, and poor memory.
  • Vaginal symptoms (eg dryness and pain during sex) – these symptoms are due to your vagina becoming fragile and thinner. You may also have some itching and irritation.
  • Loss of interest in sex (reduced libido) – the hormonal changes of the menopause can affect your sex drive. You may also have less interest in sex if you have vaginal symptoms that make you uncomfortable (eg vaginal dryness or pain).
  • Urinary problems – these symptoms include repeated urinary tract infections, leaking urine and needing to go to the toilet more often.

Emotional effects of the menopause

The changes that occur in your body as you approach and reach the menopause can affect your emotions and how you feel. You may find you get anxious or irritable, or have mood swings. These symptoms can be worse if you’re not sleeping enough because of night sweats.

Some changes to your lifestyle may be able to help ease these effects. Your pharmacist or GP may also be able to recommend treatments that can help. See our section below for more information on treatments that can help emotional symptoms of the menopause.

Women going through the menopause may have an increased chance of developing depression, which is more serious than mood swings. If you find your mood stays low for several weeks, contact your GP.

Bleeding after the menopause

If you start to have bleeding after you’ve reached the menopause (when you haven’t had a period for a year or more), see your GP. Many women get this, and there’s usually a simple explanation. For instance, the normal changes that happen to your vagina after menopause can cause bleeding. But bleeding after the menopause can also be a symptom of certain cancers, including womb cancer, so your GP will want to rule this out.

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When to seek help for the menopause

If you can manage your symptoms yourself, you may not need to see a doctor for symptoms of the menopause. But you may want to see a doctor if you’re finding your symptoms hard to deal with, or if you’re getting symptoms before the age of 40. Some women may find it difficult to talk about some of the symptoms they’re having. But remember, your GP is there to help and will have helped many other women in your situation before.

If you’re under 45 and you have symptoms of the menopause, your GP may suggest that you have a blood test. This is to measure the level of follicle stimulating hormone (FSH) in your blood. The blood level of this hormone increases as you approach the menopause. By measuring your blood level, it’s possible to tell if your symptoms might be caused by the menopause.

Self-help for symptoms of the menopause

Many women cope with their symptoms without having any specific medical treatment. There’s a lot you can do to help yourself.

Here are some things to try that may help to ease some of your symptoms.

  • Take practical steps to deal with hot flushes by keeping cool and avoiding possible triggers, such as spicy foods, caffeine, alcohol, smoking or stress. It may also help to dress in layers, so you can take off some of your clothes when you feel too warm.
  • Regular exercise may help improve some symptoms of the menopause. It may help you to sleep better and to lift your mood. Aim to do 30 minutes of moderate exercise, at least five days a week.
  • Pelvic floor exercises can help strengthen your pelvic muscles (squeezing and releasing the muscles that support your bowel, bladder and vagina). This may improve your bladder control. You can get guidance on pelvic floor exercises from a physiotherapist. Or visit the website of the British Association of Urological Surgeons where a leaflet describing pelvic floor exercises can be downloaded from their page on incontinence.

You may find it helpful to read our health blog, symptoms of menopause – how to help hot flushes.

Treatment of the menopause

Hormone replacement therapy (HRT)

If you’re finding it hard to manage your symptoms, your GP may suggest you try hormone replacement therapy (HRT). HRT can help some symptoms of the menopause, such as night sweats and hot flushes, mood swings and vaginal dryness. It can also help reduce your risk of osteoporosis. Most symptoms improve within three months of starting HRT.

HRT works by helping to restore your blood levels of the hormones oestrogen and progesterone. The therapy can be oestrogen alone or a combination of oestrogen and progesterone. Your doctor may offer you oestrogen alone if you’ve had a hysterectomy so you no longer have a uterus (womb). You’ll probably be offered a combination of oestrogen and progesterone if you still have your uterus. HRT comes in tablets, patches, skin gels and nasal sprays, as well as vaginal rings.

You may have heard of some potential risks associated with taking HRT. These include an increased risk of developing blood clots (for example deep vein thrombosis) and certain types of cancer. Some of the possible risks of HRT are greater for women aged over 60. Some are more of a concern if you have taken HRT for a long time.

Whether you wish to take HRT is an individual decision for you. Your GP can talk with you about the possible risks and benefits of taking HRT in your particular circumstances. For more information, see our information on hormone replacement therapy. And see our section ‘other helpful websites’ below for details of organisations that provide information about the menopause, including the pros and cons of HRT.

Bioidentical hormones

You may have heard about an alternative to HRT called bioidentical hormone therapy. These include hormones which are similar to the body’s own hormones, but are made from plant sources. They are often promoted as being more ‘natural’ than standard HRT, even though they’ve been processed in a laboratory.

Bioidentical hormone preparations that are custom made (compounded) for you are not recommended. This is because they are unregulated, which means doctors can’t be sure they’re safe and effective. The advice of experts in treating the menopause is to take only medicines which are licensed by the UK regulatory authorities.

You can find out more about bioidentical hormone therapies from some of the organisations listed in our section ‘other helpful websites’ below.

Other treatments

If you don’t want, or are unable to take HRT, your GP may suggest other treatment options. These will vary depending on your symptoms, and may include the following.

  • Talking therapies, like cognitive behavioural therapy (CBT) to help with low mood and mood changes. Your GP may offer you antidepressant medicines if they think you have depression.
  • Vaginal lubricants, to help with vaginal dryness.
  • Non-hormonal medicines such as antidepressants or a medicine called clonidine, for hot flushes and sweats. Your doctor may offer these in certain circumstances, but they aren’t recommended as the first choice for easing menopause symptoms. If your doctor offers them, they’ll explain why they think these medicines might help.
  • Eating a healthy diet, getting regular exercise, losing excess weight and giving up smoking if you smoke. See our section below on staying healthy through the menopause.

Complementary therapies

Doctors don’t think that complementary therapies such as aromatherapy, acupuncture and reflexology can improve the symptoms of the menopause. The same is generally true for plant or herbal remedies. Some women, however, do choose to take herbal remedies, such as black cohosh, soya-based foods and red clover for hot flushes.

Remember – like medicines, herbal remedies can have side-effects and can interact with other drugs. Ask your pharmacist for advice if you plan to try any herbal treatment.

Causes of the menopause

The menopause is a natural part of ageing which occurs to all women in time. It happens when your ovaries run out of, or stop producing eggs, and your blood levels of the female sex hormone oestrogen drop.

However, there are some things that can cause the menopause to happen early. These include:

  • surgery to remove your ovaries, which may be carried out during surgery to remove your womb (hysterectomy)
  • chemotherapy
  • radiotherapy to your pelvic area
  • premature ovarian failure (or premature ovarian insufficiency) – when your ovaries stop working properly and earlier than would be expected. In most cases it’s not known why this happens, but it can run in families. This may not always be permanent.

Staying healthy through the menopause

The drop in your level of oestrogen that happens during and after the menopause can increase your risk of developing certain diseases. These include osteoporosis (thinning of the bones) and heart and circulation problems. So, it’s more important than ever to try to stay healthy during and after the menopause.

Keep active

Exercises that put some pressure on your bones, such as running and walking, can help strengthen them and reduce your risk of osteoporosis. Being physically active can also help to protect against heart disease and stroke. Although there’s no proof exercise can reduce hot flushes, it will probably improve your feeling of wellbeing and raise your mood.

Eat well

It’s important for everyone to eat a healthy diet. If you have hot flushes, you may want to avoid foods that trigger them. This may include spicy foods and drinks containing caffeine.

The menopause causes you to lose calcium from your bones, so it’s particularly important to try to include two or three portions of calcium-rich foods in your daily diet. It’s also important to get enough vitamin D because it’s vital for bone health. See our information on vitamins and minerals to find out how to make sure you get enough calcium and vitamin D.

Look after your heart by eating at least two portions of fish a week – one should be oily fish. And try to cut down on salt and saturated fats.

Lose excess weight

Some women put on weight while going through the menopause, especially around the abdomen (tummy). This may be linked to lowered oestrogen levels but also to general ageing and lifestyle changes. If you’re getting hot flushes and night sweats, it may help to lose any excess weight you have. This will also help reduce your risk of getting heart disease after your menopause.

Stop smoking

Smoking can lead to an earlier menopause, and may trigger hot flushes. There are many good reasons to stop smoking. Ask your GP or practice nurse for advice and support, and there’s also lots of information online from the NHS about stopping smoking.

Limit alcohol

Alcohol may trigger hot flushes in some women, so it may help to limit how much you drink. For more about recommended limits for alcohol, see our information on sensible drinking.

Frequently asked questions

  • Strictly, the menopause is the point in time 12 months after your last period. Most women in the UK reach the menopause between the ages of 45 and 55, with the average age being 51.

    However, the timing of the menopause varies widely, as you can see by the following numbers.

    • One in 1000 women has the menopause in their 30s. A few are even younger.
    • One in 100 women reaches the menopause by the age of 40.
    • Up to one in five women has had the menopause by the age of 45.

    Menopause can also happen late – some women over 55 still have periods.

    There are many factors which may affect when you reach the menopause, including how many pregnancies you’ve had and whether you’re overweight. Your age at the menopause may be linked to when other women in your family reached theirs. And we know that if you smoke, this can bring the menopause forward by around two years.

  • It could be – one in 100 women reaches the menopause before the age of 40. And they may have all the same symptoms as older women going through the menopause, including hot flushes. See our section on symptoms of the menopause above.

    If you’re having hot flushes and night sweats and you’re not sure whether these are caused by the menopause, talk to your GP. There can be a number of reasons for your symptoms. For instance, conditions such as an overactive thyroid and panic attacks can cause hot flushes. They can also be a reaction to certain medicines or foods.

    Your GP will ask you about your symptoms, and may recommend a blood test to check the levels of follicle stimulating hormone (FSH) in your blood. If the level is raised, you’ll need to have a repeat test four to six weeks later. These tests can help show if you’re going through a premature (early) menopause.

    If your GP thinks you’re going through an early menopause, they’ll probably refer you to a gynaecologist for further tests. Your GP or gynaecologist will advise you about specific treatments that can help ease your hot flushes. You may be offered hormone replacement therapy (HRT), for example.

    Your ovaries may release eggs from time to time, even if you’re going through an early menopause. If you don’t want to get pregnant, your doctor may advise you to continue using contraception.

    It can be very upsetting to go through an early menopause if you were hoping to start a family. You may find further information, help and support from some of the organisations we list below under ‘other helpful websites’.

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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, February 2018
    Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
    Next review due February 2021

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