Expert reviewers, Mr Robin Crawford, Consultant Gynaecologist and Dr Samantha Wild, Bupa Clinics GP
Next review due June 2023

The menopause is when a woman’s ovaries stop working and her periods stop. It causes symptoms such as hot flushes, night sweats and mood changes. 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 lady in the pool

About the menopause

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, sometimes longer.

You can still get pregnant while going through the perimenopause, so you need to keep using contraception. Doctors usually recommend stopping contraception at 55 because it’s exceptionally rare to get pregnant after this age, even if you still have periods.

Premature and early menopause

If you reach the menopause before 40, it's called premature menopause. When the menopause happens between 40 and 45, it’s called an early menopause.

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Causes of the menopause

The menopause is a natural part of ageing. It happens when your ovaries run out of 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.

Some things can cause the menopause to happen early. These include the following.

  • surgery to remove your ovaries (oophorectomy), which may be done during a hysterectomy.
  • Some types of medicine, including chemotherapy.
  • Radiotherapy to your pelvic area.
  • Premature ovarian failure (or premature ovarian insufficiency) – when your ovaries stop working early. Doctors don’t know why this happens but it can run in families. And it may not always be permanent.

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 but around one in four women will have more significant problems.

When your symptoms start can vary widely. They may begin five years before your periods stop, or they may start a year or more after your last period.

Menopause symptoms can go on for about four years or more after your periods stop. But every woman is different. Half of women have some of the symptoms, such as hot flushes, for seven years; for around one in 10 women, symptoms carry on for up to 12 years.

The possible signs and symptoms of the menopause include the following.

  • 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 but it’s something you should talk to your GP about.  
  • 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. 
  • Joint and muscle pain or stiffness.
  • Difficulty sleeping (insomnia) – you may find it hard to sleep because of the night sweats.
  • Vaginal symptoms (for example, 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.
  • 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 happen in your body as you approach and reach the menopause can affect 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. You may also have difficulty concentrating, and have a poor memory.

If you make some changes to your lifestyle, it may help to ease these effects. Your pharmacist or GP may also be able to recommend treatments that can help.

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 two weeks or more, 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 may be 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.

When to seek help for the menopause

If you can manage your symptoms yourself, you may not need to see a doctor. But you may wish to see one if you’re finding your symptoms hard to deal with or if you get symptoms before 40. You might find it difficult to talk about some of the symptoms you’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 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 of FSH, 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.

  • Take practical steps to deal with hot flushes by keeping cool and avoiding possible triggers, such as spicy foods, caffeine, alcohol, smoking or stress. Dress in layers, so you can take off some of your clothes when you feel too warm. 
  • Regular exercise may help you to reduce hot flushes, sleep better and lift your mood. 
  • Pelvic floor exercises can help strengthen your pelvic muscles. (These exercises involve 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 the British Association of Urological Surgeons (PDF, 0.2MB).
  • Lifestyle changes – for more information, see our section: Managing your health.

You can also learn more in our health article: 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 womb (uterus). You’ll probably be offered a combination of oestrogen and progesterone if you still have your womb. HRT can be provided as 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 or not 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. For more information, see our information on hormone replacement therapy.

Most women take HRT for two to five years to treat symptoms such as hot flushes, but you might want or need to take it for longer. Your GP will offer you the choice to gradually reduce or stop taking HRT. Your symptoms may come back for a short time after you stop taking it.

Bioidentical hormones

These include hormones that are similar to your body’s own hormones, but are made from plant sources. They are often promoted as being more ‘natural’ than standard HRT, although 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 that are licensed by the UK regulatory authorities.

Other treatments

If you don’t want or are unable to take HRT, your GP may suggest other treatment options. These 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.
  • Testosterone, if you have a low sex drive.

Complementary therapies

There isn’t any evidence that complementary therapies such as aromatherapy, acupuncture and reflexology, can improve menopausal symptoms. Some women, however, 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.

Premature menopause

Caroline talks about her experience of premature menopause after surgery

Staying healthy during and after 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

Exercise that puts 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 too. Although there’s no proof exercise can reduce hot flushes, it will probably improve your feeling of wellbeing and your mood. Another activity that may improve your mood is yoga.

Eat well

Aim to eat a healthy diet. If you have hot flushes, you may want to avoid foods that trigger them, such as spicy foods and caffeinated drinks.

The menopause causes you to lose calcium from your bones, so it’s important 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.

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

A healthy diet may also help if your hair starts to thin after you go through the menopause.

Lose excess weight

Some women put on weight while going through the menopause, especially around the tummy (abdomen). 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.

Stop smoking

Smoking can lead to an earlier menopause, and may trigger hot flushes. Ask your GP or practice nurse for advice and support to quit, and there’s information from the NHS about stopping smoking. Stopping smoking will also improve the look of your skin.

Limit alcohol

Alcohol may trigger hot flushes in some women, so it may help to limit how much you drink.

Look after your skin

The loss of collagen and elasticity may lead to aging skin after the menopause and it may become dry. Use sun lotion and moisturisers to hydrate your skin to improve its appearance and prevent further damage.

Frequently asked questions

  • Most women in the UK reach the menopause between 45 and 55, with the average age being 51. But the timing of the menopause varies.

    • One in 1,000 women reaches the menopause in their 30s. A few are even younger.
    • One in 100 women reaches the menopause by 40.
    • Up to one in five women has had the menopause by 45.

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

    There are lots of things that can affect when you reach the menopause, including how many pregnancies you’ve had and if you’re overweight. It may be linked to when other women in your family reached theirs. And if you smoke, this can bring the menopause forward by around two years.

  • It could be. If you’re having hot flushes and aren’t 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.

    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 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, you’ll need to continue using contraception.

    It can be very upsetting to go through an early menopause, particularly if you were hoping to start or add to your family. You may find further information, help and support from some of the organisations listed in our section: Other helpful websites.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2020
    Expert reviewers, Mr Robin Crawford, Consultant Gynaecologist and Dr Samantha Wild, Bupa Clinics GP
    Next review due June 2023