Menopause
- Dr Samantha Wild, Clinical Lead for Women's Health and Bupa GP
The menopause is when your ovaries stop working and your periods stop. For most women, the menopause is a natural stage of life. Menopause symptoms include hot flushes, night sweats and mood changes. The average age that women in the UK reach the menopause is 51, but this can vary widely.
About the menopause
The menopause is the time in a woman’s life when her periods stop completely. It can also affect some intersex, trans and non-binary people. You’re said to have reached the menopause if you haven’t had a period for at least a year. This is usually between the ages of 45 and 55. The time leading up to the menopause is called the perimenopause (or menopausal transition). This can last for a few months to several years. During the perimenopause, you may notice several symptoms. Your periods may also change. They may:
- happen less often than they used to
- happen more often
- be heavier or lighter
- stop completely
If you keep getting periods more often than usual, contact your GP for advice.
You may still be able to get pregnant while going through the perimenopause, so you need to keep using contraception. Doctors usually suggest you can stop contraception:
- when you’re 55
- if you’re over 50, aren’t using other hormonal treatments, and haven’t had a period for a year
- if you’re between 40 and 50, aren’t using other hormonal treatments, and haven’t had a period for two years
Premature and early menopause
If you reach the menopause before you’re 40, this is called premature menopause or premature ovarian insufficiency. When the menopause happens between 40 and 44, it’s called an early menopause.
Causes of the menopause
For most women, the menopause is a natural part of ageing. It happens when your ovaries run out of eggs. Your ovaries also make the hormone oestrogen. So, when they stop working, your blood levels of oestrogen fall. This change disrupts your periods and causes the symptoms of the menopause. Some things can cause a premature or early menopause. These include:
- surgery to remove your ovaries (oophorectomy), which may be done during a hysterectomy
- some types of medicine, including chemotherapy
- radiotherapy to your pelvic area
You may also go through the menopause at an earlier age if you’re:
- from certain ethnic backgrounds – for example, South Asian (from India, Pakistan or Bangladesh backgrounds)
- have certain medical conditions –for example, thyroid problems
In around 9 in 10 women who have an early menopause, doctors can’t find a specific medical cause. Premature ovarian insufficiency can run in families. It may not always be permanent.
Signs and symptoms of the menopause
The menopause affects everyone differently. Your symptoms may not cause you much trouble. Or they may significantly affect your daily life. Around 1 in 4 women and some non-binary people and trans men will have more severe menopausal symptoms. The timing of menopausal signs and symptoms can vary widely. Your symptoms may begin while you’re still having periods or they may start a year or more after your last period. You may not have any vaginal or urinary symptoms until 10 years after your last period. Hot flushes and night sweats may go on for seven years or more after your periods stop. But everyone is different.
During the perimenopause, you may have irregular periods. Your periods may happen more or less often before they stop completely. You may bleed more or less heavily than usual. Speak to your GP if your periods are longer, heavier or more frequent than usual.
Other possible signs and symptoms of the perimenopause and postmenopause include the following.
- 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.
- Mood changes. You may get anxious or irritable or have mood swings. These symptoms can be worse if you’re not sleeping properly.
- Joint and muscle pain or stiffness.
- Difficulty sleeping (insomnia). You may find it hard to sleep because of night sweats. But the menopause can affect your sleep, even if you don’t have night sweats.
- Vaginal symptoms (such as vaginal dryness and pain during sex). These symptoms are due to your vaginal tissue 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 uncomfortable vaginal symptoms.
- Urinary problems. These symptoms include repeated urinary tract infections, leaking urine (incontinence) and needing to go to the toilet more often.
- Memory problems. You may also have difficulty concentrating.
If you’re going through the menopause, you may have an increased chance of developing depression. This is more serious than mood swings. If you find your mood stays low for two weeks or more, contact your GP.
Vaginal bleeding after the menopause
If you start to have vaginal bleeding after you’ve reached the menopause (when you haven’t had a period for a year or more), contact your GP. This is quite common, and there may be a simple explanation. Postmenopausal bleeding may be caused by hormonal changes affecting your vagina. But it can also be a symptom of certain cancers, including womb cancer. So many bleeding from your vagina after the menopause needs to be checked out by your GP.
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 your doctor if your symptoms are hard to deal with or happen before you’re 40.
You may 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 others in your situation. Your GP can support you with lifestyle changes and medicines.
Blood tests
If you’re over 45, your GP will usually diagnose the perimenopause and menopause from your symptoms without doing any tests. If you’re between 40 and 45, your GP may wish to do some blood tests to rule out other causes for your symptoms. If you’re under 40, your GP will do a thorough investigation to determine if you’re having a premature menopause because this can cause long-term health problems. Sometimes, doctors may offer you blood tests to check your levels of follicle-stimulating hormone (FSH). FSH helps to control egg production and oestrogen production in the ovaries. But hormone tests aren’t usually reliable. This is because FSH levels vary naturally during the perimenopause. Your hormone levels can change hour by hour, day by day. So a blood test just shows your hormone levels at that particular moment. There’s also a wide range of normal hormone levels. So you could be getting menopausal symptoms but a blood test may still show your changing hormone levels are normal.
Get personalised menopause support
Speak to a GP with specialist menopause training and get an individual care plan that suits your personal needs.
Self-help for symptoms of the menopause
Many people cope with their symptoms without any specific medical treatment. There’s a lot you can do to help yourself.
Low oestrogen levels during and after the menopause can increase your risk of getting certain diseases. These include osteoporosis (thinning of the bones) and heart and vascular (blood vessel) problems. So, it’s more important than ever to try to stay healthy during and after the menopause.
Keeping active
Exercise that puts pressure on your bones – for example, running and walking – can help to strengthen them and reduce your risk of osteoporosis. Being physically active can also:
- help to protect against heart disease and stroke
- lift your mood
- improve your general wellbeing
- ease hot flushes
Eating well
Aim to eat a healthy diet – low in saturated fat and high in fibre and protein. Reducing your intake of caffeine may help to ease hot flushes. The menopause increases bone loss. Calcium helps to build and maintain healthy bones. So it’s important to include two or three portions of calcium-rich foods such as dairy products in your daily diet. It’s also important to get enough vitamin D because it’s vital for bone health. The UK government recommends that all adults take a 10-microgram vitamin D supplement every day during the autumn and winter months.
Losing excess weight
You may put on weight during the menopause, especially around your tummy. This may be linked to lowered oestrogen levels but also to getting older and to lifestyle changes. Losing weight will help to reduce your risk of heart disease and improve your overall health. It may also help to ease hot flushes.
Stopping smoking
Smoking can cause an earlier menopause and trigger hot flushes. It can also affect your general health. Ask your GP or practice nurse for advice and support on how to quit.
Limiting alcohol
Alcohol may trigger hot flushes. It can also affect your sleep quality and your mood. So it may help to limit how much alcohol you drink.
Easing mood changes
If your mood is low or you’re feeling anxious, relaxation therapies and yoga may help.
Cognitive behavioural therapy (CBT) is recommended for anxiety and depression at the menopause. It can help to change the way you think, feel and behave. CBT may also help with:
- hot flushes and night sweats
- sleep problems due to night sweats
You can have CBT sessions with a professional therapist on your own or in a group – face-to-face or online. Or you can learn how to do CBT yourself using self-help books or an online programme.
Managing hot flushes
If you’re prone to hot flushes, you may be able to ease them by:
- avoiding possible triggers –for example, spicy foods
- keeping cool by turning down the central heating and using a fan
- dressing in layers so you can take off some clothes when you feel too warm
- reducing stress with relaxation therapies or cognitive behavioural therapies
Improving your pelvic floor health
Pelvic floor exercises can help to strengthen your pelvic floor muscles. These involve squeezing and releasing the muscles that support your bowel, bladder and vagina. This may improve your bladder control. It may also help to ease other symptoms such as long-term pelvic pain or constipation. A specialist physiotherapist can give you advice on pelvic floor exercises. You can also download pelvic floor exercise apps on your phone.
Treatment of the menopause
Hormone replacement therapy (HRT)
If you’re finding it hard to manage your menopausal symptoms, your GP may suggest you try hormone replacement therapy (HRT). HRT may help many menopausal symptoms including night sweats and hot flushes, mood swings and vaginal dryness. It can also help to reduce your risk of osteoporosis. Most menopausal symptoms should start to improve within three months of starting HRT.HRT works by helping to restore your blood levels of oestrogen. Sometimes you may need to use the hormone progesterone too. You may be offered:
- oestrogen on its own (called oestrogen-only HRT) if you’ve had a hysterectomy and your womb (uterus) has been removed
- a combination of oestrogen and progesterone (called combined HRT) if you still have your womb – you may have both hormones every day (continuous combined HRT) or have only the progesterone part for 10 to 14 days of each month (sequential combined HRT)
HRT comes in lots of different forms, including oral tablets, skin patches, skin gels, spray, vaginal rings, vaginal creams and pessaries. You and your doctor can discuss which form is the best one for you.
Using HRT has some potential risks. These risks depend on your age, which HRT you’re using and how long you’re using it for. Whether you wish to use HRT is an individual decision. Your GP can talk with you about the possible risks and benefits of using HRT and the safest option for you. You may need to use HRT for between 2 and 5 years to treat your symptoms. But you may also need to use it for longer – for most people, this is safe to do. Your symptoms may come back for a short time after you stop using it. Gradually reducing HRT, rather than stopping suddenly, will help to prevent this. Testosterone is also used with HRT by some women if they have a low sex drive.
Body-identical and bioidentical hormones
Your doctor can prescribe licensed body-identical hormones in the form of oestradiol and micronised progesterone’s on the NHS. Body-identical hormones are strictly regulated. They are different from bioidentical hormones.
Bioidentical hormone preparations are often custom-made (compounded) and are not recommended. They are often promoted as being more ‘natural’ than standard HRT but can’t be prescribed on the NHS. This is because these hormones are unregulated, which means doctors can’t be sure they’re safe and effective.
Other treatments
If you can’t or don’t want to take HRT, your GP may suggest other treatments. These may include the following.
- Talking therapies, such as 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 moisturisers or lubricants to help with vaginal dryness.
- Non-hormonal medicines such as antidepressants, fezolinetant or clonidine, for hot flushes and sweats.
Complementary therapies
There’s no evidence that complementary therapies such as aromatherapy, acupuncture and reflexology can help menopausal symptoms. Herbal remedies, such as black cohosh and soya-based foods, may help hot flushes. But these can have side-effects and interact with other medicines. Ask your pharmacist for advice if you plan to try any herbal products.
Menopause: your questions answered
Transcript
Who are you and what is your background?
Hello,
my name's Dr. Rebecca Rohrer. I'm a doctor
practising clinically, medical director at Bupa,
and I've got a passion for women's health.
What is the menopause?
The menopause describes a time
where people's periods stop, and that happens
because of declining hormone levels.
When we think about the menopause,
however, lots of people think about the time, both before
and after that time, both the perimenopause
and the post menopause.
It typically occurs when people are between 45 and 55,
but it's important to remember that it can happen before or
after that as well.
What's the difference between menopause and perimenopause?
Perimenopause is the time
when you still may be having periods,
but they might be irregular,
but you may have some of the symptoms of the menopause, such
as hot flushes, for example.
In contrast, the menopause describes the time when your
periods have stopped.
That time will vary depending on how old you are.
So before the age of 50, we typically term the menopause
as two years after your last period, and over the age of 50.
We term the menopause as one year after your last period.
It's really important for people to remember that
during the perimenopausal period, people still can be
fertile, so it's important
to use contraception if you're keen to avoid pregnancy.
What are the symptoms of the menopause?
Symptoms of the menopause are really,
really wide ranging. For lots of people,
they might notice some less frequent periods.
Important to recognise that if you get bleeding in
between your periods, that's a reason to go
and see your doctor because it can be a sign
of other conditions as well.
However, other symptoms of the menopause
that people might see include: night sweats
and hot sweats even during the day,
that can lead to lots of problems sleeping
for example. Some people describe a sense of brain fog
or changes in their mood potentially
with side effects like depression.
People could also notice a change in their sex drive,
and some people notice an impact on their weight.
Given how wide these symptoms are, it's really important
to be aware of anything new that's happening
to you in your body and the impact of that on your life,
and to go and see a doctor or GP if you're concerned.
How long does the menopause last?
The menopause transition,
which includes the perimenopause, the menopause,
and the post menopause, can be up to seven years long,
and it's really variable in terms of
what symptoms people might experience.
Some people may have no symptoms at all,
and some people might experience symptoms
that have a big impact on their quality of life.
It's therefore really important to be aware of what signs
and symptoms you're getting and to speak
to a doctor if necessary.
It's also important to remember that some of those symptoms,
including things like joint pain
and vaginal dryness, may last even
after that postmenopausal period, so
to seek help sooner rather than later.
What are the stages of the menopause?
The menopause transition can be thought of
as occurring in three different stages.
The perimenopause covers a time in people's lives
where their cycles might be becoming irregular.
They still might be experiencing some of the symptoms
of menopause, but they'll still be fertile,
so it's important to use contraception if they want
to avoid pregnancy.
The menopause really describes the time when periods have
stopped, and that depends on how old you are.
So under the age of 50, it's important to remember
that the menopause can only occur when you've not had a
period for two years. Over the age of 50,
It occurs when you haven't had a period for one year.
The post menopause covers the time
after that, people still might be experiencing symptoms
of the menopause, and even
after the post menopause is over,
people still might be experiencing symptoms such
as joint pain or vaginal dryness in the long run.
What causes the menopause?
The menopause is a naturally occurring process
and it happens to everybody who has periods. Broadly,
there are four reasons why it can happen.
The first is a natural decline in hormones
as the ovaries release for your eggs.
The second can be as a result of surgery, for example,
to remove the ovaries,
and the third is sometimes as a side effect
of medication treatments such
as cancer treatment and chemotherapy.
And finally, unfortunately, for some people,
the cause is unknown
and that can particularly affect younger women.
Do you start the menopause when you run out of eggs?
Menopause happens when the number
of functioning eggs has declined.
Now, when females are born, they have between one
and 3 million eggs.
During a person's reproductive lifetime,
a very small proportion of those will be lost
through ovulation,
but most will die naturally through a process called atresia.
At the time of the menopause, people can have as few
as 10,000 functioning eggs left.
What treatments are prescribed to help symptoms of the menopause?
The symptoms of the menopause really vary. Broadly,
they can be thought of in terms of the physical symptoms,
irregular periods, reduced sex drive, hot flushes,
problems with your sleep, and vaginal dryness, for example.
But we can also think about those symptoms in terms
of the psychological impact of the menopause, low mood,
and even depression in certain circumstances.
There are lots of treatments available
to support these symptoms.
Lots of people will have heard
of hormone replacement therapy,
otherwise known as HRT,
which replaces the hormones which are naturally declining
during the menopause.
But there are other treatments available to help
with those physical symptoms,
and those vary depending on your symptoms
and how severe they are.
Also worth remembering that in terms
of supporting your psychological mood
and the symptoms of the menopause, there's lots
of help available, even in terms of support groups, referral
to therapy or even medication.
What does 'HRT' stand for?
HRT stands for hormone replacement therapy,
and it's a medication that replaces some of the hormones
that naturally decline during the menopause.
What does HRT do?
HRT or hormone replacement therapy aims
to replace those hormones
that naturally decline during the menopause.
It is usually comprised of oestrogen and/or progesterone,
and they're really important not just
to regulating your cycles,
but throughout your reproductive lifetime in terms
of controlling ovulation, pregnancy,
and even things like bone health.
HRT does a great job at relieving a lot
of the symptoms of menopause.
Things like hot flushes, vaginal dryness,
and even brain fog.
It also is really effective in terms of reducing your risk
of long-term complications after the menopause,
things like osteoporosis and cardiovascular disease.
Lots of people ask about a hormone called testosterone.
Can be helpful for some women,
but at the moment is only prescribed by specialist doctors.
Does every woman get HRT?
HRT or hormone replacement therapy
may not be the best treatment for everybody.
Some people may decide that they don't want to take HRT,
and some people may not be suitable for HRT, for example,
if they've had any previous diagnosis of breast, ovarian,
or wound cancer, for example.
However, there are lots of treatment options out there,
so if HRT isn't for you, then it's still really important
to speak to your doctor or GP about
what options might be available to you.
Do you have to pay for HRT?
Whether you pay for your hormone replacement therapy
or HRT depends on where you've got the prescription from.
Any private prescriptions will need to be paid for.
If you receive your prescriptions through the NHS,
it depends on whether you pay for those or not.
If you have an exemption certificate, then you won't need
to pay for your HRT prescriptions.
If you do, there will either be a small charge every time
you get a prescription, but you can also get a prepayment
certificate, which allows you to get as many prescriptions
as you need for the year for a relatively small fee.
What different types of HRT are there?
There are lots of different kinds
of hormone replacement therapy or HRT.
They vary by the kind of hormone that they have in them.
Some have oestrogen or progesterone, and some have both.
It also varies by how you take the medicine.
The most common form is by a tablet,
but it's also available as sprays, as creams,
and even as gels or patches.
There's also the hormone coil,
which is the intrauterine system,
which contains a small amount of progesterone
and is inserted through the vagina
and sits just inside the womb.
How long do you need to take HRT for?
You can take hormone replacement therapy
or HRT for as long
as the benefits outweigh the risks of taking it.
Really recommend speaking to your doctor to see
how the treatment's working for you
and how your symptoms are having an impact on your quality
of life so that you can decide how long is right for you.
What are the risks of HRT?
The risk of developing any serious side effects from HRT
are really low, and it's likely
that the benefits outweigh those.
If you are under 60
and not at an increased risk of a blood clot
or breast cancer, it's likely
that the benefits outweigh the risks,
but this can be a complicated conversation,
so it's really important to speak to your doctor
or GP to be able to weigh up that decision
to make the best choice for you.
Are there non-hormonal treatments for the menopause?
There are lots of non-hormonal treatments
that are available to people who either don't want
to take hormonal treatment
or who can't take hormonal treatments.
They can help address some
of the physical symptoms like a low sex drive,
vaginal dryness, or hot flushes,
and can also support some of the mood symptoms
that people can develop during the menopause.
It's really important that you go and speak to your GP
or doctor about what treatments are right,
because they vary so much depending on
what symptoms are impacting your life.
Can you get pregnant during the menopause?
During the menopause, the number
of functioning eggs is declining.
Even during the perimenopause
where cycles may become irregular,
it can still be possible to become pregnant.
Now, fertility naturally starts
to decline from your mid thirties onwards,
but it's still possible to become pregnant.
Therefore, it's recommended
that you should still use contraception
if you want to avoid a pregnancy. We recommend
that you could only stop contraception if you haven't had a
period for two years under the age of 50
or for a year over the age of 50.
Does diet and exercise help the symptoms of menopause?
In general, keeping active,
eating a good varied diet can help you cope
with the symptoms of menopause, but also help to protect
and ensure your long-term health.
I think I am starting the menopause - what should I do?
I'd really recommend that you keep a track
of your symptoms so
that you can monitor them either in a diary
or perhaps an app to understand
what symptoms you're experiencing, how they relate
to your monthly cycle, and
what impact they're having on your life.
It's very helpful to go and speak to a nurse, your GP
or doctor, about those symptoms as they may want
to order some more tests
or to discuss some treatment options with you.
What causes early menopause?
If you are under the age of 45
and have noticed some symptoms of the menopause
or your periods becoming irregular
or stopping, it's a really good idea to speak
to your GP or doctor.
There can be a few different causes of an early menopause.
That can include genetic factors,
but also things like previous medical treatment,
for example, chemotherapy for cancer in the past.
In addition, operations like removal of the womb
or the ovaries can impact the menopause
and unfortunately, in a small proportion of cases,
the menopause can occur early for no known reason.
The menopause is affecting my quality of life - what should I do?
A really good first port of call is to speak
to your doctor or GP.
It may be that the symptoms require either some more tests
and/or treatments to help to reduce them.
I'd also recommend reaching out to your friends
and family so that they can support you
through this time. Worth
bearing in mind that there's lots of resources available
to people to support them through the menopause,
either charities, local support groups,
or online communities.
And finally, your employer may have particular benefits
or support services in place that can help you.
The menopause is affecting my libido - what should I do?
The symptoms of the menopause are so wide ranging
that it's no surprise
that some people find their libido is lower
during this time. Declining levels of hormones can lead
to a lower sex drive.
Vaginal dryness can mean
that penetrative sex is uncomfortable,
and there are also mood symptoms
that can happen during the menopause.
It's really important to speak to your GP
or doctor about these, sometimes
because more tests are needed,
but often there are lots of treatments available
to support you, and I'd recommend trying to speak
to your partner, even though that's really difficult,
keeping those channels
of communication open offers a really good chance
of supporting you in the long term.
What's the link between menopause and bone density?
The hormones that decline during the menopause, oestrogen
and progesterone, have a role in protecting bone health.
After the menopause, when you lose its production,
you can get reducing bone density
and that can put you at increased risk
of conditions like osteoporosis.
How will I know when the menopause has ended?
The menopause describes a time where your periods stop.
Under the age of 50,
we talk about that happening two years
after your last natural period, and over the age of 50,
that's one year after your last natural period.
But during the post-menopausal period,
you can still get symptoms of the menopause,
like hot flushes for example.
It's therefore really important
that if you're still having symptoms
and if they're still impacting your quality of life, you go
and speak to your GP or doctor
because there are lots of treatments available.
How should I talk to my partner/family about the menopause?
If you are going to find it helpful to talk
to your partner and family about the symptoms you're
experiencing and how they're affecting your life,
then I'd really recommend it.
Often, people don't understand what impact menopause
or symptoms have on somebody,
and so explaining what symptoms you're experiencing,
how you are finding it, and what help
or support you might find helpful,
could be really beneficial.
I would like more support from my employer - what should I do?
Well, the first thing to remember is you're not alone.
Many people going through the menopause feel
that their symptoms have an adverse effect on them
and become concerned about that.
Now, your employer may offer menopause benefits,
so it's worth asking your HR department
or your benefits department about whether those apply.
Your employer also needs to provide reasonable adjustments
to allow you to work well.
That might include moving you to a cooler part
of the office, providing a desk fan, allowing you to keep
phone memos to help you deal with the brain fog,
for example. If you are finding that your employer
isn't helpful, then please remember
that actually it's a statutory requirement for them
to make reasonable adjustments,
and menopause can be classed
as a disability in this respect,
so it's worth having a conversation with them.
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Most people in the UK reach the menopause between 45 and 55. The average age is 51. But the timing of the menopause varies.
For more information, see our section about the menopause.
Hot flushes can have lots of causes, including an early menopause. Your GP may recommend blood tests to check what may be causing them. If you go through the menopause before the age of 40, this is called a premature menopause.
There’s no specific end to the menopause. You’re said to have reached the menopause when you’ve had no periods for 12 months. The time leading up to the menopause is called the perimenopause. This can last for several years. Once you’ve reached the menopause, you’re in the postmenopause stage.
For more information, see our section about the menopause.
During the perimenopause, your periods may be irregular or stop completely. You may notice several symptoms, including hot flushes, mood swings, memory changes (‘brain fog’) and aching joints. But these may not cause you much trouble. For more information, see our section on symptoms of the menopause.
Hormone replacement therapy (HRT)
Osteoporosis
Symptoms of menopause – how to help hot flushes
Going through the menopause is a natural biological change for women.
What is the perimenopause?
The perimenopause is when your hormone levels start to change, but before your periods stop for good. It can cause a wide range of symptoms, both physically and mentally. Here we discuss the perimenopause, ways to cope with it and how to look after your body as it changes.
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- Bioidentical HRT. The British Menopause Society. thebms.org.uk, published March 2024
- Fezolinetant. Indications and dose. NICE British National Formulary. bnf.nice.org.uk, last updated October 2024
- Osteoporosis treatment and management. Medscape. emedicine.medscape.com, updated January 2024
- Prevention of cardiovascular disease. Patient. patient.info, last updated April 2023
- Nutrition in menopause. Women’s Health Concern. www.womens-health-concern.org, published June 2023
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- Stopping smoking. Action on Smoking and Health. ash.org.uk, published March 2020
- Alcohol and sleep. Drinkaware. www.drinkaware.co.uk, last reviewed November 2022
- What is the menopause? The British Menopause Society. thebms.org.uk, published October 2021
- FSRH guideline: Contraception for women aged over 40 years. Faculty of Sexual and Reproductive Health (FSRH). www.fsrh.org, amended July 2023
- Premature ovarian insufficiency (POI). The British Menopause Society. thebms.org.uk, reviewed March 2024
- Personal communication by Dr Samantha Wild, Clinical Lead for Women's Health and Bupa GP, January 2025
- Cognitive behaviour therapy (CBT) for menopause symptoms. The British Menopause Society. thebms.org.uk, published October 2019
- Cognitive and behavioural therapies. Patient. patient.info, last updated December 2022
- Pelvic floor dysfunction: prevention and non-surgical management. Context NICE guideline NG210. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated December 2021
- Bioidentical HRT. The British Menopause Society. thebms.org.uk, published March 2024
- Menopause. Differential diagnosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last updated November 2024
- Vitamin D and clinically extremely vulnerable (CEV) guidance. Department of Health and Social Care. www.gov.uk, updated February 2021
- Victoria Goldman, Freelance Health Editor
