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Menopause

Menopause, Perimenopause and endometrial protection

Menopause is a natural process when menstruation stops permanently because of loss of ovarian follicular activity. It coincides with follicular depletion and a drop in oestrogen and progesterone levels. A diagnosis is usually made after 12 months of amenorrhoea. The mean age of natural menopause is 51 years.

  • Before the menopause, patients undergo a period of irregular cycles of ovulation and menstruation. This is called perimenopause.
  • Some patients may undergo menopause earlier between the ages of 40-45 years. This is defined as early menopause. However before the diagnosis is made the causes of secondary amenorrhoea (i.e. pregnancy, cushing's syndrome, hormone secreting tumours etc) need to be excluded.
  • If ovarian function is lost before the age of 40, this is referred to as premature ovarian insufficiency.

On average, most symptoms last around

4 years
from when a woman’s periods end, however, around
1 in every 10
 women experience them for up to
12 years

Menopausal Symptoms

The following symptoms are commonly associated with the peri-menopause and the menopause:

  • Change in Menstrual pattern 
  • Vasomotor symptoms (Hot flushes/night sweats)
  • Sleep disturbance
  • Mood disorders (labile mood, depression)
  • Urogenital symptoms 
  • Altered sexual function
  • Fatigue
  • Problems with memory/concentration 
  • Joint pain
Defining the Menopause

Diagnosing the Menopause

Diagnosis is usually made clinically based on symptoms. A blood test is not usually indicated.     

Serum follicle-stimulating hormone (FSH) levels may be considered in the following patients:

  • over 45 years with atypical symptoms.
  • suspected early menopause (i.e. menopausal symptoms between 40–45 years).
  • suspected premature ovarian insufficiency (i.e. menopausal symptoms before age 40).
Diagnosing the Menopause

History Taking

Important questions to consider during initial assessment are:

These questions will all help determine which treatment is necessary for the patient.

Menopause by Numbers
,

Bitesize, Educational Menopause modules

Urogenital Symptoms and Sexual Difficulties
(5 mins) Often underreported and undertreated symptoms that significantly affect a woman's relationships.
PP-PF-WHC-IUS-GB-0085 October 2024
Relationship Between Flushes and Sweats, Sleep and Mood
(4 mins) Vasomotor symptoms (VMS), sleep disturbances, and mood changes are distressing menopause symptoms.
PP-PF-WHC-IUS-GB-0083 October 2024
Musculoskeletal Symptoms, Anxiety, Low Mood and Brain Fog
(4 mins) Causes for musculoskeletal (MSK) symptoms, how menopause can worsen existing anxiety and depression.
PP-PF-WHC-IUS-GB-0084 October 2024

PP-PF-WHC-IUS-GB-0080 | April 2025

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Menorrhagia