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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
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
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).
History Taking
Important questions to consider during initial assessment are:
These questions will all help determine which treatment is necessary for the patient.
Symptoms and impact on quality of life
Past medical history
Contraception
Smear status
Previous treatment
Drug history
Family history including history of early menopause
Lifestyle
Menopause by Numbers,
- What is the average age of Menopause?expand_more
51 years old is the average age of menopause. Premature menopause affects 1 in 100 women under 40.
- How long do menopausal symptoms last?expand_more
Menopausal symptoms typically continue around 4 years after the last period.
- Is it normal to get hot flushes and night sweats?expand_more
80% of those going through the menopause experience common symptoms such as hot flushes and night sweats.
- How many women are going through the menopause in the United Kingdom?expand_more
1.5 million women are estimated to be going through the menopause in the UK right now.
PP-PF-WHC-IUS-GB-0080 | April 2025
- Referencesexpand_less
- 1National Institute for Health and Care Excellence (NICE), 2024. Menopause. Available at: https://cks.nice.org.uk/topics/menopause/ [Accessed: April 2025]
- 2Healthline, 2025. Menopause: Symptoms, Causes, Diagnosis, and Treatment. Available at: https://www.healthline.com/health/menopause [Accessed: April 2025]
- 3Wired-Gov, 2015. Women with symptoms of menopause should not suffer in silence, says NICE. Available at: https://www.wired-gov.net/wg/news.nsf/articles/Women+with+symptoms+of+menopause+should+not+suffer+in+silence+14112015080500?open [Accessed:April 2025]
- 4National Institute for Health and Care Excellence (NICE), 2024. Menopause: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-pdf-1837330217413 [Accessed: April 2025]