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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

Defining the Menopause

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

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.

  • Symptoms_and_impact_on_quality_of_life
    Symptoms and impact on quality of life
  • Past_medical_history
    Past medical history
  • Contraception
    Contraception
  • Smear_status
    Smear status
  • Previous_treatment
    Previous treatment
  • Drug_history
    Drug history
  • Family-history
    Family history including history of early menopause
  • lifestyle
    Lifestyle

Menopause by Numbers
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Bitesize, Educational Menopause modules

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

    • 1
      National Institute for Health and Care Excellence (NICE), 2024. Menopause. Available at: https://cks.nice.org.uk/topics/menopause/ [Accessed: April 2025]
    • 2
      Healthline, 2025. Menopause: Symptoms, Causes, Diagnosis, and Treatment. Available at: https://www.healthline.com/health/menopause [Accessed: April 2025]
    • 3
      Wired-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]
    • 4
      National 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]