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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
,

    51 years old is the average age of menopause. Premature menopause affects 1 in 100 women under 40.

    Menopausal symptoms typically continue around 4 years after the last period.

    80% of those going through the menopause experience common symptoms such as hot flushes and night sweats.

    1.5 million women are estimated to be going through the menopause in the UK right now.

Bitesize, Educational Menopause modules

urogential symptoms
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 
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
Muscuskeletol thumbnail
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

    • 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]