Menopause

Menopause is a natural stage of life caused by changing hormone levels. It usually affects women between the ages of 45 and 55, although it can happen earlier.

• Perimenopause is the time leading up to menopause, when symptoms may begin and periods may become irregular.
• Menopause is normally reached when someone has not had a period for 12 months and there is no other medical reason for periods stopping.
• Post-menopause describes the time after menopause.

Anyone who has periods can experience menopause. That includes women, and it also includes some transgender men and non-binary people.

Menopause can also happen following surgery to remove the ovaries, chemotherapy, radiotherapy or certain other medical treatments. When this happens, symptoms can begin suddenly rather than gradually.

Experiences vary greatly. Some people have few symptoms. Others have symptoms that seriously affect everyday life, sometimes for several years.

• Changes to the usual pattern of periods.
• Hot flushes.
• Night sweats.
• Difficulty sleeping.
• Tiredness.
• Low mood, anxiety or mood changes.
• Problems with memory or concentration, sometimes called “brain fog”.
• Headaches or migraines.
• Palpitations — noticeable heartbeats.
• Muscle aches and joint pain.
• Changes in body shape or weight.
• Dry or itchy skin.
• Vaginal dryness, soreness or discomfort.
• Pain during sex.
• Reduced interest in sex.
• Recurrent urinary infections or other urinary symptoms.

These symptoms can also have other causes. Do not assume that every new symptom is due to menopause — thyroid problems, anaemia, depression and other conditions can feel similar. A GP can help work out what is going on.

Our Water Infections (UTIs) and Headaches and Migraines pages cover some of these symptoms in more detail.

During perimenopause, periods may become irregular, lighter, heavier, shorter or longer. Gaps between periods may grow and then shorten again. This is common and does not always need treatment.

Contact a GP if:

• Symptoms are affecting sleep, work, relationships or everyday life.
• You are experiencing symptoms before the age of 45.
• Your periods stop before the age of 45.
• You have unexpected bleeding, or any bleeding after menopause.
• You are uncertain whether symptoms have another cause.
• Treatments are not helping, or are causing side effects.
• Symptoms are affecting your mental wellbeing.

You do not have to wait until symptoms become severe, or until periods stop completely, before asking for help. Our GP Services page explains how appointments and referrals usually work, and Find Local Services helps you locate a surgery or pharmacy near you.

• Menopause before the age of 45 is described as early menopause.
• Menopause before the age of 40 is described as premature menopause, and may involve premature ovarian insufficiency (POI).

Losing oestrogen earlier in life may affect bone and heart health over time, so proper medical assessment and treatment advice are important. A GP can arrange tests and, where appropriate, refer to a specialist.

POI is not always exactly the same as natural menopause. Ovarian activity can occasionally return for a time, so periods and even pregnancy remain possible for some people. This is one reason individual medical advice matters.

Do not start hormones or any other medication without medical assessment. The Daisy Network supports people with premature ovarian insufficiency.

HRT replaces hormones that fall to lower levels during perimenopause and menopause. It can help with symptoms such as hot flushes, night sweats, sleep difficulties, low mood caused by menopause, and vaginal dryness.

• HRT is available in different forms, including tablets, patches, gels and sprays.
• Oestrogen may also be used locally as a vaginal cream, tablet, pessary or ring for vaginal and urinary symptoms.
• Someone who still has a womb will normally require progestogen alongside systemic oestrogen, to protect the lining of the womb.
• Treatment must be chosen according to the person’s symptoms, medical history and preferences.
• Benefits and risks differ between individuals, and between different forms of HRT.

• Cognitive behavioural therapy (CBT) where appropriate.
• Regular physical activity.
• A balanced diet.
• Keeping the bedroom cool.
• Wearing lighter layers that can be removed during hot flushes.
• Reducing possible triggers such as caffeine, alcohol, smoking or spicy food.
• Vaginal moisturisers or water-based lubricants.
• Support for sleep or mental health.
• Other prescribed non-hormonal treatments in appropriate circumstances.

Lifestyle measures may help a great deal, but they are not a guaranteed cure and not a replacement for professional advice. If something is not working, go back to the GP rather than putting up with it.

See also our Sleep, Physical Activity and Obesity and Healthy Weight pages.

Pregnancy may still be possible during perimenopause, even when periods are irregular or infrequent.

HRT is not contraception. It does not prevent pregnancy.

Ask a GP, pharmacist or sexual-health professional how long contraception may be needed. The answer depends on your age, your periods and the contraceptive method being used, so there is no single stopping date that is safe for everybody.

Lower oestrogen levels after menopause can contribute to bone loss, and may affect longer-term cardiovascular health. Sensible general steps include:

• Weight-bearing and resistance exercise, such as walking, dancing or light strength work.
• Eating a balanced diet with appropriate calcium and vitamin D.
• Not smoking.
• Limiting alcohol.
• Having blood pressure and other health risks checked when appropriate.

Do not start high-dose supplements without professional advice. A GP or pharmacist can advise what is suitable for you. Our High Blood Pressure page explains routine checks in more detail.

Symptoms such as hot flushes, heavy periods, poor sleep, anxiety and concentration problems may affect someone at work. Practical requests that often help include:

• Access to drinking water and toilets.
• Better ventilation, or a desk fan.
• Flexibility with uniforms or work clothing.
• Short breaks when symptoms become difficult.
• Adjusted hours or temporary changes where appropriate.
• A private conversation with a manager, occupational health or HR.

Menopause itself is not a separate protected characteristic under the Equality Act 2010. However, unfair treatment may sometimes relate to protected characteristics such as age, sex or disability. Whether that applies depends entirely on the individual circumstances, so this page cannot give a legal conclusion about any particular case.

Acas — menopause at work and the Equality and Human Rights Commission publish current guidance for employees and employers.

Menopause can affect confidence, mood, intimacy, relationships and social life. Broken sleep and constant symptoms wear people down, and that is not a personal failing.

Talking openly with a partner or someone you trust often helps, and so does knowing that what you are feeling is recognised and treatable. Get professional support if anxiety, low mood or distress is persistent or affecting everyday life — see our Mental Health page.

Partners, relatives, friends and colleagues can help by:

• Listening without dismissing symptoms.
• Avoiding jokes or judgement.
• Asking what support would actually help.
• Learning about menopause from trustworthy sources.
• Being patient when symptoms affect sleep, mood or concentration.
• Encouraging medical help where it is needed.

Avoid blaming every change in mood or behaviour on menopause. People still have ordinary feelings, opinions and bad days, and other health problems can occur at the same time.

• NHS — Menopause and perimenopause
• NHS — Menopause and perimenopause: treatment
• NHS — Hormone replacement therapy (HRT)
• NHS — Early menopause
• NICE guideline NG23 — Menopause: identification and management
• Women’s Health Concern
• The Daisy Network — premature ovarian insufficiency
• Acas — Menopause at work
• NHS inform (Scotland) — Menopause
• NHS 111 Wales — Menopause
• nidirect (Northern Ireland) — Menopause
• NHS — Find a GP
• NHS 111

Important notice: Sixpence Support UK provides general information only. This page is not a diagnosis, individual medical advice, or a substitute for assessment and treatment by a qualified healthcare professional. Always speak to a GP, pharmacist or another qualified health provider about your own symptoms, medicines and circumstances. In an emergency, call 999.