Menopause and Hormone Replacement Therapy (HRT)

The menopause can cause various symptoms such as hot flushes and changes to your vagina and genital skin. Hormone replacement therapy (HRT) may ease your symptoms. If you are considering taking HRT, you should discuss the risks and benefits fully with your doctor. The lowest effective dose of HRT should be taken. You should have regular follow-up to decide whether you still need HRT. For most women who use HRT in the short term for the treatment of their menopausal symptoms, the benefits of treatment outweigh the risks.

What is the menopause?

Strictly speaking, the menopause is your last menstrual period. However, most women think of the menopause as the time of life leading up to, and after, their last period. In reality, your periods don't just stop. First they tend to become less frequent. It can take several years for a woman to go through the menopause completely. Women are said to have gone through the menopause (be postmenopausal) when they have not had a period at all for one year.

What causes the menopause?

A natural menopause occurs because as you age your ovaries stop producing eggs and make less oestrogen (the main female hormone). The average age of the menopause in the UK is 51. Your menopause is said to be early if it occurs before the age of 45 and it is called Premature Ovarian Insufficiency if it occurs before the age of 40 years.

There are certain things that may cause an early menopause - for example:

•     If you have surgery to remove your ovaries for some reason, you are likely to develop menopausal symptoms straightaway.
•     If you have radiotherapy to your pelvic area as a treatment for cancer.
•     Some chemotherapy drugs that treat cancer may lead to an early menopause.
•     If you have had your womb (uterus) removed (hysterectomy) before your menopause. Your ovaries will still make oestrogen. However, it is likely that the level of oestrogen will fall at an earlier age than average. As you do not have periods after a hysterectomy, it may not be clear when you are in 'the menopause'. However, you may develop some typical symptoms (see below) when your level of oestrogen falls.

•     An early menopause can run in some families.
•     In many women who have an early menopause, no cause can be found.

Early menopause and premature menopause are not discussed in detail in this leaflet.

What are the possible symptoms and problems of the menopause?

The menopause is a natural event. Every woman will go through it at some point. You may have no problems. However, it is common to develop one or more symptoms which are due to the low level of oestrogen. About 8 out of 10 women will develop menopausal symptoms at some point. Around a quarter of women have very severe symptoms.

Symptoms of the menopause can last much longer than most women realise. More than half of women actually have symptoms for more than seven years.

Short-term symptoms

These short-term symptoms only last for a few months in some women. However, for others they can continue for a few years after their last period:

•     Hot flushes occur in about 3 in 4 women. A typical hot flush lasts a few minutes and causes flushing of your face, neck and chest. You may also sweat (perspire) during a hot flush. Some women become giddy, weak, or feel sick during a hot flush. Some women also develop a 'thumping heart' sensation (palpitations) and feelings of anxiety during the episode. The number of hot flushes can vary from every now and then, to fifteen or more a day. Hot flushes tend to start just before the menopause and can persist for several years.
•     Sweats commonly occur when in bed at night. In some cases they are so severe that sleep is disturbed and you need to change your bedding and nightclothes.
•     Other symptoms may develop, such as headaches, tiredness, being irritable, difficulty sleeping, depression, anxiety, aches and pains, loss of sex drive (libido), and feelings of not coping as well as before.
•     Changes to your periods. The time between periods may shorten in some women around the menopause; in others, periods may become further apart, perhaps many months apart. It can also be common for your periods to become a little heavier around the time of the menopause.

Longer-term changes and problems

•     Skin and hair. You tend to lose some skin protein (collagen) after the menopause. This can make your skin drier, thinner and more likely to itch.
•     Genital area. Lack of oestrogen tends to cause the tissues in and around your vagina to become thinner and drier. These changes can take months or years to develop:

1.         Your vagina may shrink a little and expand less easily during sex. You may experience some pain  when you have sex.
2.         Your vulva (the skin next to your vagina) may become thin, dry and itchy.
3.         You may notice that you need to pass urine more frequently.
4.         Some women develop problems with recurrent urine infections.

•     'Thinning' of the bones (osteoporosis). As you become older, you gradually lose bone tissue. Your bones become less dense and less strong. The amount of bone loss can vary. If you have a lot of bone loss then you may develop osteoporosis. If you have osteoporosis, you have bones that will break (fracture) more easily than normal, especially if you have an injury such as a fall. Women lose bone tissue more rapidly than men lose it, especially after the menopause when the level of oestrogen falls. Oestrogen helps to protect against bone loss.
•     Cardiovascular disease. Your risk of cardiovascular disease (disease of the heart and blood vessels), including heart disease and stroke, increases after the menopause. Again, this is because the protective effect of oestrogen is lost. Oestrogen is thought to help protect your blood vessels against atheroma. In atheroma, small fatty lumps develop within the inside lining of blood vessels. Atheroma is involved in the development of heart disease and stroke.

Do I need any tests to see if I am going through the menopause?

Your doctor can usually diagnose the menopause by your typical symptoms. Hormone blood tests are not usually needed to confirm that you are going through the menopause. However, they may be helpful in some cases - for example, in women aged under 45 years.

Other blood tests or scans may be undertaken in some women, especially if they do not have symptoms which are typical of the menopause.

It is important that you keep up to date with the national cervical screening programme and breast cancer screening programme, if appropriate.

Do I need treatment for the menopause?

Without treatment, the short-term symptoms discussed above last for several years in most women. HRT is available to ease the symptoms of the menopause. It has benefits and risks, which are discussed below.

There are treatments other than HRT for menopausal symptoms. As a rule, they are not as effective as HRT but may help relieve some symptoms. See separate leaflet called Menopause - Alternatives to HRT for more details.

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