The menopause

The usual age of onset of the menopause when women start experiencing symptoms is around 45-47 years old. The average age for their last period is around 50 years old.

The most common symptoms include hot flushes, difficulty sleeping, mood changes, loss of energy, low sex drive, dry vagina – which can lead to pain or discomfort during sex, and urinary symptoms like stress incontinence. As women go through their forties their hormone levels can fluctuate – sometimes wildly. Hot flushes can go on for decades – but usually stop within a few years of someone’s last period. But symptoms like a dry vagina or urinary symptoms often persist.

Most women do not take hormone replacement therapy (HRT), which has to be prescribed by a doctor. They just accept that the menopause is a natural event and get on with it, not allowing it to dominate their life. Around a quarter of women have problematic symptoms that affect their quality of life significantly, so they need treatment. Research shows that a woman on HRT should get on average 18 fewer hot flushes per week. HRT does not stop ageing changes, it masks the symptoms of the menopause, rather than delays it.

HRT can be taken as tablets or absorbed from patches or applied as oestrogen hormone cream or pessaries for a dry vagina or urinary symptoms.


Q1. I’ve taken HRT since I was 50 years old; and five years on my GP wants to stop it. My mother took HRT until she was 70 years old to stop her bones thinning. Why can’t I?

  1. You can take HRT for 5 years or so whilst your menopausal symptoms are worse. But HRT is no longer recommended long term to prevent osteoporosis, as there are concerns about HRT causing possible increased risks of heart disease and breast cancer. Recent research has shown that for women taking HRT around the time of their menopause, heart disease is no more likely to happen. HRT may slightly increase risks of breast cancer, ovarian cancer and endometrial cancer (of your uterus or womb) – but research findings vary depending on the age of women included in the trials and exact content of HRT taken.

Q2. I have terrible hot flushes but don’t want to take any drugs. What else can I try?

A. You might try cognitive behavioural therapy (CBT) which could work or even hypnosis. Other medication that might help with hot flushes is clonidine – which can also be used to treat raised blood pressure but side effects might be sleeplessness, dry mouth, constipation.

Q3. My periods stopped when I was 38 years old and I’ve been on HRT for 8 years since then. Is it too risky to carry on for longer? I’m scared of hot flushes coming back.

A.The risks of women with a premature menopause like yours, taking HRT are different. General advice is to take HRT until the age of 50 years to boost your hormones until the age that most other women go through the menopause.