What Is Menopause? A Specialist’s Guide

What menopause and perimenopause mean, symptoms that can occur, and the main types of support that may be discussed with a healthcare professional.

By Mr Silas Gimba, FRCOG, Consultant Gynaecologist and Menopause Society Certified Practitioner (MSCP), certificate valid to 31 December 2028

Menopause is a natural life transition. Symptoms and their effect vary considerably: some people have few difficulties, while others find that changes affect sleep, mood, work, relationships or daily wellbeing. This guide explains what menopause and perimenopause mean, symptoms that can occur, and the main types of support that may be discussed with a healthcare professional.

What is menopause?

Menopause means that periods have stopped because ovarian hormone levels have changed. It usually occurs between the ages of 45 and 55, although it can happen earlier. In someone who is not using hormonal contraception, menopause is identified after 12 months without a period.

Menopause itself is not an illness. However, symptoms associated with the menopause transition can be troublesome and deserve appropriate assessment and support.

Perimenopause, menopause and postmenopause

Perimenopause

Perimenopause is the time leading up to menopause. Periods may become less regular, and symptoms can begin months or years before the final period. The pattern is different for each person and symptoms may change over time.

Menopause

Menopause refers to the final menstrual period. It is confirmed only after 12 months without a period, provided hormonal contraception is not affecting the bleeding pattern.

Postmenopause

Postmenopause describes the time after menopause. Some symptoms may improve, while others can continue. Vaginal and urinary symptoms, including vaginal dryness or discomfort, can persist and may need treatment.

Why does menopause happen?

Natural menopause happens as ovarian function changes and hormone levels fall. Menopause may also occur earlier after surgery or some medical treatments. Premature ovarian insufficiency (POI) means the ovaries stop working normally before the age of 40 and requires individual assessment and support.

What symptoms can occur?

There is no single official number of menopause symptoms. Recognised symptoms include:

Changes in periods

Periods may become irregular or change in frequency or flow during perimenopause.

Hot flushes and sweats

Hot flushes and night sweats are common symptoms caused by changes in the body’s temperature control. Their frequency and severity vary.

Mood, memory and concentration changes

Some people experience low mood, anxiety, irritability, memory problems or difficulty concentrating. These symptoms can have several causes and should be considered in the context of the person’s wider health.

Muscle and joint symptoms

Joint and muscle pain can occur during the menopause transition.

Vaginal, urinary and sexual symptoms

Symptoms can include vaginal dryness, discomfort or pain during sex, vulval or vaginal irritation, discomfort when passing urine and reduced sexual desire.

Sleep problems

Difficulty falling asleep, waking during the night or waking earlier than intended may occur. Sleep can also be disrupted by night sweats, mood symptoms or unrelated health and lifestyle factors.

Symptoms such as palpitations, persistent fatigue, unexpected bleeding or significant mood changes can also have causes unrelated to menopause. New, severe or worrying symptoms should be assessed rather than assumed to be hormonal.

How are perimenopause and menopause identified?

In otherwise healthy people aged 45 or over, perimenopause and menopause can usually be identified from symptoms and menstrual history without routine laboratory testing. The approach is different when the person is under 45, is using hormonal treatment, has had a hysterectomy, or when another condition may explain the symptoms.

What support and treatments may be considered?

Treatment and support should be tailored to the individual. The right option depends on symptoms, medical and family history, personal preferences, medical reasons that may make a treatment unsuitable, and the possible benefits and risks.

Hormone replacement therapy

Hormone replacement therapy is one option for some menopause-associated symptoms. A prescriber should discuss its possible benefits and risks, suitable types of HRT and alternatives in the context of the person’s health and priorities. A consultation does not guarantee that a prescription will be issued.

Menopause-specific cognitive behavioural therapy

Menopause-specific cognitive behavioural therapy (CBT), a type of talking therapy, may be considered for hot flushes and sweats, sleep problems or depressive symptoms. It can be used alongside other treatment or when hormone therapy is not suitable or is not preferred.

Vaginal and urinary symptoms

Non-hormonal vaginal moisturisers or lubricants may help some symptoms. Vaginal oestrogen may also be discussed where clinically appropriate. The choice should take account of individual circumstances, preferences and relevant treatment information.

General health measures

Sleep routines, physical activity, stopping smoking, moderating alcohol and eating a balanced diet can support general health. They should not be presented as guaranteed treatments for menopause symptoms.

When should you seek further help?

Speak to a healthcare professional if symptoms are affecting daily life, you are under 45 and think you may have menopause symptoms, or you are unsure whether menopause explains what you are experiencing. Referral to a healthcare professional with expertise in menopause may be appropriate when symptoms do not improve with treatment, side effects continue, or the clinical situation is complex.

Seek urgent medical help for severe or rapidly worsening symptoms. Call 999 or attend A&E for a life-threatening emergency. Use NHS 111 for urgent medical help that is not life-threatening.

Key points

  • Menopause is a natural life transition, but associated symptoms can require support.
  • Perimenopause can begin before periods stop, and its duration and pattern vary.
  • There is no single official count of menopause symptoms.
  • Symptoms should not automatically be assumed to be hormonal when another cause is possible.
  • Treatment decisions should follow an individual clinical assessment and discussion of benefits, risks, alternatives and preferences.

This article provides general information and is not a diagnosis or a substitute for individual medical advice.

Sources

Sources accessed 17 August 2026.