Menopause information can be confusing. This page examines five misconceptions using current NICE and NHS guidance. It provides general information and does not replace an individual clinical assessment.
Key points
- Perimenopause can begin before periods stop, and symptoms can occur while periods continue.
- Menopause is usually identified after 12 months without a period when the person is not using hormonal contraception.
- For otherwise healthy people aged 45 or over who were registered female at birth and have menopause-associated symptoms, NICE usually advises identification from symptoms and changes in periods without laboratory tests.
- HRT decisions require an individual discussion of benefits, risks and alternatives. HRT should not be offered solely to prevent diseases of the heart and blood vessels or dementia.
- Healthy eating, physical activity, sleep and mental wellbeing support general health. They do not replace clinical assessment when symptoms are troublesome or affecting daily life.
Misconception 1: “Symptoms only begin after periods stop”
Perimenopause can begin before periods stop. Menstrual-cycle changes, hot flushes, night sweats, mood changes, and memory or concentration difficulties can occur while periods continue.
Menopause is confirmed only after at least 12 months without a period when the person is not using hormonal contraception and there is no other cause for absent periods. Hormonal contraception can change bleeding patterns, so an individual assessment may be needed.
Misconception 2: “You just have to put up with symptoms”
The menopausal transition is a natural stage of life, but support is available if symptoms are troublesome or affect sleep, mood, work, relationships or daily life.
Options depend on symptoms, preferences and medical history. They may include general health measures, menopause-specific cognitive behavioural therapy (CBT), a type of talking therapy, HRT or other treatments after an individual clinical assessment. A consultation does not guarantee that a particular treatment or prescription will be appropriate.
Misconception 3: “Everyone needs a blood test to confirm menopause”
NICE advises identifying perimenopause or menopause without laboratory tests in otherwise healthy people aged 45 or over who were registered female at birth and have menopause-associated symptoms.
A blood test for follicle-stimulating hormone (FSH) may be considered for people aged 40 to 45 with menopause-associated symptoms, including a change in their menstrual cycle, or for people under 40 when menopause is suspected. NICE advises against using FSH to identify menopause in people taking combined hormonal contraception containing oestrogen and progestogen, or high-dose progestogen.
Testing may still be appropriate when another condition is suspected. A clinician should decide this from the individual history and assessment.
Misconception 4: “HRT is unsafe for everyone”
HRT is not suitable for everyone, but it may be appropriate for some people after an individual assessment. Suitability depends on age, symptoms, medical and family history, risk factors, whether a person has a womb, the type of HRT and how it is taken.
NICE advises discussing benefits and risks. Combined HRT increases breast-cancer risk, and the increase rises with duration of use. Oestrogen-only HRT is associated with very little or no increase in breast-cancer risk. HRT tablets increase the risk of a blood clot in a vein. HRT used through the skin, such as a patch or gel, is not linked to an increased risk compared with people not taking HRT.
HRT is used to manage menopause-associated symptoms. NICE says it should not be offered solely to prevent diseases of the heart and blood vessels or dementia.
Misconception 5: “Natural remedies can replace clinical assessment and treatment”
Healthy eating, physical activity, sleep and mental wellbeing support general health and may help some symptoms. Herbal supplements are not a substitute for clinical assessment, may interact with medicines, and are not all shown to be effective or safe.
Treatment should be chosen for the individual. Depending on symptoms, preferences and medical history, options may include HRT, menopause-specific cognitive behavioural therapy or other treatments.
Food and supplements should not be presented as cures for menopause-associated symptoms.
When to seek advice
Speak to your GP if symptoms are troublesome, persist, or affect daily life. A GP can also consider whether another condition may be contributing.
MenoCareHealth provides online-only consultations for adults in England. A consultation is an individual clinical assessment and may or may not lead to a prescription or treatment. Read the consultation service information.
Frequently asked questions
What is the difference between perimenopause and menopause?
Perimenopause is the time when menopause-associated symptoms and changes in periods may begin before periods stop. Menopause is confirmed only after at least 12 months without a period when the person is not using hormonal contraception and there is no other cause.
Do I need a GP referral for a private consultation?
MenoCareHealth currently accepts direct enquiries from adults in England for online-only consultations. You do not need a GP referral to request an appointment. The consultation is an individual assessment and does not guarantee a prescription or treatment.
Is HRT suitable for everyone with symptoms?
No. HRT may be suitable for some people after an individual assessment. The discussion should cover symptoms, medical and family history, risk factors, preferences, benefits, risks and alternatives.
Can lifestyle changes stop hot flushes?
People may find that general health measures help some symptoms, but responses vary. If hot flushes or other symptoms are troublesome or affect daily life, speak to your GP about assessment and treatment options.
Why are routine hormone blood tests usually unnecessary from age 45?
In otherwise healthy people aged 45 or over who were registered female at birth and have menopause-associated symptoms, hormone levels can change from day to day, so NICE advises using symptoms and changes in periods rather than routine blood tests. A clinician may consider tests when another condition is suspected.
Sources
- NICE NG23: Menopause – identification and management, updated 15 April 2026.
- NHS: Menopause and perimenopause.
- NHS: Menopause treatment.
Written by Mr Silas Gimba, FRCOG, Consultant Gynaecologist, MSCP.