What Is Menopause? A Specialist’s Complete Guide
By Mr Silas Gimba, FRCOG, Consultant Gynaecologist, MSCP
If you’re reading this, you probably have questions about menopause – and you’re not alone. Despite affecting every woman, menopause remains one of the most misunderstood areas of women’s health. As a Consultant Obstetrician and Gynaecologist with nearly four decades of clinical experience, I’ve helped thousands of women navigate this transition. This guide explains what menopause is, what it means for your body, and what you can do about it.
What Is Menopause?
Menopause is a natural biological process that marks the end of your menstrual cycles. It is officially diagnosed when you have gone 12 consecutive months without a period. In the UK, the average age of menopause is 51, but it can occur anywhere between 45 and 55 years of age.
Menopause is not a disease or a disorder. It is a normal stage of life. However, the hormonal changes it brings can cause symptoms that significantly affect your quality of life, your work, your relationships, and your overall wellbeing.
The Three Stages of Menopause
1. Perimenopause (The Transition)
Perimenopause is the period leading up to menopause when your ovaries gradually produce less oestrogen. This stage can begin 4 to 10 years before your final period. During perimenopause, your oestrogen levels fluctuate unpredictably, which is why symptoms can come and go and feel confusing.
2. Menopause
Menopause is a single point in time – the date of your last menstrual period. You only know you’ve reached menopause in retrospect, after 12 months without a period.
3. Postmenopause
Postmenopause refers to all the years after menopause. While some symptoms like hot flushes may ease, others – particularly genitourinary symptoms – can worsen without treatment.
What Causes Menopause?
Menopause occurs because your ovaries gradually stop producing oestrogen and progesterone. Oestrogen receptors exist throughout your body – in your brain, bones, heart, skin, joints, bladder, and more. This is why declining oestrogen can cause such a wide range of symptoms.
Surgical menopause occurs when both ovaries are removed. Premature ovarian insufficiency (POI) is when menopause occurs before 40, affecting approximately 1 in 100 women.
What Are the Symptoms of Menopause?
There are over 34 recognised symptoms of menopause. The most common include:
Vasomotor Symptoms
Hot flushes and night sweats, affecting up to 80% of women.
Psychological Symptoms
Anxiety, low mood, irritability, brain fog, difficulty concentrating and memory problems can occur during the menopause transition. These symptoms can have several causes and should be assessed in the context of your overall health.
Physical Symptoms
Joint pain, fatigue, weight gain, headaches, muscle aches, hair thinning, dry skin, and palpitations.
Genitourinary Symptoms
Vaginal dryness, painful intercourse, reduced libido, urinary frequency, and recurrent UTIs – collectively known as genitourinary syndrome of menopause (GSM).
Sleep Disturbance
Difficulty falling asleep, frequent waking, and early morning waking.
How Is Menopause Diagnosed?
For women over 45 with typical symptoms, menopause is diagnosed clinically – based on symptoms and menstrual history. Blood tests are not routinely required. This is consistent with NICE guideline NG23.
What Treatments Are Available?
Hormone Replacement Therapy (HRT)
Hormone therapy is one option for some menopause symptoms. Whether it is appropriate depends on the symptoms being treated, personal and family medical history, contraindications and individual preferences. A clinician should discuss the expected benefits, possible risks and suitable alternatives before treatment is started.
Non-Hormonal Options
Non-hormonal options depend on the symptom and the individual. They can include menopause-specific cognitive behavioural therapy and practical lifestyle measures. Some medicines may be considered in particular circumstances, but antidepressants and clonidine are not routinely recommended as first-line treatment for vasomotor symptoms alone.
Local Treatments
Local vaginal oestrogen may be considered for genitourinary symptoms. Suitability, formulation and duration should be discussed with a clinician, taking account of individual circumstances and the relevant product information.
When Should You See a Menopause Specialist?
- Your symptoms are complex or not responding to treatment
- You have POI or early menopause
- You have a complex medical history
- You want a comprehensive, personalised treatment plan
- You have surgical menopause
Key Takeaways
- Menopause is a natural transition, not a disease – but its symptoms deserve proper management
- Perimenopause can begin years before your periods stop
- Over 34 symptoms are recognised – it is not just hot flushes
- Treatment choices should be based on your symptoms, medical history, preferences and an individual discussion of benefits and risks
- Specialist help is available – you do not need to manage this alone
If menopause symptoms are affecting your quality of life, discuss them with a qualified healthcare professional who can assess your individual circumstances and explain appropriate options.
Medical Disclaimer: This article is for general information only. Always consult a qualified healthcare professional. MenoCareHealth is regulated by the CQC. Sources: NICE NG23, British Menopause Society 2024 Guidelines, International Menopause Society.