Menopause Symptoms and HRT: What Are Your Options?

More than hot flushes

Many women think of the menopause as hot flushes and little else. In reality, symptoms can be far wider-ranging, and they often begin years before periods actually stop.

Understanding what is happening — and what can help — means you do not have to simply put up with it.

What is the menopause?

Strictly speaking, the menopause is a single point in time: the day you have gone 12 months without a period. In the UK, the average age is around 51.

The years leading up to it are called the perimenopause. Hormone levels rise and fall unpredictably during this time, which is why symptoms can come and go, and why periods often become irregular first.

For some women it happens earlier. Menopause before the age of 45 is considered early, and before 40 it is called premature ovarian insufficiency. Both deserve proper assessment.

What are the symptoms?

Hot flushes and night sweats are the best known, but they are only part of the picture. Many women also notice disturbed sleep, low mood, anxiety or irritability, difficulty concentrating, joint aches, reduced libido, vaginal dryness, discomfort during sex and recurrent urinary symptoms.

Not everyone experiences every symptom, and severity varies enormously. What matters is the effect on your day-to-day life.

Do I need a blood test?

Often, no. For women over 45 with typical symptoms, the perimenopause and menopause are usually diagnosed from symptoms and menstrual pattern rather than a blood test, because hormone levels fluctuate and a single result can be misleading.

Blood tests can be useful for younger women, or when other conditions such as thyroid problems or anaemia could be contributing to how you feel.

What is HRT?

Hormone replacement therapy (HRT) replaces the oestrogen that the body produces less of. It is the most effective treatment for many menopausal symptoms.

Women who still have a womb also need a progestogen alongside oestrogen to protect the lining of the womb. HRT can be taken as tablets, patches, gels or sprays, and low-dose vaginal oestrogen can treat local symptoms such as dryness and discomfort.

There is no single best HRT. The right type, dose and delivery method depends on your symptoms, medical history and preferences.

Is HRT safe?

For most healthy women, the benefits of HRT outweigh the risks, particularly when it is started before the age of 60 or within 10 years of the menopause.

The risks are small but they are not zero, and they depend on the type of HRT, the dose, how long it is used and your own history. Combined HRT is linked to a small increase in breast cancer risk, and oestrogen tablets carry a small increased risk of blood clots, whereas patches and gels at standard doses do not appear to. This is why HRT should be a personalised decision rather than a one-size-fits-all prescription.

What if HRT is not suitable for me?

Some women cannot or prefer not to take HRT, and there are still options. Regular exercise, a balanced diet, limiting alcohol and caffeine, and good sleep habits can all help. Cognitive behavioural therapy has good evidence for flushes, low mood and sleep problems, and there are non-hormonal prescription medicines that can ease symptoms.

Vaginal oestrogen is often suitable even when HRT tablets or patches are not, so it is always worth asking.

When should I speak to a doctor?

Consider an assessment if symptoms are affecting your sleep, mood, work or relationships, or if you are under 45 and experiencing menopausal symptoms.

You should always seek advice promptly if you have any bleeding after the menopause, bleeding after sex, or very heavy or unusually irregular bleeding. These are not normal symptoms of the menopause and need to be checked.

Menopause care that is personal to you

At Family Doctor Group, we take an individual approach to women's health. Our GPs and consultant gynaecologists can talk through your symptoms, review your risks and help you decide whether HRT or another approach is right for you.

The menopause is a natural transition, but you do not have to struggle through it alone.