Diseases & care
Menopause and HRT explained
Menopause is a natural stage of life when a woman's periods stop and the ovaries produce less of the hormone oestrogen. It usually happens between the ages of 45 and 55, though it can occur earlier. The years of change leading up to it, when symptoms often begin, are called perimenopause. While menopause is normal and not an illness, the drop in hormones can cause symptoms that affect daily life, sometimes for several years. There are effective treatments, including hormone replacement therapy, or HRT, as well as lifestyle measures and other options. This guide explains what happens during menopause, the symptoms and treatments available on the NHS, and how to protect long-term health.
Education and reference only. This article explains how treatments work in plain language — it contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician.
What menopause is
A woman is said to have reached menopause when she has not had a period for 12 months. It happens because the ovaries gradually stop releasing eggs and produce less oestrogen and progesterone. The lead-up, perimenopause, can last several years and is when periods become irregular and symptoms often start. The average age of menopause in the UK is around 51. Sometimes menopause happens earlier, before the age of 45, which is called early menopause, or before 40, known as premature ovarian insufficiency. It can also follow surgery to remove the ovaries or treatments such as chemotherapy. Understanding where you are in this transition helps make sense of the changes you may notice.
Common symptoms
Menopause affects everyone differently. Many women experience hot flushes and night sweats, where they suddenly feel very warm, and sleep problems that leave them tired. Mood changes are common, including anxiety, low mood, irritability and difficulty concentrating, sometimes described as brain fog. Periods become irregular before stopping. Vaginal dryness and discomfort, reduced sex drive, and needing to pass urine more often can also occur. Joint aches, headaches and changes in skin and hair are reported too. Symptoms can be mild or severe and may last for years. Because these changes can affect work, relationships and wellbeing, it is worth talking to your GP rather than simply putting up with them.
Hormone replacement therapy (HRT)
HRT is the main medical treatment for menopausal symptoms and works by replacing the hormones the body no longer makes. It is very effective for hot flushes, night sweats, mood and vaginal symptoms. HRT comes in different forms, including tablets, skin patches, gels and sprays, and vaginal preparations for local symptoms. Women who still have a womb usually need both oestrogen and progestogen, while those without a womb may have oestrogen alone. The right type and delivery is decided with your GP, based on your symptoms, health and preferences. For most women under 60 with troublesome symptoms, the benefits of HRT outweigh the risks, but this is an individual decision made together with your clinician.
Benefits, risks and other options
For many women, HRT greatly improves quality of life and can also help protect bone strength. Like all treatments, it has some risks, which vary depending on the type used, your age and personal health, so these are discussed individually with your GP. HRT is not suitable for everyone. Non-hormonal options exist too, including certain prescription medicines that can ease hot flushes, and talking therapies such as cognitive behavioural therapy for mood and sleep. Vaginal moisturisers and local treatments help with dryness. Lifestyle steps — regular exercise, a balanced diet, reducing alcohol and caffeine, and keeping cool — can also reduce symptoms. The best approach is tailored to you, so an open conversation with your clinician matters.
Looking after long-term health
After menopause, lower oestrogen levels can affect long-term health, including bone strength and heart health. Weight-bearing exercise, enough calcium and vitamin D, not smoking and limiting alcohol all help keep bones strong and reduce the risk of osteoporosis. A healthy diet and staying active support heart health. Continuing with cervical screening and breast screening invitations remains important. If symptoms persist or you have concerns, regular reviews with your GP allow treatments to be adjusted. Menopause is also a good moment to check blood pressure and overall wellbeing. Many women find this stage becomes much more manageable with the right information, support and, where chosen, treatment, and go on to feel well and active.
In short
Key takeaways
- Menopause is when periods stop for good, usually around age 51, caused by falling oestrogen levels.
- Perimenopause is the lead-up, when symptoms such as hot flushes, sleep and mood changes often begin.
- HRT replaces lost hormones and is effective for many symptoms; it comes as patches, gels, sprays, tablets and vaginal forms.
- For most women under 60 with symptoms, HRT benefits usually outweigh risks, but the decision is individual.
- Exercise, a healthy diet, not smoking and continued screening protect long-term bone and heart health.
Answers
Frequently asked questions
Is HRT safe?
For most women under 60 with troublesome menopausal symptoms, the benefits of HRT generally outweigh the risks. The level of risk depends on the type of HRT, how it is taken, your age and your personal and family health history. Some women are advised against HRT. Because it is an individual decision, your GP will weigh up your circumstances with you and review it over time. Never start or stop HRT without discussing it first.
How long do menopause symptoms last?
This varies a lot. Symptoms often begin during perimenopause, a few years before periods stop, and many women have symptoms for around four to eight years, though some experience them for longer and others only briefly. Hot flushes and night sweats commonly ease over time, while vaginal dryness may persist. If symptoms are affecting your life at any stage, it is worth speaking to your GP, as effective help is available.
Do I still need contraception during perimenopause?
Yes, potentially. You can still become pregnant during perimenopause because ovulation may continue even when periods are irregular. General guidance is to keep using contraception until one to two years after your last period, depending on your age. HRT is not a contraceptive. Your GP or a sexual health clinic can advise on suitable options that fit alongside menopause treatment, so it is worth asking rather than assuming you no longer need it.
Go deeper
Related guides
Sources
Where this is drawn from
- NICE Guideline NG23: Menopause — diagnosis and management
- British Menopause Society — Consensus statements and patient information
- NHS — Menopause: overview, symptoms and treatment
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