The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

Periods usually start to become less frequent over a few months or years before they stop altogether. Sometimes they can stop suddenly.

The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51.

But around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.

Symptoms of the menopause

Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.

Common symptoms include:

• hot flushes
• night sweats
• vaginal dryness and discomfort during sex
• difficulty sleeping
• low mood or anxiety
• reduced sex drive (libido)
• problems with memory and concentration

Menopausal symptoms can begin months or even years before your periods stop and last around 4 years after your last period, although some women experience them for much longer.

When to see a GP

It's worth talking to a GP if you have menopausal symptoms that are troubling you or if you're experiencing symptoms of the menopause before 45 years of age.

They can usually confirm whether you're menopausal based on your symptoms, but a blood test to measure your hormone levels may be carried out if you're under 45.

Treatments for menopausal symptoms

Your GP can offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day life.

These include:

• hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen
• vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness
• cognitive behavioural therapy (CBT) – a type of talking therapy that can help with low mood and anxiety
• eating a healthy, balanced diet and exercising regularly – maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms

Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you're unable to take HRT.

What causes the menopause?

The menopause is caused by a change in the balance of the body's sex hormones, which occurs as you get older.

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Premature or early menopause can occur at any age, and in many cases there's no clear cause.

Sometimes it's caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down's syndrome or Addison's disease.

Not all women want treatment to relieve symptoms of the menopause, but treatments are available if you find the symptoms particularly troublesome.

The main treatment for menopausal symptoms is hormone replacement therapy (HRT), although other treatments are also available for some of the symptoms.

Hormone replacement therapy (HRT)

HRT involves taking oestrogen to replace the decline in your body's own levels around the time of the menopause. This can relieve many of the associated symptoms.

National Institute for Health and Care Excellence (NICE) guidelines state that HRT is effective and should be offered to women with menopausal symptoms, after discussing the risks and benefits.

There are two main types of HRT:

• combined HRT (oestrogen and progestogen) – for women with menopausal symptoms who still have their womb (oestrogen taken on its own can otherwise increase your risk of womb cancer)
• oestrogen-only HRT – for women who have had their womb removed in a hysterectomy

HRT is available as tablets, skin patches, a gel to rub into the skin or implants.

HRT is extremely effective at relieving menopausal symptoms, especially hot flushes and night sweats, but there are a number of side effects, including breast tenderness, headaches and vaginal bleeding. It's also associated with an increased risk of blood clots and breast cancer in some women.

HRT is not advisable for some women, such as those who have had certain types of breast cancer or are at high risk of getting breast cancer.

Your GP can give you more information about the risks and benefits of HRT to help you decide whether or not you want to take it.

Read more about HRT.

Hot flushes and night sweats

If you experience hot flushes and night sweats as a result of the menopause, simple measures may sometimes help, such as:

• wearing light clothing
• keeping your bedroom cool at night
• taking a cool shower, using a fan or having a cold drink
• trying to reduce your stress levels
• avoiding potential triggers, such as spicy food, caffeine, smoking and alcohol
• taking regular exercise and losing weight if you're overweight

If the flushes and sweats are frequent or severe, your GP may suggest taking HRT.

If HRT isn't suitable for you, or you would prefer not to have it, your GP may recommend other medications that can help, such as clonidine (a high blood pressure medicine) or certain antidepressants.

These medications can cause unpleasant side effects, so it's important to discuss the risks and benefits with your doctor before starting treatment.

Mood changes

Some women experience mood swings, low mood and anxiety around the time of the menopause.

Self-help measures such as getting plenty of rest, taking regular exercise and doing relaxing activities such as yoga and tai chi may help. Medication and other treatments are also available, including HRT and cognitive behavioural therapy (CBT).

CBT is a type of talking therapy that can improve low mood and feelings of anxiety. Your GP may be able to refer you for CBT on the NHS, or recommend self-help options such as online CBT courses.

Antidepressants may help if you've been diagnosed with depression.

Reduced sexual desire

It's common for women to lose interest in sex around the time of the menopause, but HRT can often help with this. If HRT isn't effective, you might be offered a testosterone supplement.

Testosterone is the male sex hormone, but it can help to restore sex drive in menopausal women. It’s not currently licensed for use in women, although it can be prescribed by a doctor if they think it might help.

Possible side effects of testosterone supplements include acne and unwanted hair growth.

Read more about loss of libido and female sexual problems.

Vaginal dryness and discomfort

If your vagina becomes dry, painful or itchy as a result of the menopause, your GP can prescribe oestrogen treatment that's put directly into your vagina as a pessary, cream or vaginal ring.

This can safely be used alongside HRT.

You'll usually need to use vaginal oestrogen indefinitely, as your symptoms are likely to return when treatment stops. However, side effects are very rare.

You can also use over-the-counter vaginal moisturisers or lubricants in addition to, or instead of, vaginal oestrogen.

Read more about vaginal dryness and sex as you get older.

Weak bones

Women who have been through the menopause are at an increased risk of developing osteoporosis (weak bones) as a result of the lower level of oestrogen in the body.

You can reduce your chances of developing osteoporosis by:

• taking HRT – HRT can help to prevent osteoporosis, although this effect doesn't tend to last after treatment stops
• exercising regularly – including weight-bearing and resistance exercises
• eating a healthy diet that includes plenty of fruit, vegetables and sources of calcium, such as low-fat milk and yoghurt
• getting some sunlight – sunlight on your skin triggers the production of vitamin D, which can help to keep your bones strong
• stopping smoking and cutting down on alcohol
• taking calcium and/or vitamin D supplements if you don't feel you're getting enough of these – discuss this with your GP

Read more about menopause and bone health and preventing osteoporosis.

Follow-up appointments

If you're having treatment for your menopausal symptoms, you'll need to return to your GP for a follow-up review after 3 months, and once a year after that.

During your reviews, your GP may:

• make sure your symptoms are under control
• ask about any side effects and bleeding patterns
• check your weight and blood pressure
• review the type of HRT you're taking and make any necessary changes
• discuss when you could stop treatment and how this could be done

Many women will need treatment for a few years, until most of their menopausal symptoms have passed.

Complementary and alternative therapies

Complementary and alternative treatments, such as herbal remedies and bioidentical ("natural") hormones, aren't recommended for symptoms of the menopause, because it's generally unclear how safe and effective they are.

Some remedies can also interact with other medications and cause side effects.

Ask your GP or pharmacist for advice if you're thinking about using a complementary therapy.