Menopause

Menopause is a single day, defined in retrospect. Everything people actually mean by the word happens in the years around it, and some of it continues for the rest of a life.

The vocabulary

Perimenopause is the transition: hormone levels fluctuate, cycles become irregular, and symptoms begin. It commonly lasts several years. Menopause itself is a point in time, identified only in hindsight as the date of the last menstrual period, once twelve months have passed without another. Everything after that is postmenopause.

Early menopause describes the transition happening before the age of forty five, and premature ovarian insufficiency describes it happening before forty. Both need medical assessment rather than acceptance, because the long term implications for bone and cardiovascular health differ, and the management differs with them. Menopause induced by surgery, chemotherapy or radiotherapy tends to arrive abruptly and with more intense symptoms, because there is no gradual decline.

Two different kinds of symptom

This distinction runs through the whole section and explains most of the confusion around it.

The first group, which includes hot flushes, night sweats, disturbed sleep, mood change, joint aches and difficulty concentrating, is driven by fluctuating and then falling hormone levels. These symptoms are often at their worst during perimenopause and in the first years afterwards, and for most people they ease over time.

The second group is different. The vulva, vagina, urethra and bladder base all contain oestrogen receptors, and the tissue there depends on oestrogen to stay thick, elastic and well lubricated. When oestrogen stays low, that tissue changes and remains changed. Dryness, soreness, itching, pain with sex, urinary urgency and repeated urinary infections do not resolve with time. Left alone they usually progress slowly. Treated, they improve. The page on genitourinary syndrome of menopause covers this in full, and it is the single most under treated part of menopause care.

Why so much goes unmentioned

Vasomotor symptoms are discussed. Genital symptoms are not. Surveys of women with genitourinary symptoms consistently find that only a minority raise them with a clinician, and a substantial number assume the changes are simply what age does. The consequence is years of discomfort, avoidance of sex, and repeated courses of treatment for infections that were never there.

The practical response is straightforward: describe the symptom in plain terms at an appointment. Dryness, burning, soreness with penetration, needing to pass urine more often, and repeated urine infections are all treatable, and the treatments are safe for the great majority of people.

Treatment in outline

Hormone replacement therapy addresses the first group of symptoms and is prescribed after a discussion of individual risks and benefits. It comes in several forms, and it is a genuinely individual decision that depends on age, time since menopause, medical history and preference. This library does not print dosages or product names, because that discussion belongs in a consultation.

Genitourinary symptoms are treated separately and can be treated whether or not someone takes systemic hormone therapy. Vaginal moisturisers and lubricants help mechanically. Vaginal oestrogen, applied locally, restores the tissue itself and works for the majority of people who use it consistently. Many women use both.

Non hormonal approaches to hot flushes, including changes to clothing, room temperature, alcohol and caffeine, plus cognitive behavioural approaches for sleep and mood, have reasonable support and are the mainstay for people who cannot or prefer not to take hormones. Some non hormonal prescription options exist and are worth asking about.

What to read next

Start with perimenopause if periods are changing and symptoms have begun. Read genitourinary syndrome of menopause if there is dryness, soreness, urinary urgency or recurrent infection. Read vaginal dryness for the practical detail on moisturisers and lubricants, and sex after menopause for what changes and what does not. The symptom record is worth filling in before an appointment.

One thing that is never normal

Bleeding after the menopause, meaning any vaginal bleeding once twelve months have passed without a period, always requires assessment. Most causes turn out to be benign, and thinned tissue is among the commonest of them. It is investigated urgently because a minority of cases are not benign, and because early diagnosis changes the outcome substantially.

Last reviewed: September 2026