Menopause: symptoms and the help available

What are the symptoms of menopause?

NICE guidance covers hot flushes and night sweats, vaginal and urinary symptoms, and effects on mood. The perimenopause is the time of change before periods stop, and symptoms can begin then. The NHS lists hot flushes, night sweats, low mood or anxiety, mood swings, brain fog, difficulty sleeping and changes to periods. Others include headaches and migraines, joint and muscle pain, weight gain, skin changes and a lower sex drive. The NHS says a person may have a number of symptoms, or none. Menopause is confirmed once a person has had no period for 12 months. The NHS says menopause usually affects people between the ages of 45 and 55, though it can happen earlier.

What is HRT?

The NHS says the main medicine for menopause and perimenopause symptoms is hormone replacement therapy, or HRT. Oestrogen comes as skin patches, a gel or spray, implants or tablets. Anyone who still has a womb also needs a progestogen to protect the womb lining.

How soon does treatment work?

According to the NHS, hot flushes or night sweats often improve within a few weeks. Other symptoms, such as mood changes and vaginal dryness, can take a few months to improve.

What are the benefits and risks?

The NHS says HRT can lower the risk of osteoporosis, the thinning of the bones. Some types of HRT slightly raise the risk of breast cancer, and HRT tablets carry a small increase in the risk of blood clots. Because benefits and risks differ from person to person, the NHS and NICE both describe a discussion with a clinician.

What else is available?

Vaginal oestrogen, as a pessary, cream, gel or ring, can treat vaginal dryness and other genitourinary symptoms of the menopause. For people who cannot or choose not to take HRT, the NHS lists cognitive behavioural therapy (CBT), which can help with low mood and anxiety caused by menopause and perimenopause. Vaginal lubricants and moisturisers are also used. The NHS suggests that regular exercise may reduce hot flushes, and that spicy food, caffeine, smoking and alcohol can be triggers.

When should someone see a GP?

The NHS says people with menopause or perimenopause symptoms can talk to a GP about their options. The NHS advises seeing a GP about any vaginal bleeding after periods have stopped for 12 months or more, even if it has only happened once.

Where can someone get urgent help?

Menopause can affect mood and sleep. If low mood becomes severe or there are thoughts of self-harm, help is available at any time. If you or someone else is in immediate danger, or has been physically harmed, call 999 or go to A&E. For urgent help that is not an emergency, NHS 111 has a mental health option (option 2), which trusts describe as available at any time, for yourself or on someone else's behalf. Samaritans listen at any time of day or night, and the number, 116 123, is free to call.