The menopause is defined as when a woman’s periods have stopped for 12 months. It occurs because the amount of oestrogen made by the ovaries declines.¹ This is one of the key hormones involved in the control of a woman’s menstrual cycle.
For most women the menopause is a natural process that happens between the ages of 45 and 56 years. However, for some women the menopause is not linked to ageing. They may go through the menopause earlier due to other reasons such as medical treatments, certain illnesses or surgery (removal of the ovaries or womb).
The symptoms of the menopause can begin long before a woman's periods stop. This is called the perimenopause.2 During this time a woman's periods may be more irregular: they may be heavier or lighter or they may be shorter or last longer. Irregular periods is one of the first signs of the menopause. The menopausal symptoms are related to the decline in oestrogen and include:
The number and severity of symptoms will vary from woman to woman and each symptom can last for different lengths of time.2 Unlike hot flushes or night sweats, the symptoms of vaginal atrophy (sometimes called genitourinary syndrome of menopause or GSM which includes symptoms such as vaginal dryness, irritation and pain during sexual intercourse) are unlikely to resolve without treatment.4
Systemic Hormone Replacement Therapy (HRT)
The most common medical treatment for managing symptoms is HRT. This is systemic treatment that treats symptoms throughout the body. The main hormones that HRT 'replaces' are oestrogen and progestogen. If you have a womb, you will need to take another hormone, progestogen. Progestogen helps to protect the lining of your womb. Taking both hormones is called combined HRT.1
The benefits of HRT are well known. It can help relieve most menopausal symptoms including hot flushes, night sweats, mood swings and vaginal atrophy. Systemic HRT may help reduce the risk of osteoporosis and associated fractures.1
As with all medicines, there are risks, such as endometrial cancer, deep vein thrombosis and pulmonary embolism, associated with HRT, and these vary from one woman to another, depending on individual factors. However, the risks can often be outweighed by the benefits. If you are at all concerned about the risks of HRT (or any other medicine) talk to your doctor or pharmacist.
You can take HRT in a variety of ways.
Oestrogen is available as:
Progestogen is available as:5
Local (Vaginal) Oestrogen Therapy
The reduction in oestrogen also affects the vagina and urinary tract. Vaginal dryness and pain during sex are common symptoms of the menopause. It causes many women irritation, pain and discomfort. These symptoms can be treated with vaginal oestrogen. It's available as a cream, gel, pessary, vaginal tablet or ring which you insert into your vagina.1
The dose of vaginal oestrogen is very low, and the oestrogen is only minimally absorbed into the bloodstream. No evidence of increased breast cancer risk, although unknown if low-dose vaginal oestrogens stimulate recurrence of breast cancer.6 While not definitive, there is reassuring evidence regarding endometrial cancer, breast cancer, venous thromboembolism and cardiovascular disease risks.7 If you stop using vaginal oestrogen, your symptoms are likely to come back.8
Other Medicines/Approaches
You can also use moisturisers or lubricants to provide symptom relief from vaginal dryness.9
There are other treatments which do not contain oestrogen and can be provided to relieve certain symptoms. These include ospemifene10 (a selective oestrogen receptor modulator or SERM), dehydroepiandrosterone11 (DHEA, promotes oestrogen production) and laser therapy12
If any symptom is causing you particular trouble, talk to your doctor or pharmacist about the treatments available.
There is a great deal you can do yourself to help manage symptoms of the menopause and perimenopause. Looking after your physical health and mental health can provide you with long-term benefits.
Things you can do include:
References:
EU-REG-07-25-00001 April 2026
