Health condition · Clinically reviewed
Menopause, the guide that answers what to do next.
A hormonal transition that affects sleep, mood, memory, joints and long-term health. Here is what modern UK guidance says — about HRT, alternatives and everything in between.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced from guidance
Every claim is checked against NICE, BMS or peer-reviewed sources you can see at the end.
- 03
Current for 2026
Reflects current UK guidance on HRT, cardiovascular and bone protection, and long-term health.
Key facts
Menopause at a glance.
The essentials, in plain English — what it is, when it happens, what the symptoms mean, and how it is treated in the UK today.
-
What it is
The natural end of ovarian function — defined as 12 months without a period. Perimenopause is the transition years before.
-
Average age (UK)
51 for menopause; perimenopause typically starts in the mid-40s.
-
Early menopause
Under 45 — deserves investigation and, usually, treatment to protect bone and heart.
-
Common symptoms
Hot flushes, night sweats, disrupted sleep, mood change, brain fog, joint pain, vaginal dryness.
-
Long-term effects
Faster bone loss, higher cardiovascular risk, urogenital changes.
-
First-line treatment
HRT is first-line for menopausal symptoms in most under-60s. Non-hormonal options exist.
Why this guide matters
A transition worth taking seriously.
Menopause is treatable — and untreated symptoms have real, long-term consequences for heart, bone and brain. The three points below shape everything else on this page.
-
It is more than hot flushes
Sleep, mood, memory, joints and bladder are all affected — and all treatable.
-
HRT is first-line for most
For under-60s within 10 years of menopause, benefits generally outweigh risks.
-
Early menopause deserves treatment
Under 45, HRT is usually offered to protect long-term heart, brain and bone health.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK GP will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Spotting the pattern of perimenopausal symptoms
Phase 2 · Confirming
Baseline checks and treatment discussion
Phase 3 · Managing
A prescription plan and follow-up
- 01
Recognising
Symptoms in the perimenopause
Cycle change, hot flushes, sleep and mood changes — often several years before periods stop.
- 02
Recognising
A pattern is enough
Over 45, no blood test is needed — the pattern of symptoms is diagnostic.
- 03
Recognising
Blood tests only sometimes
Under 45, or if the picture is unclear, FSH is checked — twice, six weeks apart.
- 04
Confirming
Baseline check
Blood pressure, weight and personal risk of clot, breast cancer and heart disease.
- 05
Confirming
HRT vs alternatives discussed
For most under-60s within 10 years of menopause, benefits of HRT outweigh risks.
- 06
Managing
A prescription plan
Type (estrogen alone or combined), form (patch, gel, spray, tablet) and progesterone choice.
- 07
Managing
Reviewed at 3 months
Symptom control, side effects and dose adjusted — most doses settle within 3–6 months.
Typical timeline: 3–6 months from first appointment to a settled HRT dose.
Symptoms
What menopause actually feels like.
Symptoms vary widely between people and across the transition. Here is what to look for and when to seek review.
-
Hot flushes & night sweats
The most recognisable symptom — typically several a day, worse at night.
-
Disrupted sleep
Often broken by night sweats, but insomnia can occur independently.
-
Low mood or anxiety
Common and often underestimated — can mimic or coexist with depression.
-
Brain fog & memory
Word-finding, focus and short-term memory dips — usually reversible with treatment.
-
Joint & muscle aches
A commonly missed feature. Estrogen loss affects joints and muscles directly.
-
Reduced libido & vaginal dryness
Very common; local estrogen or lubricants make a large difference.
-
Urinary symptoms
Recurrent UTIs, urgency and incontinence often improve with vaginal estrogen.
-
Red flags
Bleeding after a year of no periods, or heavier or irregular bleeding on HRT — see a GP.
Treatment
How menopause is treated in the UK.
HRT is first-line for most — with non-hormonal, local and lifestyle options where it is not suitable or not wanted.
-
Transdermal estrogen
Patch, gel or spray — first-line HRT with lower clot risk than tablets.
-
Combined HRT
Estrogen plus progesterone (Utrogestan is the body-identical option) if you still have a uterus.
-
Vaginal estrogen
Local treatment for dryness, urinary symptoms and recurrent UTIs — can be used with or without systemic HRT.
-
Testosterone (specialist)
Considered for persistent low libido not resolved by HRT alone.
-
Non-hormonal (SSRIs, SNRIs)
For hot flushes when HRT is not suitable — venlafaxine and paroxetine have the best evidence.
-
CBT for menopause
Evidence-based for hot flushes, mood and sleep — available on the NHS and privately.
-
Lifestyle levers
Regular activity, strength training, sleep hygiene, moderate alcohol — each improves symptoms measurably.
-
Bone protection
DEXA scan when indicated; adequate calcium and vitamin D; weight-bearing exercise.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or menopause specialist knows your history and can tell you which parts apply to you.
-
NICE. Menopause: diagnosis and management (NG23).
-
British Menopause Society. Consensus statements and patient information.
-
Women’s Health Concern. Patient factsheets.
-
NHS. Menopause: overview.
Red flags
When menopause symptoms need urgent review.
Most menopause symptoms settle with treatment. These are the situations where you should not wait.
-
Bleeding after menopause
Any bleeding a year or more after the last period — urgent GP review.
-
Heavy or unscheduled bleeding on HRT
Especially after the first 6 months — deserves review.
-
New severe headache
Especially with visual changes — stop HRT and see a doctor same day.
-
Chest pain or breathlessness
On HRT — possible clot. Call 111 or 999.
-
Painful swollen calf
Especially with warmth or redness — possible DVT. Urgent assessment.
-
Sudden weakness or speech difficulty
FAST signs — call 999.
-
New breast lump
Any breast change deserves review — especially on HRT.
-
Menopause under 45
Deserves investigation and, usually, treatment — untreated early menopause raises long-term health risks.
-
Severe mood change
Suicidal thoughts, severe anxiety or panic — urgent GP or crisis line.
Living with it
A life stage, not a diagnosis to endure.
Four things that make the biggest difference through the transition — strength, sleep, work and long-term health.
A quiet reminder
You do not have to just get through it.
Modern guidance is clear: symptoms can be treated, long-term health can be protected, and most women feel meaningfully better within 3–6 months.
- 01 Strength & bone
Muscle and bone need loading
Twice-weekly resistance training reduces fracture risk and helps mood.
- 02 Sleep
A cool, dark, boring bedroom
Small changes — and often HRT — transform sleep during the transition.
- 03 Work
It is legitimately affecting you
Symptoms can affect concentration, memory and confidence. Workplace conversations and support are increasingly recognised.
- 04 Long-term
Heart, brain and bone
HRT started early has cardiovascular and cognitive benefits alongside symptom control.
Frequently asked
Everything we get asked about menopause.
Quick answers on diagnosis, HRT, body-identical hormones, non-hormonal options and long-term health.
-
What is the difference between perimenopause and menopause?
Perimenopause is the transition when hormones fluctuate and symptoms often start — usually mid-40s. Menopause itself is the day it has been 12 months since your last period.
-
Do I need a blood test to diagnose menopause?
Over 45, no — the pattern of symptoms is diagnostic. Under 45, or when the picture is unclear, FSH is measured (usually twice, six weeks apart).
-
Is HRT safe?
For most women under 60 and within 10 years of menopause, benefits outweigh risks. Transdermal estrogen carries less clot risk than tablets, and body-identical progesterone (Utrogestan) has a favourable profile.
-
What is body-identical HRT?
Regulated HRT that is molecularly identical to your own hormones — transdermal estradiol and micronised progesterone. Different from unregulated “bioidentical” compounded products.
-
How long can I stay on HRT?
There is no fixed time limit. Reviewed periodically, HRT can be continued as long as benefits outweigh risks for you individually.
-
Will HRT help brain fog and joint pain?
Often, yes. Both are commonly under-recognised menopause symptoms and frequently improve with estrogen replacement.
-
What if HRT is not suitable?
Non-hormonal options exist — SSRIs and SNRIs for flushes, CBT for hot flushes and sleep, and lifestyle changes. Vaginal estrogen is safe for almost everyone.
-
What about early menopause?
Menopause under 45 (and especially under 40) raises long-term risks to heart, bone and brain. HRT is usually recommended until at least the average age of natural menopause.
-
Do I need testosterone?
Sometimes. If HRT has not resolved low libido, testosterone can be prescribed by a specialist — it is not yet a licensed indication for women in the UK, so it is off-label.
-
When should I see a GP urgently?
Any bleeding a year or more after your last period, new breast lump, severe headache, chest pain, calf swelling on HRT, or FAST stroke signs.