In short: Menopause is when periods stop permanently because the ovaries make much less oestrogen. In the UK it usually happens between 45 and 55, with an average age of 51. Symptoms such as hot flushes, poor sleep, low mood, brain fog and vaginal dryness often begin in the years before (perimenopause). Effective help is available, from lifestyle changes and CBT to HRT and non-hormonal treatments, and a clinician can help you weigh up the options.

This guide, written by a Ready Health prescribing pharmacist, explains menopause symptoms, how menopause is diagnosed and the treatment options set out in NICE guidance.

What is menopause and perimenopause?

Perimenopause is the transition, when hormone levels fluctuate and periods change. It can last several years.
Menopause is reached once you have had no periods for 12 months (if you are not using hormonal contraception or treatment that affects periods).
Early menopause happens between 40 and 45, and premature ovarian insufficiency before 40. Both need medical assessment, because hormone treatment is usually advised to protect long-term health.

What are the common symptoms of menopause?

Symptoms vary a lot between women. They can include:

hot flushes and night sweats
changes to periods, such as irregular, heavier or lighter bleeding
difficulty sleeping and tiredness
low mood, anxiety and irritability
problems with memory and concentration (brain fog)
vaginal dryness, discomfort during sex and more frequent urine infections
reduced sex drive
joint and muscle aches

Lower oestrogen after menopause also increases the long-term risk of osteoporosis and heart disease, which is why bone and heart health are part of menopause care.

How is menopause diagnosed?

For women over 45 with typical symptoms, NICE advises that perimenopause and menopause are diagnosed from symptoms alone. Blood tests are not usually needed, because hormone levels change from day to day. Tests may be useful if you are under 45, or to rule out other causes of symptoms, such as thyroid problems or anaemia.

What treatments are available for menopause symptoms?

Option	What it can help with	Things to consider
Lifestyle changes	Sleep, mood, weight, bone and heart health	Regular exercise, healthy diet, limiting alcohol and caffeine, stopping smoking
Cognitive behavioural therapy (CBT)	Hot flushes, night sweats, low mood, anxiety and sleep	Recommended by NICE; can be used with or without other treatments
Hormone replacement therapy (HRT)	Hot flushes, night sweats, mood, sleep, vaginal symptoms; helps protect bones	The most effective treatment for many symptoms; benefits and risks depend on your age, health and the type of HRT
Vaginal oestrogen, moisturisers and lubricants	Vaginal dryness and urinary symptoms	Low-dose vaginal oestrogen acts locally and is suitable for many women
Non-hormonal medicines	Hot flushes when HRT is unsuitable or not wanted	Several options exist; each has its own side effects

Many supplements are marketed for menopause, but evidence for most is limited. Vitamin D (10 micrograms a day) is advised for most UK adults, especially in autumn and winter. Always check with a pharmacist before taking herbal products, as some interact with medicines.

What are the benefits and risks of HRT?

NICE updated its menopause guideline in 2024 to help women understand HRT risks more clearly. In summary:

HRT is the most effective treatment for hot flushes and night sweats, and can improve mood and sleep.
Combined HRT (oestrogen plus progestogen) is linked to a small increase in breast cancer risk, which depends on how long it is used. Oestrogen-only HRT has little or no effect on breast cancer risk.
HRT tablets slightly increase the risk of blood clots; HRT used through the skin (patches, gels or sprays) at standard doses does not appear to.
Started before 60, HRT does not increase the risk of heart disease.
HRT helps prevent bone loss while it is taken.

Whether HRT is suitable is an individual decision made with a prescriber, who will review your medical and family history.

When should I see a clinician about menopause?

symptoms are affecting your work, relationships or wellbeing
you are under 45 and your periods have become irregular or stopped
you have any bleeding after menopause, or unexpected bleeding while on HRT (this should be checked promptly)
you would like to understand your treatment options

Frequently asked questions

How long does menopause last?

Symptoms usually last several years after periods stop, and some women have them for much longer. Vaginal symptoms may continue unless treated.

Can I still get pregnant during perimenopause?

Yes. Contraception is advised until 2 years after your last period if you are under 50, or 1 year after if you are over 50, or until age 55.

Does menopause cause weight gain?

Hormonal changes can shift where fat is stored, and age-related changes in muscle and activity play a part. Staying active and keeping up strength exercise helps.

Is HRT safe?

For most women under 60, the benefits of HRT outweigh the risks, but it is not right for everyone. A prescriber will discuss your personal risks.

Key takeaways

Menopause usually occurs between 45 and 55; symptoms often start years before periods stop.
For women over 45 with typical symptoms, blood tests are not usually needed for diagnosis.
CBT, lifestyle changes, HRT, vaginal treatments and non-hormonal medicines can all help.
HRT benefits and risks depend on your age, health and the type of HRT.
Menopause before 45 should always be assessed by a clinician.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

If menopause symptoms are affecting you, you can book a menopause consultation at Ready Health in Standish, Wigan. Our clinicians will talk through your symptoms and help you choose an approach that suits you.