Understanding the menopause

The menopause is when a woman stops menstruating permanently due to the loss of ovarian follicular activity. It is diagnosed after a woman has had 12 months without periods (amenorrhoea). The average age of menopause diagnosis in the UK is 51 years, although this varies by ethnicity.

The menopause is preceded by the perimenopause or period of 'the change', when the ovaries gradually stop functioning, oestrogen and progesterone levels fall and women experience altered and irregular menstrual cycles. Some may start to experience these symptoms from their late 30s onwards.

In the past, women have been advised that the menopause is a normal part of ageing and symptoms should be lived with. However, symptoms can have a profound adverse effect on wellbeing and quality of life, so it is important to avoid being dismissive and to provide reassurance, constructive advice and support.

Hot flushes and night sweats (vasomotor symptoms) are the most common reported symptoms of the menopause, experienced by up to 80 per cent of women; urogenital symptoms occur in around 40 per cent. Around 20 per cent of women get few symptoms. Lifestyle measures can help many. HRT can be used for vasomotor symptoms, and vaginal oestrogen is effective at treating vaginal and urinary symptoms. As oestrogen levels decline, the risk of osteoporosis and fragility fractures increases.

It is important to ask about the nature, frequency, duration and time of day of symptoms, and about their severity and impact on quality of life. Consultations about menopause and associated symptoms will cover sensitive information, so use of the pharmacy’s consultation area is important.