Menopause is often reduced to hot flushes and the end of periods. In reality, it marks a new stage of health, preceded by a transition that can last several years and followed by changes that deserve personalised preventive care. Menopause is confirmed after 12 consecutive months without a period, in the absence of another cause, and typically occurs between ages 45 and 55. Symptoms and their impact vary widely, but effective support and treatments are available.
Key points
- Natural menopause is confirmed after 12 consecutive months without periods.
- It usually occurs between ages 45 and 55, with an average age of about 51.
- Symptoms can start years earlier during perimenopause.
- Hormone testing is usually unnecessary in women over 45 with a typical presentation.
- Menopausal hormone therapy is effective for some women after individual assessment of benefits and risks.
- Prevention after menopause should include bone, cardiovascular, metabolic and genitourinary health.
What is menopause?
Natural menopause is the permanent end of ovulation and menstruation as ovarian follicular activity declines. It is diagnosed retrospectively: 12 months must pass without a period before the final menstrual period is confirmed.
Oestrogen and progesterone production do not stop overnight. Menopause is preceded by perimenopause, when hormones fluctuate and cycles often become irregular. Postmenopause begins once menopause is confirmed and continues for the rest of life.
When does menopause happen?
Natural menopause most often occurs between 45 and 55, with an average age of approximately 51. Timing is influenced by genetics, smoking, certain medical conditions and treatments.
Menopause-related ovarian loss before age 40 is described as primary ovarian insufficiency. Menopause between 40 and 45 is considered early. Surgery to remove the ovaries, chemotherapy or radiotherapy can also cause menopause, sometimes abruptly. Earlier or treatment-induced menopause requires specific assessment because the health implications differ.
What are the symptoms of menopause?
Symptoms vary in type, intensity and duration. Some women have very few; others experience a major effect on daily life.
Hot flushes and night sweats
A sudden sensation of heat may spread across the chest, neck and face, sometimes with sweating, palpitations and chills. At night, these episodes may repeatedly interrupt sleep and cause substantial fatigue.
Sleep and fatigue
Night sweats are only one possible reason for poor sleep. Anxiety, pain, urinary urgency and other sleep disorders may also contribute. Persistent fatigue should be assessed rather than automatically attributed to menopause.
Mood and cognition
Irritability, anxiety, low mood, concentration problems and “brain fog” are often reported. Sleep, life circumstances, previous mental health difficulties and general health all matter. Depression should never be dismissed as an inevitable part of menopause.
Vaginal and urinary symptoms
Lower oestrogen levels can affect vulval, vaginal and urinary tissues. Dryness, burning, discomfort during sex, repeated urinary infections, urgency and leakage may occur. Unlike some temporary symptoms, genitourinary symptoms can persist or worsen without treatment.
Sexual wellbeing
Desire and comfort may change because of hormones, vaginal dryness, sleep, body image, relationship factors or medication. Sexual wellbeing is not explained by one hormone level; a whole-person approach is more helpful.
Joint discomfort and body changes
Joint pain, headaches, drier skin and altered body composition may occur. Ageing, movement, muscle mass, sleep and metabolic health interact with hormonal change.
How is menopause diagnosed?
For a woman aged 45–55, 12 months without periods and a compatible history are usually enough. Blood tests are generally not required.
Targeted assessment may be appropriate when symptoms begin before age 45, hormonal contraception affects bleeding, another cause of absent periods is possible or symptoms are atypical. A single FSH or oestradiol result should never be interpreted without context.
How can health change after menopause?
Menopause is not a disease. However, sustained lower oestrogen levels and ageing can influence several areas of health.
Bone health
Bone-density loss accelerates around menopause, contributing to osteoporosis and fracture risk. Risk also depends on age, previous fractures, family history, body weight, smoking, alcohol, physical activity and medication.
A bone-density scan is not automatically needed for every woman at menopause. It is recommended according to personal risk factors and clinical context.
Cardiovascular health
Blood pressure, blood lipids, body composition and insulin sensitivity may change after menopause. Prevention should assess overall cardiovascular risk rather than focusing on hormonal status alone.
Metabolic health and body composition
Fat distribution may become more abdominal and muscle mass tends to decline with age. Menopausal hormone therapy is not a weight-loss treatment. Strength training, aerobic activity, nutrition and sleep all matter, without reducing health to a number on the scale.
Genitourinary health
Vaginal dryness and urinary symptoms may continue long after the final period. Moisturisers, lubricants, local treatments and other options can be discussed with a healthcare professional.
What treatments can help?
The right option depends on the main symptoms, their impact, age, time since menopause, whether the uterus is present, medical history and personal preferences.
Menopausal hormone therapy
Menopausal hormone therapy (MHT, also known as HRT) is the most effective treatment for troublesome hot flushes and night sweats. It can also help prevent bone loss while it is being used.
Women who have a uterus generally need a progestogen alongside oestrogen to protect the endometrium. After hysterectomy, oestrogen alone may be appropriate, depending on individual circumstances.
MHT is neither mandatory nor automatically unsafe. Its benefit–risk balance depends on factors including age, time since menopause and personal cardiovascular, clotting and cancer risks. French health authorities recommend careful assessment before treatment and at least annual review thereafter.
Local treatment
For vaginal dryness and some urinary symptoms, vaginal moisturisers, lubricants and, when appropriate, local vaginal oestrogen may be offered. Its indications and systemic exposure differ from systemic MHT.
Non-hormonal options
Non-hormonal medicines may be considered when MHT is not wanted or suitable. “Natural” products are not automatically effective or risk-free; interactions, inconsistent quality and contraindications should be considered.
Lifestyle and psychological support
Regular activity, balanced nutrition, stopping smoking, limiting alcohol, improving the sleep environment and some psychological approaches can support overall health and sometimes reduce symptoms. They complement medical care and should not become a reason to leave severe symptoms untreated.
What health follow-up matters after menopause?
Good follow-up is not about ordering every available test. It means maintaining recommended screening and personalising prevention. Depending on age and risk, this may include:
- blood pressure and cardiovascular-risk assessment;
- metabolic health and weight-related care without stigma;
- lipid and glucose testing when indicated;
- bone health and falls risk;
- breast, cervical and bowel cancer screening according to national guidance;
- mental health, sleep, sexual health and genitourinary symptoms;
- vaccinations and oral health.
When should you consult a healthcare professional?
Seek advice when symptoms reduce your quality of life or when you want to discuss treatment. The following should not simply be attributed to menopause:
- any vaginal bleeding after 12 months without periods;
- very heavy or unusual bleeding during the transition;
- persistent pelvic pain;
- a breast lump or new breast change;
- breathlessness, chest pain or persistent palpitations;
- profound fatigue, unexplained weight loss or sudden symptoms;
- significant psychological distress.
A new stage — not invisible health
Menopause deserves more than a symptom checklist. It is an opportunity to connect present symptoms with previous cycle history, medical background, bone, cardiovascular and metabolic health, sleep and quality of life.
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Reviewed by the OVEA medical committee