Key takeaways

  • Menopause usually happens between 45 and 55, but can come earlier. It affects anyone who has periods. Perimenopause starts before periods stop. NHS overview
  • Sleep, mood and memory can be affected together. Night sweats disrupt sleep, and tiredness can make mood and concentration problems feel worse. NHS symptoms
  • Discuss symptoms while you are still having periods. A doctor, nurse or pharmacist can explain HRT and other options. NHS treatment
  • HRT comes in several forms. Oestrogen can be a tablet, patch, spray or gel; progestogen protects the womb if you have not had a hysterectomy. NHS treatment
  • Vaginal and urinary symptoms have local treatment options. Oestrogen cream or pessaries can address dryness, soreness and urinary symptoms after menopause. NHS treatment
  • Report any bleeding after 12 months without a period. NHS advice includes a single episode, spotting or pink/brown discharge, even without other symptoms. NHS symptoms
  • HRT is not the only treatment discussion. The NHS describes CBT and non-hormonal medicines for some symptoms and cautions that evidence for red clover and black cohosh is limited. NHS treatment

Broken sleep, mood changes and trouble concentrating can be menopause symptoms too. They often disrupt life more than the expected hot flushes and get blamed on stress, overwork or ageing. Periods change and eventually stop as hormone levels fall; the symptoms around that change deserve a treatment discussion.

What are the symptoms, really?

A cluster that reaches well past hot flushes, and which often does not get recognised as one thing.

The NHS lists what to expect:

  • Changes to periods, usually the first sign of perimenopause. They may come more or less often, and bleeding may get heavier or lighter, until eventually they stop.
  • Hot flushes and night sweats, where the face, neck and chest suddenly feel very hot or cold. These can cause heavy sweating, palpitations, anxiety or dizziness, and can last several minutes, by day or night.
  • Sleep problems, difficulty getting to sleep or staying asleep, which the NHS notes may be worse if you also have night sweats.
  • Mood changes, poor memory and brain fog, including mood swings, low mood or depression, and problems with memory or concentration.
  • Weight gain, commonly around the stomach and upper body.
  • Vaginal problems, including dryness, soreness, burning, itching and pain during sex.
  • Urinary symptoms, including more frequent UTIs or UTI-like symptoms such as burning when passing urine and needing to go more often, including at night. NHS

The compounding effect is worth naming, because the NHS points at it directly: mood and memory symptoms may feel worse if you have sleep problems and feel very tired. So a woman whose nights are broken by sweats is not experiencing three separate problems; she is experiencing one process with a chain of consequences.

Hot flushes deserve a local note. In a climate where feeling hot is unremarkable for half the year, and where air conditioning masks a lot, the distinctive character of a flush, sudden, internal, often with palpitations or anxiety, is what distinguishes it from simply being warm.

When should I talk to someone?

When symptoms are affecting your life, rather than when you think you have crossed some threshold.

The NHS framing is that if you have symptoms of perimenopause or menopause, you should talk to a doctor, nurse or pharmacist about HRT and the other options available. There is no requirement to have stopped having periods, and perimenopause can begin several years before that.

Mention what is happening to sleep, relationships, work and memory. The NHS says symptoms usually last 7 to 9 years, sometimes longer, and can change over that time. Night sweats may improve while other symptoms, such as low mood or vaginal dryness, become more troublesome. NHS

Hormonal contraception can obscure the period pattern. The NHS names the progestogen-only pill, hormonal coil, implant and injection as methods that can make periods irregular or stop them. The combined pill can continue to produce monthly bleeds. Tell the clinician what you use. NHS

Fatigue, low mood, weight change and poor concentration also occur with thyroid problems. Assessment uses the whole picture. Bleeding has its own review rules: the NHS advises assessment for any vaginal bleeding after 12 months without periods, even spotting or pink/brown discharge. If HRT has left you with irregular or heavier bleeding or spotting beyond 6 months, talk to the doctor. NHS

What does HRT actually consist of?

Oestrogen can be taken as tablets or used as patches, spray or gel; progestogen protects the womb for most women taking it.

The NHS bases the HRT choice on whether you still have periods and whether you have had a hysterectomy. The route also affects convenience and suitability: difficulty with one form need not rule out the others. NHS

Progestogen is the part most often misunderstood. The NHS states it directly: if you are taking oestrogen and have not had a hysterectomy, it is important to take progestogen to protect your womb. This is not an optional addition or a second-line extra. It can be taken as tablets, as part of a combined patch, or as the hormonal coil, also called an intrauterine system (IUS). Oestrogen alone stimulates the womb lining; women who have had a hysterectomy generally do not need progestogen.

Local oestrogen is used as a cream or pessary to treat vaginal dryness and soreness, or urinary symptoms, after the menopause. This is a distinct treatment from systemic HRT and is often the right answer when the vaginal and urinary symptoms are the main problem.

Testosterone gel or cream can help improve low libido for some women, and may be available on prescription from a menopause specialist. The NHS is careful to note that low libido around menopause has many possible causes, including relationship difficulties, how you feel about yourself, and physical discomfort. Treating it as purely hormonal can miss the actual reason.

What if HRT is not suitable for me?

CBT and non-hormonal medicines can help some symptoms when HRT is unsuitable, unwanted or ineffective.

The NHS describes antidepressants for low mood, depression or anxiety related to menopause. For hot flushes and night sweats, it describes cognitive behavioural therapy (CBT); if this does not help, a doctor may suggest clonidine or an antidepressant. Local vaginal treatment can also be used in some circumstances where systemic HRT is inappropriate. Suitability depends on your history. NHS

Do and don’t

Do:

  • Raise symptoms while periods are still changing. Mention contraception such as the progestogen-only pill, IUS, implant or injection, which can obscure the bleeding pattern. NHS
  • Mention sleep, mood and memory, not just hot flushes.
  • Take progestogen alongside oestrogen if you still have your womb.
  • Ask about local vaginal treatment if those are your main symptoms.
  • Bring the active ingredient, strength and formulation from an HRT prescription started abroad. Local formulations may differ, so review the treatment rather than matching only the brand.
  • Ask about bone health. Falling oestrogen affects bone density; the NHS lists bone weakening that can lead to osteoporosis, as well as joint/muscle pain, hair thinning, skin changes, sensitive teeth and painful gums. NHS
  • Report bleeding after 12 months without periods, even a small amount or a single episode. NHS
  • Check storage for patches and gels. Most medicines here are labelled for below 25°C, discussed in storing medicine in a Gulf summer.

Don’t:

  • Don’t assume symptoms must be stress or ageing.
  • Take oestrogen alone without advice if your womb is still present. Progestogen may be supplied as tablets, a combined patch or an IUS. NHS
  • Assume a friend’s HRT will suit you, or that red clover and black cohosh are established treatments. The NHS says evidence of their effectiveness and safety is very limited; some herbal products can cause serious effects with other medicines. Discuss them with the prescriber. NHS
  • Treat low libido as purely hormonal or dismiss the hormone contribution. The NHS names relationship difficulties, self-image and physical discomfort as other possible contributors. NHS
  • Don’t stop HRT abruptly without discussing it.

Match a continuing prescription by active ingredient, strength and formulation.

The menopause and HRT and hormone therapy categories list what is stocked here, and menopausal vasomotor symptoms approaches it from the indication. The ingredients index is the reliable way to match a prescription started in another country.

MedicForce option: our hormone listings show active ingredient, dose and formulation, which are the three details needed to continue an existing HRT prescription accurately.