Menopause — defined as 12 consecutive months without a menstrual period — typically occurs between ages 45 and 55, with an average age of 51 in the UK. The perimenopause (the transition leading up to menopause) can begin years earlier and often brings the most difficult symptoms. Understanding what’s happening hormonally transforms how you manage it.
What’s Happening in the Body
As ovarian function declines, oestrogen and progesterone levels fall. This affects virtually every tissue in the body — these hormones have receptors in the brain, bones, heart, blood vessels, skin, vagina, bladder and breasts. The declining levels explain the diversity of menopausal symptoms. The hypothalamus (which regulates body temperature) is particularly sensitive to oestrogen — its loss causes the dysregulation responsible for hot flushes and night sweats.
The Most Common Symptoms
Vasomotor symptoms: hot flushes and night sweats (affect 75–80% of women). Urogenital symptoms: vaginal dryness, discomfort, increased UTI frequency. Sleep disruption (both directly and secondary to night sweats). Mood changes: anxiety, irritability, low mood — oestrogen supports serotonin and dopamine function. Cognitive changes: “brain fog,” word-finding difficulty (usually transient). Musculoskeletal: joint pain and stiffness — often underrecognised as a menopausal symptom. Skin changes: reduced collagen production causes thinning and dryness. Long-term: accelerated bone density loss (osteoporosis risk rises sharply); increased cardiovascular risk.
OTC Support Options
Vaginal dryness: non-hormonal vaginal moisturisers (Replens Long-Lasting) 3× weekly; lubricants for comfort during sexual activity. Gina 10mcg estradiol vaginal tablets — now available OTC without prescription for postmenopausal women over 50 with vaginal symptoms. Nutritional support: Calcium 1000–1200mg + Vitamin D 20mcg for bone protection. Magnesium for sleep, mood and joint symptoms. Omega-3 for cardiovascular and mood support. Hot flushes: black cohosh has limited but plausible evidence in some trials (not safe with breast cancer history); red clover isoflavones (plant oestrogens) have modest evidence. Sleep: magnesium glycinate; valerian; OTC promethazine-based sleep aids for short-term use.
When to See a GP About HRT
Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms. The risk-benefit profile has been significantly revised since the 2002 WHI study — for most women under 60 with moderate to severe symptoms, HRT is appropriate and beneficial. The NICE menopause guideline strongly endorses HRT for suitable women. If symptoms are affecting quality of life, relationships or work, a GP or menopause specialist consultation is worthwhile.
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