Menopause

This guideline applies to females

 

 Introduction

• Menopause is the final menstrual period and is usually diagnosed clinically after 12 months of amenorrhoea, after which the woman is post-menopausal
• In the UK, the mean age of natural menopause is 51 years, although this can vary between different ethnic groups
• Perimenopause can start when women are in their 30’s.  This is the period before menopause, characterised by symptoms of menopause, irregular cycles of ovulation and menstruation
• Early menopause is the cessation of ovarian function between 40 and 45 years, in the absence of other causes
• Premature ovarian insufficiency (POI) describes the transient or permanent loss of ovarian function before 40 years of age.  Please see separate POI page.

 

In scope                  

• Menopause

 

Not in scope      

• Post Menopausal Bleeding (PMB) For Women Not On HRT  
• Unscheduled Bleeding (USB) on Hormone Replacement Therapy (HRT)
• POI

  

Red Flag Features

PV bleeding in post-menopausal women- please see:

• Post Menopausal Bleeding (PMB) For Women Not On HRT   

OR

• Unscheduled Bleeding (USB) on Hormone Replacement Therapy (HRT)

 

Investigations required prior to referral

• FSH and other blood tests are not required to diagnose menopause. 

 

Management optimisation

• Consider using a symptom checker prior to or during a consultation.
• Most menopausal women can be managed in primary care.
• For Hormone Replace Therapy- please see HRT page, otherwise see other management options:

 

Lifestyle measures:

Provide information on:

• Healthy diet and smoking cessation
• Reducing alcohol intake.
• Regular physical activity.
• Bone health/osteoporosis

See NICE CKS for further information on lifestyle changes for menopause management

 

Discuss the need for contraception:

• For women aged 40-50 years: women are potentially fertile for 2 years after her last menstrual period
• For over 50 years of age: women are potentially fertile for a year after her last menstrual period.
• In general, all women can stop contraception at 55 years.
• HRT does not provide contraception.
• All progestogen-only methods of contraception are safe to use as contraception alongside sequential HRT (Continuous combined HRT is generally used in post-menopause women who do not need contraception).
• Combined hormonal contraception (CHC) can be used in eligible women under 50 years of age as an alternative to HRT for relief of menopausal symptoms and prevention of loss of bone mineral density providing UKMEC is 2 or less.
• At 50 years old, women should be advised to switch to a non-injectable progestogen-only contraception or a non-hormonal method at 50 years of age as the risks of CHC generally outweigh the contraceptive benefits.  See FSRH guideline for more details.

 

Non- hormonal treatments

For vasomotor symptoms:

• Consider CBT
• See BMS guide to prescribable alternatives to HRT which includes doses and adverse effects.
• Oxybutynin, which is usually used to treat overactive bladder, has been shown to reduce the incidence of hot flushes. It is being used off licence by some menopause specialists for this purpose. The usual dose is 2.5 mg twice daily, with the option of increasing to 5 mg twice daily.²

 

For sleep problems associated with menopause:

• Consider online CBT through Silvercloud “space for sleep”
• See sleep problems for further information.

 

For urogenital symptoms

• Consider vaginal oestrogen (see HRT Page for more information).
• Consider non-hormonal OTC vaginal lubricants eg KY jelly and moisturisers alone or along with HRT.
• See vaginal dryness for patient information. 

 

For people considering unregulated preparations or complementary therapies advise: The efficacy and safety of unregulated hormone preparations are unknown-this fact sheet may be helpful.  

 

Advice and Guidance

See Menopause Advice & Guidance page for details about this service.

 

Referral

• Please not that there is no commissioned service for menopause management at RCHT.  The Gynaecology service will not accept referrals for this
• For infertility for women with POI: please see Infertility page.

 

Reference

• https://thebms.org.uk/wp-content/uploads/2025/11/04-BMS-ConsensusStatement-Non-hormonal-based-treatments-for-menopausal-symptoms-NOV2025-C.pdf

 

Supporting Information

For professionals

• BMS Tools for Clinicians - British Menopause Society
• BMS PPMC Resources Toolkit - British Menopause Society

 

For patients

See https://www.womens-health-concern.org/help-and-advice/factsheets/Women’s Health Concern for fact sheets on topics including:

• The menopause - also available in Bulgarian, Lithuanian, Polish, Romanian and Spanish
• CBT for menopausal symptoms
• Exercise and menopause
• Nutrition in menopause
• Contraception over 40
• Vaginal dryness
• Sleep problems
• Menopause in the Workplace 

 

References

1. Menopause NICE CKS
2. FSRH Contraception for Women aged over 40 years
3. UKMEC_2025_Summary_Tables.pdf

 

Page Review Information

Review date	15 May 2026
Next review date	15 May 2028
Clinical editor	Dr Melanie Schick
Contributors	Dr Charlotte Patton, Clinician for Cornwall's Menopause Advice & Guidance Service and Women's Health GP, St Austell Healthcare, St Austell