MENOPAUSE means cessation of periods. The diagnosis of natural menopause can only be made 12 months after a woman’s last period, whereas surgical removal of the ovaries, or any event that causes ovarian failure, results in immediate cessation of periods.

Perhaps less well known is the term perimenopause, used to define the period before this event and after, when declining levels of sex hormones may result in several symptoms both physical and mental, to varying degrees.

The average age of natural menopause in the UK is 51, yet women may experience hot flushes and night sweats as early as their early forties, sometimes even before this. These may continue for years after menopause has occurred.

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Other complaints including brain fog, anxiety and depression, reduced libido, joint and muscle pains may also be due to declining levels of the principal hormone oestrogen, as well as progesterone and testosterone.

Although the menopause is a natural event, 25 per cent of women classify their symptoms as severe, with 1 in 10 admitting to feeling suicidal as a direct result.

The perimenopause has been trivialised by some, and many women will undoubtedly have been reluctant to come forward due the associated stigma, leading to many suffering in silence.

Furthermore, poorly conducted studies in the early 90’s advised that the risks of venous thromboembolism (deep vein thrombosis and pulmonary embolism), cardiovascular events (heart attack and stroke) and breast cancer made HRT unsuitable for the majority, to a point where doctors were scared to prescribe, and women fearful to enquire about it.

It is important for women to come forward as some of the reported symptoms may be due to causes other than the menopause, and will need investigating, especially those which are severe, or where another diagnosis is strongly suspected.

You don’t need to have gone through the menopause to commence treatment for it. Women who have had an early menopause, currently defined as under 45, will be offered HRT until the age of 50, to reduce the chances of osteoporosis, providing it is suitable for them.

The diagnosis of perimenopause is largely made on reported symptoms, and once this has been established, treatment options can be discussed with the majority available in general practice