The average age of menopause in the UK is 51, but perimenopause — the transitional phase when symptoms begin — can start in the early 40s. Approximately 75% of women experience vasomotor symptoms (hot flushes, night sweats), and many also report cognitive changes, mood disturbance, joint pain, and reduced libido. Despite NICE guidance recommending that menopause should be diagnosed clinically in women over 45, many patients report difficulty accessing timely, personalised care through the NHS.[1][6]
Common Symptoms
| Category | Symptoms |
|---|---|
| Vasomotor | Hot flushes, night sweats, palpitations |
| Psychological | Anxiety, low mood, irritability, brain fog, poor concentration |
| Urogenital | Vaginal dryness, recurrent UTIs, urinary urgency, reduced libido |
| Musculoskeletal | Joint stiffness, muscle aches, fatigue |
| Sleep | Insomnia, early waking, non-restorative sleep |
| Metabolic | Weight gain (particularly central), increased cardiovascular risk |
How We Diagnose Perimenopause
For women over 45 with typical symptoms, diagnosis is clinical — no blood test is required.[1] However, for women under 45, or those with atypical presentations, I request FSH, oestradiol, and thyroid function to confirm the diagnosis and exclude other causes. At Victoria Medical, results are available within 24 hours, and treatment can begin at the same appointment if clinically appropriate.
Treatment Options
| Treatment | Indication | Evidence |
|---|---|---|
| Body-identical HRT (oestrogen + micronised progesterone) | Vasomotor symptoms, mood, sleep, bone protection | NICE first-line; lowest breast risk profile among HRT types |
| Transdermal oestrogen (patch/gel) | Preferred route — no VTE risk increase vs oral | BMS 2020 guidelines recommend transdermal as default |
| Testosterone | Reduced libido not responding to oestrogen alone | Global consensus supports use in postmenopausal women |
| Vaginal oestrogen | Urogenital symptoms (dryness, UTIs) | Can be used alongside systemic HRT; minimal systemic absorption |
| CBT / lifestyle modification | Mild symptoms or patient preference | NICE recommends as adjunct or alternative |
The British Menopause Society recommends that HRT should be offered to all symptomatic women after an individualised risk–benefit discussion.[4] For most women under 60 who start HRT within 10 years of menopause, the cardiovascular benefits outweigh risks.[2]
From Our Practice
"Many women arrive having been told they are 'too young for menopause' or that HRT is 'too risky.' The evidence tells a different story. For most women, body-identical HRT started at the right time is safe, effective, and transformative. My role is to provide the information and support needed for an informed decision."
— Dr George Xynopoulos, Consultant Physician
Frequently Asked Questions
Is HRT safe?
For most women under 60 starting within 10 years of menopause, the benefits of body-identical HRT outweigh the risks. Transdermal oestrogen does not increase VTE risk, and micronised progesterone carries a lower breast cancer risk than older synthetic progestogens.
How quickly does HRT work?
Most women notice improvement in vasomotor symptoms within 2–4 weeks. Full benefits for mood, sleep, and cognition may take 2–3 months. I review progress at 3 months and adjust if needed.
Do I need blood tests?
For women over 45 with typical symptoms, diagnosis is clinical. For women under 45, or those with atypical presentations, I request FSH, oestradiol, and thyroid function. Baseline cardiovascular screening is also recommended before starting HRT.
Can I get HRT privately if my NHS GP won't prescribe it?
Yes. Many women come to us after being declined HRT on the NHS. I provide a thorough assessment, prescribe if appropriate, and can write to your NHS GP to ensure continuity of care.
What about testosterone?
Testosterone is recommended by global consensus for women with reduced libido that has not responded to oestrogen replacement alone. It is prescribed off-label in the UK and requires monitoring.
How long can I stay on HRT?
There is no arbitrary time limit. NICE states that HRT should be continued for as long as benefits outweigh risks, reviewed annually. Many women remain on HRT well into their 60s and beyond.
Related Guides
Menopause & Heart Health
Cardiovascular risk in menopause
Private Gynaecologist
Specialist women's health care
Well-Woman Health Check
Comprehensive annual screening
Book Appointment
Same-day consultations available
References
- [1] NICE NG23. Menopause: diagnosis and management. 2015 (updated 2024). View source
- [2] Newson LR. Menopause and cardiovascular disease. Post Reprod Health. 2018;24(1):44–49. View source
- [3] Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk. Lancet. 2019;394(10204):1159–1168. View source
- [4] Hamoda H, et al. The British Menopause Society & Women's Health Concern 2020 recommendations on hormone replacement therapy. Post Reprod Health. 2020;26(4):181–209. View source
- [5] Davis SR, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. View source
- [6] Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015;44(3):497–515. View source
