Understanding Menopause: Symptoms, Myths and Management

Menopause is not a disease — it is a natural transition, usually between the ages of 45 and 55. But telling a woman drenched in sweat at three in the morning that it is 'natural' is not helpful. The symptoms are real, they vary enormously, and some women need active treatment.

Perimenopause — the years leading up to the last period — is often the most disruptive phase. Irregular cycles, heavier bleeding, mood swings, sleep disturbance and hot flushes can start several years before periods actually stop. This is when many women first seek help.

Hormone replacement therapy (HRT) remains the most effective treatment for moderate to severe vasomotor symptoms (hot flushes and night sweats). Modern low-dose formulations carry a much smaller risk profile than the older studies suggested, and the benefits often outweigh the risks for women under 60 or within ten years of menopause.

Not every symptom needs hormones. Joint aches, forgetfulness and low mood can sometimes be addressed with exercise, improved sleep hygiene, and in some cases a short course of antidepressants. Vaginal dryness responds well to local oestrogen applied directly — this carries minimal systemic absorption and is safe for most women.

Bone density starts declining after menopause, increasing the risk of fractures. A baseline DEXA scan after 50, adequate calcium and vitamin D intake, and regular weight-bearing exercise form the foundation of bone health. HRT also protects bone density as long as it is continued.

The most important thing is an individualised plan. Every woman's risk profile, symptom burden and preferences are different. A thorough consultation — not a five-minute visit — is what menopause care requires.