The first sign of menopause is usually a change in the normal pattern of your periods. You may start having either unusually light or heavy periods.
The frequency of periods may also be affected. They may occur every two or three weeks, or they might not occur for months at a time. Eventually, periods will stop altogether, although for some women other menopause symptoms may continue.
Some women can start experiencing symptoms such as migraines, irritability and low mood especially around the period time, without seeing irregularity in periods.
There are many menopausal symptoms and symptoms can differ between individuals. Some of the most common symptoms include:
Menopause can also increase your risk of developing certain other problems, such as weak bones (osteoporosis (external website)) or cardiac disease.
The main medicine treatment for menopause and perimenopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels.
There are other treatments if you cannot, or choose not to, have HRT.
Hormone replacement therapy (HRT)
The main treatment option for the menopause is hormone replacement therapy, or HRT. It can be used to combat symptoms like hot flushes, mood changes, vaginal dryness and reduced sex drive. It can also help reduce your risk of osteoporosis.
In the past, HRT has been the subject of debates about safety, because it is associated with some health complications, including a slightly increased risk of blood clots and cancer. However, it’s now widely agreed that the benefits of HRT outweigh the risks (external website) for most women.
How HRT works
The menopause is caused by falling levels of oestrogen. HRT works by artificially “topping up” your oestrogen levels, which helps reduce symptoms.
Most women who use HRT will need to use a combination type i.e. one that contains oestrogen and progestogen (synthetic progesterone). This is because, taken on its own, oestrogen increases your risk of developing endometrial cancer (cancer of the lining of the womb). If you’ve had a hysterectomy, you can safely use oestrogen-only HRT.
The type of HRT you get will depend on your age, whether you still have periods or not, and whether you've had a hysterectomy.
Combined or oestrogen-only tablets
Most women who use HRT will take tablets, and will normally take one a day.
Tablet HRT is a good option as it’s easy and non-invasive. However, it is associated with a slightly higher risk of health complications like blood clots when compared to other types.
Combined or oestrogen-only skin patches
HRT skin patches are small squares like plasters that stick to the skin and release hormones over a few days, before being replaced.
As with tablets, skin patches are an easy and straightforward treatment option. Unlike tablets, there’s no increased risk of blood clots. Patches can also help you avoid side effects like nausea.
As with skin patches, oestrogen gel is absorbed through the skin and doesn’t come with an increased risk of blood clots. For it to work, you’ll need to rub it into your skin once a day.
However, if you still have your womb, you’ll need to take some form of progestogen to stay safe. For women who have an intrauterine system (IUS) for contraception, it’s safe to use this gel.
If your main menopausal symptom is vaginal dryness, you could benefit from vaginal oestrogen. This is a localised form of HRT which specifically helps with vaginal dryness and discomfort, but not any of the other symptoms of the menopause.
Vaginal oestrogen comes as a cream, pessary or ring that’s inserted directly into the vagina. It doesn’t carry the usual risks associated with HRT because it’s so localised – this means that you don’t have to take progestogen alongside it.
A rare type of HRT is an oestrogen implant, which is designed to sit under the skin (usually of your abdomen) and release oestrogen for several months before being replaced. Oestrogen implants are unlicensed and are only available through specialist clinics. Unless you've had a hysterectomy, you'll need to have a source of progestogen as well. This could be progestogen pessaries or tablets or the intrauterine system (IUS).
For some women, a loss of sex drive is one of the main symptoms of the menopause. If this has been a problem for you, and you’ve been referred to a menopause specialist for help, they might prescribe testosterone gel, which is rubbed into the skin.
Other prescription treatments for the menopausal symptoms
If you don’t want to use HRT, or if it’s not safe for you to do so, there are some other prescription medications you can try.
Tibolone is similar to combined HRT and comes as a tablet, taken once a day. It can relieve menopausal symptoms like hot flushes and low mood, although it’s thought to be less effective than HRT. You can only take Tibolone if you’re post-menopausal i.e. your periods stopped more than a year ago.
As with HRT, Tibolone is associated with health complications, like an increased risk of breast cancer and strokes.
Clonidine is a tablet medication taken two or three times a day that specifically combats hot flushes and night sweats. Clonidine doesn’t carry an increased risk of cancer or blood clots, but like any medicine, it can cause unpleasant side effects, and success isn’t guaranteed.