Myth busting the menopause: what you need to know….
….plus some common myths and assumptions we really need to debunk.
The term ‘menopause’ tends to be used to mean the period of a woman’s life, usually somewhere around mid-forties to mid-fifties, when their ovaries slow and their reproductive life begins to draw to a close. It’s also used as a shorthand for the troublesome symptoms that many women experience during this phase of life.
Medically, ‘menopause’ itself is a moment in time – when it has been exactly 12 months since your last period. The average age at which this happens is 51 (hence our name!). The time before that is called perimenopause, and the time after is post-menopause. For most women the menopause transition starts some time in their 40’s, and is finished by 60 – and menopause symptoms will be common throughout this phase of life.
80% of all women will experience some symptoms, and of those, 25% will experience severe symptoms, which hugely impact their health, wellbeing, work, relationships, and quality of life. The average length of time that symptoms last is 8 years, but for 20% of women, they can last for decades.
Given all of that, it is amazing how little focus there was on menopause during most doctors’ medical training; fortunately, that is just slowly beginning to change! But there is evidence that around 50% of women suffering from menopause symptoms don’t go to see their GP.
I’m only menopausal if I suffer from hot flushes….
There is a common misconception that menopause starts and ends with hot flushes!
Hopefully most of us now know that this isn’t the case (in fact some women will have a range of other menopause symptoms but never experience a hot flush). And yet very few women know the full extent, range and diversity of symptoms that can be experienced during this time, and so may never attribute them to the menopause.
Symptoms can be grouped into three main categories:
Physical symptoms:
Heart palpitations
Tiredness
Changes to skin, hair and nails
Insomnia
Hot Flushes
Dizziness
Feelings of tightness in the body
Tingling
Numbness
Feeling Faint
Headaches
Migraines
Difficulty Breathing
Joint & Muscle Aches
Night-sweats
Dry eyes
Allergies
Itching
Menorrhagia (heavy and prolonged menstrual bleeding)
Burning mouth
Electric shocks
Itchiness
Gum problems
Brain fog
Reduced Concentration
Bloating
Weight Gain
Changed body odour
Osteoporosis
Psychological Symptoms:
Anxiety
Panic attacks
Feelings of unhappiness
Anhedonia (lack of joy)
Crying all the time
Low mood & depression
Irritability
Worsening PMT
Genito-Urinary & Sexual Symptoms:
Vulval discomfort (often thrush like symptoms of itch and burning)
Vaginal dryness
Low libido
Recurrent UTI’s (Urinary Tract Infections)
Urinary frequency
Dysuria (burning, stinging or itching with urination)
With such a long, diverse and seemingly unconnected range of symptoms, it may be fairly unsurprising that misdiagnosis has been common….historically women have been diagnosed with depression, fibromyalgia, or just as a ‘problem patient’. They may also have been through multiple specialist referrals, treatment failures, and more.
We like to think of hormones as the 5th vital sign – and believe that all women of menopausal transition age(40-60) should be asked about their periods, whether they suffer from temperature regulation issues, genito-urinary symptoms, as a standard part of a medical assessment.
The Greene Climacteric Scale is a validated, international used tool, to measure menopause symptoms, that can really help you and your healthcare professional to understand where you are in the menopause transition – and then, after starting treatment, to understand how well it is working. There is a version of it on our ‘Is this the menopause?’ page, and you’re welcome to use in prior to a consultation with your GP or any other healthcare professional, too.
I should be able to cope with menopause symptoms – after all it’s a ‘natural’ process…
We still often hear the unhelpful idea that because the menopause is ‘natural’ women should just be able to ‘cope’. Perhaps that’s what our mothers or grandmothers told us? Or we have friends that have just managed through menopause and suggest that you do the same? The menopause, the end of our reproductive lives is completely normal and will happen to all of us, it should not be treated as a disease but it does represent a major change in our physiology that we should all understand and the symptoms caused by hormone fluctuations can last many years-life is precious, don’t let anyone tell you to put up and shut up!
As recently as around 100 years ago, women went through menopause in their late 50’s, and then would expect to die just a few years later, in their early 60s – whereas now most women will expect to live at least 1/3 of their lives post menopause. Once our ovaries stop working, our risk of cardiovascular disease (heart disease, heart attack and stroke), increases and our bone density decreases – and it surprises most people to know that cardiovascular disease is by far the biggest cause of death for women and far above breast cancer.
And yes, there are some women whose symptoms are mild enough that they can manage, or make lifestyle adjustments that mean they can. But there are as many more whose menopause symptoms are more than bothersome, they are life-changing.
I need a blood test to diagnose menopause…
NICE (the National Institute for Health & Care Excellence) produce guidance for the NHS and other healthcare professionals on what constitutes the best patient care.
In November 2024, NICE updated its guidance on menopause care in the UK, with a focus on improving diagnosis, treatment, and ongoing support. These guidelines provide clear, evidence-based recommendations. NICE advises that in otherwise healthy women, over 45, diagnosis should be based on clinical history and symptoms, not on testing. This is intended to streamline access to support and treatment.
An initial review should take place around three months after starting treatment, with annual reviews thereafter if the person is stable. If symptoms persist, side effects occur, or further clarity is needed around treatment choices, referral to a menopause specialist is recommended.
Crucially, the updated guidelines promote individualised, person-centred care. Treatment should always be tailored to the individual’s circumstances, health background, and treatment goals.
HRT should only be prescribed as a last resort …
When it comes to managing symptoms, the guidelines are clear: hormone replacement therapy (HRT) should be offered as the first-line treatment for vasomotor symptoms such as hot flushes and night sweats. For those unable or unwilling to take HRT, menopause-specific cognitive behavioural therapy (CBT) may be offered as an alternative or complementary option. Every woman should be full informed about the benefits and risks of each treatment, and supported in making choices that suit their health and preferences.
NICE has also emphasised that HRT is unlikely to have a negative impact on overall life expectancy.
For genitourinary symptoms like vaginal dryness, irritation, or discomfort during sex, NICE recommends vaginal oestrogen therapy, even for those already using systemic HRT. People should be offered a choice of treatment forms—such as creams, gels, pessaries, tablets, or vaginal rings—based on what’s most convenient and effective for them. This kind of treatment is considered safe, with minimal systemic absorption, and can be used alongside non-hormonal lubricants or moisturisers. Treatment should be reviewed after three months and then annually to ensure it remains effective.
I can’t take HRT if I have had, or have a family history of, cancer…
HRT should be avoided if you have had a hormone-dependent cancer – but most cancers are NOT hormone-dependent.
The hormone dependent cancer (eg breast and ovarian cancer) risk from HRT is small, and depends on many different factors; the type of HRT used, how long it is taken for, and the patients age and general health. The benefits in terms of both managing symptoms, and the known benefits for women in terms of decreased cardiac risk, osteoporosis, and more need to be carefully considered, so that women can make an informed choice about their health.
SSRIs and SNRIs (anti-depressants) should be first line treatment for menopause related depression and anxiety….
SSRIs and SNRIs are effective at treating clinical depression and anxiety and maybe helpful in the menopause transition but the evidence suggests that HRT is a more effective first line option for treatment of mood-related issues caused by the menopause transition ie if you suffer with depression or anxiety for the first time during this phase of life. If you can’t or don’t want to take HRT please do still consider SSRI and SNRIs for mood issues and also have evidence for improving of vasomotor symptoms (hot flushes & night sweats)
You shouldn’t take HRT if you suffer from migraines…
Women get migraine attacks for a variety of reasons, and some of them may be hormonal. They can be triggered by fluctuating hormones – and so stabilising hormones, for which the first line treatment is HRT, may help.
There is some slightly ‘stuck’ thinking that HRT shouldn’t be given to migraine sufferers, but this isn’t correct. This comes from the combined contraceptive pill, which shouldn’t be prescribed to women who suffer from migraine attacks with aura – but the type & dose of hormone in the contraceptive pill is very different from HRT.
The British Menopause Society gives very clear guidance that HRT can be beneficial for women experiencing migraine attacks, but that maintain stable blood hormone levels is key. Delivery methods such as a patch or spray are ideal as they give the most stable blood levels.
HRT can only be taken for 5 years…
This is a common myth that comes up time and time again. The NICE guidelines on menopause care advise that care should be individualised and that women on HRT should have an annual review to ensure the benefit of HRT continues to outweigh the risk. They do not advise maximum time limit or maximum age for continuing to take HRT.
Please do note that careful consideration should be given to starting HRT if it has been more than 10 years since your last natural period (this is often taken to be 60 years old by health care professionals). After this time there is no evidence of long-term health benefit, HRT may be higher risk and many symptoms will have settled as the body has got used to low stable hormones. However individual care is key as some women will continue to get hormone related symptoms for the rest of their life which HRT may effectively treat.
Here are some things it is useful to know, in relation to this particular myth:-
- It is hard to know if you still need HRT, while you are taking it! As the medicine is controlling your symptoms.
- Most women’s ovaries will have shut down completely by the time they are 55, but it can take a couple of years after that for our bodies to adjust to lower background levels of hormones
- It is perfectly possible to stop, or reduce the level of HRT you are taking, to assess how your symptoms respond - and restart or increase again if symptoms are still present, and bothersome.
- Being on HRT for up to 5 years carries the lowest level of risk
- Being on HRT until you are at least 60 gives extra protection against loss of bone density and cardiovascular disease
Ultimately, the right decision is the one that is right for YOU, and your medical history, lifestyle and symptoms - having considered the risks and benefits with your healthcare professional. Each individual’s circumstances will determine the right answer for them.
There are some brilliant resources that can help you to stay informed about truth vs. fiction when it comes to menopause. But be careful which ones you trust! There are a list of brilliant resources & further reading on the Menopause Library page of this site.
