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Menopause: Symptoms, Hormone Therapy & Long-Term Wellbeing

The average woman spends a third of her life post-menopause. Modern HRT is safe for most women and significantly improves quality of life, including bone and heart health.

Written by Suman Konda, PharmD, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last updated: · How we check our content

Average age
51 years (UK)
Perimenopause
Can start in mid-40s
Early menopause
Before 45: requires HRT until age 51
HRT risks
Reassessed: modest; benefits often outweigh

Common Symptoms

SymptomPrevalenceImpact
Hot flushes / night sweats70–80%Most bothersome; disrupt sleep
Vaginal dryness / GSM50%Dyspareunia, UTIs, urgency
Mood changes / low mood40–50%Not depression per se; oestrogen-related
Cognitive symptoms ('brain fog')60%Poor concentration, word-finding
Sleep disturbance60%Often from night sweats; independent effect
Musculoskeletal aches60%Joint pains; often overlooked
Loss of libido40%Multiple drivers: testosterone, psychological, GSM

HRT: Benefits and Risks

BenefitEvidence
Hot flush reliefHRT most effective treatment: 80% reduction
Bone protectionReduces fracture risk during use (40–50%)
Cardiovascular protectionWhen started within 10 years of menopause or before 60: reduces CVD risk
Mood and cognitionSignificant improvement in many women
GSM treatmentTopical oestrogen highly effective; no systemic risk
Transdermal HRT Is SaferOral oestrogen increases blood clot risk (VTE). Transdermal patches, gels, or sprays bypass liver first-pass metabolism and do not increase VTE risk: preferred for women with VTE risk factors or history.
Premature Menopause Needs HRTWomen under 45 who experience menopause should take HRT until at least age 51: to protect bones, heart, and brain from premature oestrogen deficiency. This is not elective, it's protective.
Does HRT increase breast cancer risk?
Combined HRT (oestrogen + progestogen) does modestly increase breast cancer risk, roughly equivalent to drinking 1–2 units of alcohol per night, or being overweight. The risk disappears after stopping HRT. Body-identical progesterone (micronised) may carry lower risk than synthetic progestogens.
How long can I take HRT?
There's no defined maximum duration. NICE recommends discussing benefits and risks annually. Many women continue beyond 5–10 years, especially for bone protection or ongoing symptoms. A 2019 large UK study reassessed and found the absolute risk is small.
Can HRT be started after 60?
Yes, but with more caution. Starting after 60 or >10 years after menopause may carry higher cardiovascular risk. The 'critical window' hypothesis suggests early initiation is most protective. Discuss risk-benefit with your GP or menopause specialist.
What is the Mirena coil's role in HRT?
The Mirena (levonorgestrel) coil provides the progestogen component of combined HRT when used alongside oestrogen patches/gel: protecting the uterine lining without systemic progestogen effects.
OsteoporosisBone protection

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

  1. Menopause. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK507826

Related reading

Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.