Facts
A lack of menopause awareness and support costs the UK economy approx. £20 Billion a year
Over 70% of Women blame menopause for their divorce or breakdown of a relationship
Early detection avoids referrals to secondary care and potentially misdiagnosis (most common are fibromyalgia, chronic fatigue and long covid)
Over 25% of women have taken a considerable amount of time off work and consider leaving their jobs
22% of women working for the NHS have taken time off for more than one month due to menopausal symptoms
Menopause is 12 consecutive months without a period and the average age is around 51 in the UK
Almost 50% of women haven't spoken to their GP about their menopausal symptoms
Approximately 14
Million women in the UK are either peri or post menopausal at the present time
67% of women report an increase in domestic abuse and arguments due to menopause
Correct treatment keeps women in the workforce, many are at the peak of their career and very experienced in their field
10% of women in the workforce leave their job due to the debilitating effects of their menopausal symptoms
The highest rate of suicide and attempted suicide in women is between the ages of 45-55
Menopause is not just hot flashes, the top 3 most dibilitating symptoms are lack of sleep, brain fog and anxiety
NICE guidance states that hormone replacement therapy should be offered to women who are struggling with menopausal symptoms as first line treatment
There are over 50 recognised menopausal symptoms
Correct treatment reduces future health issues, including Osteoporosis, Heart disease, Dementia, Diabetes, and Depression
94% of women report a negative impact on work due to the severity of their symptoms
48% of women working within the NHS were considering quitting their job as a result of menopause symptoms
One in a hundred women will experience menopause under the age of 40
41% of UK universities do not have mandatory menopause education on the curriculum
77% of women find at least one menopause symptom extremely difficult to live with
Currently around 14% of menopausal women in the UK are on Hormone Replacement Therapy
For the vast majority of women, the benefits of taking HRT far outweigh any risk
When a woman becomes Post Menopausal, she is living with a long term hormone defiency. This will have health implications for most women
Body Identical hormone replacement therapy is derived from the wild yam plant
Body Identical HRT contains hormones that are the same in molecular structure to the hormones that your own body produces before menopause
In the most recent trials, there is no known associated risk of increasing your chance of developing breast cancer with Body Identical HRT
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Frequently Asked Questions
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Compiled by Menopause Specialists and Nurses from our friends at Menopause Support
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1. What is the difference between body identical and bio identical HRT?
Body identical refers to HRT products which are licenced, regulated and available from your GP for a usual NHS prescription charge, if you pay for prescriptions. They are also prescribed by both NHS and private menopause specialists. Bio identical HRT is not licenced or regulated and is only available from private practitioners who are not necessarily menopause specialists. Bio-identical products are made up for the individual, in compounding pharmacies and can be very expensive, safety concerns have been raised over these.
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2. Can your GP refer you to a menopause specialist on the NHS? What if they refuse?
Yes, your GP can refer you and if they refuse they should have a good reason why. You can seek a second opinion from another GP within the same practice. Details of menopause clinics can be found on the British Menopause Society website.
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3. Is anxiety a symptom? What if my doctor offers me anti-depressants?
Anxiety is a very common symptom of perimenopause and menopause. Anti-depressants are not the first line treatment for menopausal anxiety, as detailed in the NICE guidance to menopause.
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4. My doctor has said that I can’t have HRT as I am still having periods, is this true?
No, you can start HRT while you are still having periods.
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5. My GP has said that I have to stop using HRT after 5 years or at the age of 55, is this true?
No, this is outdated information. There is no time limit on HRT use.
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6. I am overweight and have been told that I can’t have HRT, is this right?
No, you can have HRT, but it should be offered as a patch, gel, or spray.
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7. My skin feels very itchy and like I have insects crawling on me, is this a symptom and what should I do?
Yes, this can be a symptom for some women. Formication, as it is known, is caused by a lack of oestrogen and HRT can help to resolve this.
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8. I’ve just picked up my HRT patches/gel/spray/tablets and Utrogestan, when can I start?
Your GP should advise when and how you should use your HRT. It is likely that your GP would expect you to start straight away, but always check if in any doubt.
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9. Vaginal Atrophy – is it possible to have this without symptoms and what are the symptoms?
The most common symptoms of vaginal atrophy are vaginal dryness, soreness, irritation and burning, and repeated urinary tract infections. However, some women can be shocked by the appearance of their labia or clitoris, particularly if they are not use to checking and they have not experienced any symptoms.
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10. Can menopause cause changes to your hair? E.g., hair loss, drying, change in texture?
Yes, women have oestrogen receptors all over their bodies and hormonal fluctuations can result in different symptoms for different women.
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11. I have been referred to a gynaecologist instead of a menopause specialist, but they know all about menopause don’t they?
Unfortunately, gynaecologists do not all receive mandatory menopause training, so you need to see a doctor who specialises in menopause.
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12. Can I use vaginal oestrogens alongside my HRT? Is it safe to use both?
Yes, you can use vaginal oestrogen at the same time as your systemic HRT.
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13. Is restless legs a symptom and what can I take for it?
Yes, restless limbs can be a symptom for some women. HRT and/or a magnesium supplement can be useful.
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14. Magnesium – what does it do and what types are available, can it help with muscle aches and pains?
Magnesium is one of the most abundant minerals in our body, needed for literally hundreds of different chemical processes. Low levels of magnesium can interfere with your sleep, contribute to low mood, brain fog, fatigue, muscle and joint aches and pains as well as headaches. Magnesium is available in many synthetic forms as a supplement but can be found naturally in nuts and seeds, whole grains, dark green vegetables, and avocados.
If you are looking for a supplement, look for a chelated magnesium such as magnesium citrate. This is easily absorbed and therefore more likely to work more quickly and least likely to cause any digestive problems. Magnesium citrate is good for calmness and relaxation and can be taken in the morning to help with anxiety or at night to help with sleep.
Magnesium glycinate is also absorbed very easily and has a more potent calming effect, it can be useful to take in the evening (an hour before bed) to help with disrupted sleep.
At higher doses, magnesium can have a laxative effect. If you already suffer with a sensitive gut (such as IBS), be particularly mindful of starting with a low dose (100-200mg) and do not exceed 400mg without consulting a qualified practitioner.
Alternatively, adding Epsom Salts (that contain magnesium sulphate) to a warm bath can be good for relaxing muscles and achy joints, as can using a magnesium oil spray directly to the affected areas.
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15. What are the official figures for cancer risks for HRT?
It very much depends on which piece of research you choose to read but the overall risks of taking HRT are very low and for the vast majority the benefits outweigh the risks. Your doctor should discuss up to date statistics with you when prescribing.
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16. Can my GP prescribe testosterone?
In theory they can as the NICE guidelines say that in some circumstances testosterone should be considered, but many doctors do not feel confident to prescribe and some are told not to by their practice or ICB.
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17. What are the official contra-indications to HRT?
This is very much assessed on a patient-by-patient basis and should always be assessed taking into account the individual’s quality of life.
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18. What is testosterone used for?
Testosterone is often prescribed to women who report a continued reduction in libido even once established on HRT. It must be considered for women in surgical menopause. Testosterone also has a part to play in bone, muscle and skin health and can have an effect on cognitive function and confidence.
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19. Does HRT cause weight gain?
No, menopause causes weight gain. During peri-menopause and menopause, the amount and type of the hormone oestrogen alters, and this can cause body shape and weight distribution changes.
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20. I have a family history of breast cancer, does this mean that I can’t have HRT?
No, not necessarily. Your risk should be individually assessed. Your GP may feel that a referral to a menopause specialist is required to discuss all possible treatment options for you.
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21. Can I have HRT if I have high blood pressure?
High blood pressure (hypertension) puts us at greater risk of developing blood clots. Oral HRT is also known to slightly increase the risk of developing blood clots. Therefore, it is appropriate to use transdermal forms (patches/gels/spray) of HRT along with micronised progesterone (if required) to minimise these risks. It is appropriate for your high blood pressure to be stabilised using medication, if necessary, prior to introducing HRT.
Surgical Menopause Questions and Answers with Dr Hannah Short.
By Dr Hannah Short, GP Specialist in Menopause, Premature Ovarian Insufficiency (POI) and Premenstrual Disorders.
Could you please explain what surgical menopause is?
Surgical menopause occurs following the removal of both ovaries (in a procedure known as a bilateral oophorectomy [BO]). In many cases a hysterectomy (removal of the womb) and bilateral salpingectomy (removal of both fallopian tubes) is also performed; however, it is the removal of the ovaries that is key. The surgical removal of the ovaries leads to a rapid drop off in ovarian hormones (oestrogen, progesterone, and testosterone) and results in an immediate menopausal (low) hormonal state. Surgical menopause is permanent and is a form of iatrogenic menopause (menopause that comes about as a result of medical/surgical treatment).
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The question at the forefront of most women’s minds is how long do surgical menopause symptoms last?
It is a common misconception that if you are in surgical menopause, you will, at some point, “get through it” or “come through the other side”. However, if you are in surgical menopause, you will always be in surgical menopause; it is a permanent state. Having said that, symptom duration is very individual, much as it is with a more natural menopausal transition. The vast majority of women will experience symptoms of oestrogen deficiency almost immediately following surgery, but the severity and duration will vary and will depend on age and the reasons for oophorectomy (amongst other things). Surgical menopause is a chronic condition and for many women symptoms will be life-long (although not necessarily at the same intensity).
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How soon after a bilateral oophorectomy will symptoms be experienced?
Surgical menopause results in the sudden removal of ovarian hormones; symptoms can be experienced within hours. However, in some cases symptoms can come on more gradually (and, in a minority, not at all). As with symptom duration, this may depend on the age of the woman, the reasons for surgery and whether or not hormone replacement therapy (HRT) is used before, and immediately following, the procedure.
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If a woman has had a unilateral oophorectomy (the removal of one ovary) can she still experience menopause symptoms?
A unilateral oophorectomy will not result in surgical menopause. In the vast majority of cases, women will go through a natural menopausal transition and the surgery will not affect this. However, if the remaining ovary is damaged during surgery, or the blood flow to this ovary is affected (e.g. following a hysterectomy) then menopausal symptoms may still be experienced earlier, and more suddenly, than would otherwise have been expected.
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How long can a woman in surgical menopause take HRT for?
There are no arbitrary time or age limits when it comes to taking HRT, whether women are in surgical or natural menopause. Current NICE guidelines (NG23) and British Menopause Society (BMS) recommendations are quite clear about this. The decision to use HRT is very individual and should be made after a fully informed discussion with a doctor knowledgeable in this area. As long as the benefits of HRT use outweigh any risks, HRT can be continued. This can be life-long.
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If a woman has a history of endometriosis, can she take oestrogen as part of HRT?
The short answer is yes, in most cases. However, if there is a history of severe or widespread endometriosis then a progestogen may also be needed, to reduce the risk of stimulating any remaining deposits, even if a hysterectomy has been performed. Please note, all women require a progestogen as part of HRT if they have not had a hysterectomy. Women’s Health Concern (the patient arm of the BMS) has a helpful factsheet on this: Induced Menopause in Women with Endometriosis.
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If surgical menopause is brought on as a result cancer, is it safe to use oestrogen as part of HRT?
This will depend on the type of cancer in question. Cervical, vulval and vaginal cancer are not hormone dependent, so systemic and topical (local) HRT can safely be prescribed. Breast cancer is considered a contraindication to systemic HRT use (meaning its prescription is not recommended); however, in some cases it can be considered in joint discussion with the woman’s oncology team. Evidence suggests that HRT can be considered in patients with a history of early stage endometrial (womb) cancer and that survival rates are not affected in women with epithelial ovarian cancer. Specialist management is always required.
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Can you explain the benefits of testosterone as part of an HRT regimen?
Testosterone is an important female hormone and there is a sharp drop off in levels following surgical menopause. Current medical guidelines state that testosterone replacement therapy (TRT) can be considered for women with low sexual desire, which has not improved with oestrogen/HRT alone. Many women also find that TRT helps improve energy, concentration, mood, and general well-being. There is further evidence that it may be additionally beneficial for women who suffer with migraine following removal of the ovaries. Having said that, unfortunately, not all women find benefit from TRT, even if blood tests show that their levels are low following surgery. Adequate oestrogen replacement and a 3-6 month trial of TRT is usually recommended to assess effect.
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Is testosterone available on the NHS?
Yes, but it is not licensed for use by women in the UK. As a result, many doctors do not feel comfortable prescribing it as they are unfamiliar with doing so. Furthermore, in some areas there can be restrictions on prescribing. Referral to, or advice from, a menopause specialist is usually required before TRT can be started.
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How would you advise a woman to look after her long-term bone, brain, and heart health in surgical menopause especially if she’s unable to take HRT?
All women who are in surgical menopause should have the option of being referred to a doctor with specialist knowledge in this area. Some GPs do have the requisite knowledge and training and, therefore, can advise women in the primary care (GP) setting. However, many women will require referral to (or, at the very least, written advice and guidance from) a menopause specialist in secondary care. For those unable to safely take HRT, and especially those below the age of forty-five, specialist input is paramount. Alternatives to HRT should be offered and discussed: Complementary and Alternative Treatments A holistic and individualised approach is required for all women in surgical menopause, whether or not HRT is used. Dietary and lifestyle measures are of great importance, both in terms of symptom control and in terms of protecting long-term health.
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Key things include:
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Not smoking or vaping (and seeking advice/support to help stop for those who currently do). Smoking increases the risk of osteoporosis, heart disease and dementia and can worsen menopausal symptoms. Quit smoking and How to Stop Vaping
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Limiting alcohol intake to fewer than 7 units a week (around 2/3 bottle of wine) and no more than 2 units (~ 1 medium glass of wine) on any occasion. Intake of more than seven units a week is associated with impaired brain function/cognition in later life. Drink less alcohol
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Centring diet around plant-based whole foods (e.g. fruits, vegetables, wholegrains, beans, legumes, nuts & seeds) to ensure adequate intake of fibre, micronutrients, and prebiotics. Evidence suggests that women who follow a plant-based diet exhibit fewer menopausal symptoms; they also have lower rates of cancer, heart disease and diabetes: Plant-Based Diet Factsheets
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Ensuring sufficient calcium and vitamin D intake, including non-dairy sources of calcium e.g. leafy greens, almonds, beans, tofu: How much calcium do you really need?
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Including regular sources of phyto-oestrogens in the diet (e.g. soya [tofu, tempeh, miso, edamame beans, soya milk], chickpeas, lentils, flaxseeds, sesame seeds). Phyto-oestrogens may improve menopausal symptoms and can have a positive effect on bone and heart health, with no negative effect on cells in the breasts or uterus (womb). In fact, regular soya ingestion may even reduce the risk of breast cancer (including recurrence): Soy and Cancer Risk
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Regular weight-bearing exercise (3-5 times/week) to maintain/build bone and muscle strength e.g. weight/resistance training, brisk walking/running, tennis, dance. Practising Yoga, Pilates, and/or Tai Chi; this can be very helpful in improving balance, core strength and posture, which becomes increasingly important to reduce the risk of falls (and, therefore, fractures) as women age: Physical activity for adults and older adults
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Stress-reduction, relaxation, and self-care. This is important for everyone. Consider a regular mindfulness/meditation practice, take time out in nature, or begin a new, creative hobby.
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Above all be kind to yourself.
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Should women in surgical menopause have a bone density scan and, if so, how often would you recommend?
A bone density (DEXA) scan is recommended for all women who have had an early menopause (below the age of 45), whether or not they are in surgical menopause. A baseline DEXA scan would also be recommended for older women who had an early menopause and did not/could not take HRT. If bone density is shown to be normal, and oestrogen replacement is started, then there is thought to be little-no benefit in repeating the scan. However, if bone density is lower than expected (i.e. the scan shows osteopenia or osteoporosis, the scan may need to be repeated at 2-5 years (this will depend on individual circumstances and, to some extent, local guidelines).
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The TISM team all had a history of PMDD prior to surgical menopause. This makes it difficult to manage hormone fluctuations when taking certain types of HRT. Do you know why this is?
A history of Premenstrual Dysphoric Disorder (PMDD) means that there is an inherent sensitivity to hormone fluctuations (the brain has an abnormal, and exaggerated, response to normal hormonal changes). Following surgical menopause, the main trigger for PMDD (the menstrual cycle) has been removed; however, this sensitivity remains. Studies suggest that it can take up to a month for a hormone-sensitive brain to adjust to any new hormonal change (even if that change will ultimately be positive). More research in this area is needed. However, the key to managing this is to maintain stable hormone levels as much as possible and to aim to alter the brain’s response to any changes. A combination of careful HRT prescription, and monitoring, and dietary and lifestyle measures are needed. Psychological work/support is also likely to be beneficial to help the brain “unlearn” unhelpful responses to stress as these are often ingrained after many years. Some women may benefit from the addition of a low dose anti-depressant, which can help stabilise the neurotransmitters (e.g. serotonin) in the brain. See: Surgery & Surgical Menopause — International Association for Premenstrual Disorders.
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Dorset Menopause Support is pleased to be able to provide this information, originally created by the team at Together in Surgical Menopause (TISM), which closed in 2025. Thanks to the former team there for their collaboration in ensuring that this important information remains available.