Menopause is normal but struggling is not something you have to “just put up with”

Menopause is a completely natural part of life. It happens when a woman’s ovaries stop releasing eggs and her hormone levels, mainly oestrogen and progesterone, gradually fall. Periods become irregular and eventually stop altogether. Menopause is officially confirmed when a woman has not had a period for 12 months in a row. The average age in the UK is 51, but it can happen anywhere between the mid-40s and mid-50s. 

The time leading up to this is called perimenopause. Symptoms can start years before the final period.

Common symptoms include:

• hot flushes
• night sweats
• poor sleep
• mood changes
• anxiety or low mood
• brain fog
• joint aches
• vaginal dryness
• pain during sex
• recurrent urine infections

Menopause affects every woman differently. Some women have mild symptoms. Others find symptoms affect work, relationships, sleep, confidence and quality of life. The good news? There is effective treatment available.

What is hormone therapy?

Hormone therapy for menopause is often called HRT or MHT. These terms are commonly used to mean treatment with hormones, usually oestrogen, sometimes combined with progesterone or a progestogen.

Oestrogen is the main hormone that falls during menopause. Replacing it can help with symptoms such as hot flushes and night sweats. It can also help protect bones from thinning.

There are two main types:

• Combined HRT — contains oestrogen and progesterone. This is recommended for women who still have a womb (uterus), because oestrogen alone can thicken the womb lining and increase the risk of womb cancer. Adding progesterone protects against this.
• Oestrogen-only HRT — used by women who have had a hysterectomy (surgical removal of the womb).

HRT also comes in different forms:

• Patches and gels (applied to the skin) — these are now the preferred options for most women, as they are absorbed directly into the bloodstream, bypassing the liver
• Tablets (taken by mouth)
• Vaginal oestrogen — creams, pessaries or rings used locally for vaginal dryness; this is low-dose and safe for almost all women

What are the benefits of HRT?

The evidence for HRT is strong, and the updated NICE 2024 guidelines make clear that for most women, the benefits outweigh the risks.

HRT is the most effective treatment available for hot flushes, night sweats, mood swings, and sleep problems. Many women notice a significant improvement in quality of life.

Protects your bones. Oestrogen is important for keeping bones strong. After menopause, bone density drops, increasing the risk of osteoporosis (fragile bones) and fractures. HRT helps preserve bone strength. This benefit lasts while you take it.

For vaginal and bladder symptoms, local vaginal oestrogen can be very helpful. This comes as a pessary, cream, tablet or ring. It acts mainly in the vaginal area and can often be used long term.

What are the risks?

HRT is not completely risk-free, and it is important to understand the risks honestly without either dismissing them or exaggerating them (as often happens on social media).

• Breast cancer: This is the risk women worry about most. Oestrogen-only HRT does not appear to increase breast cancer risk, and may slightly reduce it. Combined HRT (oestrogen + synthetic progestogen) is linked to a small increase in risk, which rises the longer HRT is taken. However, the risk from combined HRT is broadly similar to the risk linked to drinking alcohol regularly or being overweight. Importantly, the type of progesterone matters: body-identical micronised progesterone (the type increasingly used in the UK) appears to carry a lower breast cancer risk than older synthetic progestins. Women who have had breast cancer should discuss HRT with a specialist, as the decision requires careful individual assessment.
• Blood clots (DVT): Oral (tablet) HRT slightly increases the risk of blood clots in the legs or lungs. However, this risk is largely avoided with patch or gel forms of HRT, which do not go through the liver. For women at higher risk of blood clots guidelines recommend using a patch or gel rather than a tablet, and possibly seeking a specialist opinion first.
• Stroke: There is a slightly increased risk of stroke with combined oral HRT, particularly in older women or those starting HRT many years after menopause. Again, this risk is lower with transdermal (skin) preparations.
• Womb (endometrial) cancer: Taking oestrogen alone when you still have a womb increases this risk. This is exactly why combined HRT (with progesterone) is used — the progesterone protects the womb lining completely.

Putting the risks in perspective

It can help to think in real numbers. Among 1,000 women in their 50s who take combined HRT for five years, research suggests roughly 4–6 extra breast cancer cases may occur compared to the 1 in 8 lifetime risk most women face anyway. For many women, the quality-of-life gains from HRT far outweigh this small additional risk. This is a personal decision, made with your doctor.

Importantly  you cannot assess your personal risk from a TikTok video or an Instagram post. Individual risks depend on your age, your health history, your family history, the type and dose of HRT, and how you take it. Only a proper conversation with a healthcare professional can give you a picture that is tailored to you.

What about “bioidentical hormones”?

This is where social media can become confusing.

Some people use the word “bioidentical” to describe hormones that are similar to the body’s own hormones. But there is a big difference between:

Regulated body-identical HRT

These are prescribed medicines, such as oestradiol and micronised progesterone, made to quality and safety standards.

Compounded bioidentical hormones

These are often private, tailor-made hormone mixtures. They may include several hormones, sometimes in untested doses or routes such as pellets. Medical guideline warns that these products do not have the same level of safety, quality and effectiveness data as regulated treatments.

In simple terms: “natural sounding” does not always mean safer.

When should you seek specialist help?

Your GP is an excellent first port of call for menopause and HRT. However, there are situations where a specialist menopause clinic is strongly recommended:

• your periods stop or become very irregular before age 40
• you have menopause symptoms between 40 and 45
• you may have premature ovarian insufficiency
• you have a history of breast cancer
• you have a high risk of hormone-related cancer
• you have had a blood clot
• you have complex heart disease or stroke risk
• you have uncontrolled high blood pressure
• symptoms are not improving after HRT
• you are getting troublesome side effects

Why social media is not enough

There is a lot of menopause information online. Some of it is helpful. Some of it is misleading, frightening or trying to sell something.

Social media advice often misses the most important point: menopause care should be personal.

The right treatment for one woman may not be right for another. Your safest option depends on your symptoms, medical history, cancer risk, blood pressure, clot risk, diabetes status, migraines, medicines and personal preferences.

Use social media to learn that help exists and that you are not alone. Then take that conversation to your doctor, who can give you advice based on your body, your history, and the best available evidence.

The take-home message

Menopause is natural, but symptoms can be significant and deserve proper treatment. HRT can be life-changing for many women, but it should be prescribed thoughtfully. It is not something to fear automatically, and it is not something to start because a social media post says everyone should take it.

If menopause symptoms are affecting your life, speak to a qualified healthcare professional. Ask questions. Discuss your options. Make a decision based on evidence, your health and what matters to you.