Menopause is the stage of reproductive ageing defined retrospectively by the final menstrual period, after which a person has had no menstrual bleeding for 12 consecutive months when there is no other explanation for the absence of periods. It results primarily from depletion and loss of ovarian follicular function and the consequent sustained reduction in ovarian oestrogen production. Natural Menopause most commonly occurs between approximately 45 and 55 years, although the exact timing varies.
It is not a disease, but the hormonal transition can produce symptoms and changes affecting physical, sexual, psychological and social wellbeing. Menopause can also occur because of surgery or medical treatment affecting ovarian function, in which case the timing and clinical course may differ from natural menopause. WHO describes it as one point within a continuum of life stages marking the end of reproductive years.
Menopause should be distinguished from the menopausal transition and from Perimenopause. The transition commonly begins when menstrual cycles become persistently different, with variations in cycle length, bleeding pattern and ovulatory function as ovarian activity becomes increasingly irregular. Menopause itself is the retrospectively identified final menstrual period, while the period after it is called Postmenopause. In ordinary conversation, “menopause” is often used to refer to the entire transition and its symptoms, but medically the terms can have more precise meanings. The transition is hormonally dynamic rather than an abrupt disappearance of all ovarian activity. Oestrogen levels can fluctuate considerably before eventually reaching a persistently lower postmenopausal state, while follicle-stimulating hormone generally rises as ovarian feedback decreases.
Common symptoms associated with Menopause and the surrounding transition include hot flushes, night sweats, sleep disturbance, mood changes, anxiety, vaginal dryness, reduced libido, urinary symptoms, headaches, palpitations, muscle aches and joint pains. Not everyone experiences the same symptoms, and some people have few symptoms while others experience substantial effects on work, relationships, sleep and daily activities. Symptoms can change over time rather than appearing simultaneously or remaining constant.
Genitourinary symptoms can persist after the final menstrual period because reduced oestrogen affects tissues of the vagina, vulva and lower urinary tract. The NHS notes that symptoms can continue into Postmenopause, so reaching the formal definition of Menopause does not necessarily mark the end of all menopausal symptoms.
The diagnosis of natural Menopause in people aged 45 or older is commonly based on the clinical history of menstrual change and characteristic symptoms rather than routine hormone testing. This is because hormone concentrations fluctuate considerably during the transition, making a single blood measurement potentially misleading. Hormonal contraception can also alter or suppress bleeding, making menstrual patterns less useful for identifying the final menstrual period.
Alternative explanations for absent periods or abnormal bleeding may need consideration, particularly when the pattern is atypical. In people under 45, assessment is more likely to involve investigation for early or premature ovarian insufficiency or other causes of menstrual cessation. NHS guidance notes that laboratory testing may be considered in younger people but is generally not routinely required for healthy people aged 45 or over with typical symptoms.
Menopause has important long-term relationships with bone and cardiovascular health because sustained oestrogen reduction affects multiple tissues. Bone turnover increases after ovarian oestrogen declines, contributing to accelerated bone loss and increased osteoporosis risk. Cardiovascular risk also changes with age and menopause, although cardiovascular disease is multifactorial and cannot be attributed solely to menopause. Body composition, lipid metabolism and glucose regulation can also change during midlife.
These effects do not mean that every postmenopausal person will develop osteoporosis or cardiovascular disease; rather, Menopause represents one biological factor within a larger network of genetic, metabolic, behavioural and environmental influences. The relationship with bone health is particularly well established, and the first years after menopause can involve relatively rapid loss of bone density.
Management of Menopause is individualised according to symptoms, age, medical history, risk factors and preferences. Hormone replacement therapy can replace oestrogen and, where required to protect the endometrium in someone with a uterus, include a progestogen. Oestrogen can be administered systemically through tablets, patches, gels or sprays, while local vaginal preparations can address genitourinary symptoms. Non-hormonal treatments can also be used for particular symptoms. HRT can reduce menopausal symptoms and has beneficial effects on bone health, but its risks vary according to formulation, route, duration and individual circumstances. It is therefore not a universally appropriate treatment or a treatment that should be assessed without considering personal risk factors.
Menopause has historically been described primarily as a reproductive event, but modern healthcare increasingly recognises its wider effects on quality of life and long-term health. Sexual health can be affected through vaginal dryness, discomfort during intercourse, changes in libido and altered genitourinary tissues. Sleep disruption and vasomotor symptoms can indirectly affect mood, concentration, relationships and occupational functioning. Cultural expectations and the degree of available healthcare support also influence how menopause is experienced. Importantly, Menopause does not mean that sexual activity or sexually transmitted infection risk disappears; WHO notes that sexually transmitted infections remain possible after menopause, and thinning of vaginal tissues can increase vulnerability to small injuries during intercourse.
Natural Menopause should be distinguished from early Menopause and premature Menopause. NHS terminology generally describes menopause before age 45 as early menopause and before age 40 as premature menopause, and these situations can have additional implications for long-term bone and cardiovascular health. Surgical removal of both ovaries can produce an abrupt fall in ovarian hormones, while chemotherapy, radiotherapy and some medical treatments can impair ovarian function.
Menopause is also not synonymous with infertility in every practical sense during the transition because ovulation can still occur before the final menstrual period, meaning pregnancy remains possible during Perimenopause. WHO recommends contraception until 12 consecutive months without menstruation because reproductive potential has not necessarily ceased during the transition itself.
