Menopause Treatment & HRT in the UK: An Evidence-Based Approach

Menopause is a natural stage of life, but the symptoms can be anything but simple. Hot flushes, night sweats, sleep problems, mood changes, brain fog, vaginal dryness, reduced libido, joint aches and changes in weight can all affect quality of life.

The good news is that you do not have to simply accept these symptoms as something you have to live with. Book your appointment now to evaluate your options.

Modern menopause care is increasingly focused on personalised treatment. Rather than taking a one-size-fits-all approach, treatment can be tailored around your symptoms, medical history, individual risk factors, preferences and stage of menopause.

At 121 Clinic, we believe menopause care should be based on informed discussion, appropriate assessment and a treatment plan that is right for the individual.

What is menopause?

Menopause is the time when menstrual periods stop permanently because ovarian activity and oestrogen production decline.

Menopause is usually diagnosed retrospectively after 12 months without a period in women who are not using hormonal contraception. However, the menopause transition, or perimenopause, can begin several years earlier.

During perimenopause, hormone levels can fluctuate considerably. This can lead to changes in menstrual cycles and a wide range of physical, emotional and cognitive symptoms.

Menopause can occur naturally, but it can also occur earlier because of surgery, certain medical treatments or premature ovarian insufficiency.

What are the symptoms of menopause?

Menopause affects everyone differently. Some people experience relatively few symptoms, while others experience symptoms that significantly interfere with work, relationships, sleep and everyday life.

Common menopause and perimenopause symptoms include:

• Hot flushes and night sweats
• Sleep disturbance and insomnia
• Mood changes, anxiety or low mood
• Brain fog and difficulty concentrating
• Fatigue
• Headaches or migraines
• Palpitations
• Joint and muscle aches
• Changes in skin and hair
• Reduced sexual desire
• Vaginal dryness or discomfort
• Pain during sex
• Urinary symptoms
• Changes in menstrual bleeding
• Changes in body composition and weight

It is important to remember that symptoms can have other causes. A medical assessment can help determine whether symptoms are related to menopause or whether another condition may need investigation.

How is menopause diagnosed?

For many women aged 45 and over, menopause and perimenopause can be diagnosed based on symptoms and changes in menstrual cycles rather than routine hormone blood tests.

Hormone levels fluctuate during perimenopause, meaning that a single blood test may not accurately reflect what is happening.

FSH testing may be considered in particular circumstances, including women aged 40–45 with menopause-associated symptoms and menstrual changes, or in younger women where premature ovarian insufficiency is suspected.

A personalised clinical assessment is therefore often more useful than relying solely on a hormone test.

What is HRT?

Hormone Replacement Therapy (HRT) replaces hormones that the body is producing at lower levels during menopause, primarily oestrogen.

HRT can be used to treat troublesome menopause symptoms and may also have important benefits for bone health. The decision to use HRT should be individualised according to the person's symptoms, medical history, age, risk factors and preferences. Want to know more chat with the doctor!

HRT can be prescribed in different forms, including:

• Tablets
• Patches
• Gels
• Sprays
• Vaginal preparations

The choice of treatment depends on individual circumstances.

Oestrogen-only HRT

Oestrogen-only HRT is generally suitable for women who have had a total hysterectomy.

Combined HRT

Women who still have a uterus generally need a progestogen alongside oestrogen to protect the lining of the womb.

There are different ways of providing this protection, and the most appropriate option depends on the individual's circumstances.

Is HRT safe?

HRT is not automatically right or wrong for everyone.

Its benefits and risks depend on several factors, including:

• Age
• Time since menopause
• Type of HRT
• Route of administration
• Dose
• Duration of treatment
• Personal medical history
• Family history
• Individual risk factors

Current British Menopause Society guidance emphasises an individualised approach to HRT, with treatment reviewed according to the person's benefits, risks and changing circumstances.

For some women, transdermal oestrogen delivered through the skin may be preferable to oral oestrogen, particularly when certain risk factors for venous thromboembolism are present. The route of administration should therefore be considered as part of personalised prescribing.

HRT should not be viewed as a single treatment with identical effects for every woman. The right preparation, dose and route matter.

Vaginal oestrogen for vaginal and urinary symptoms

Menopause-related oestrogen decline can affect the tissues of the vagina, vulva and urinary tract.

Symptoms may include:

• Vaginal dryness
• Burning or irritation
• Pain during sex
• Reduced sexual comfort
• Urinary urgency
• Recurrent urinary symptoms

Vaginal oestrogen is an effective treatment option for genitourinary symptoms associated with menopause.

It delivers a low dose of oestrogen locally and has very low systemic absorption. It may be used alone or alongside systemic HRT when appropriate. Current menopause guidance supports its use for appropriate symptoms, including longer-term treatment when needed to control symptoms.

Vaginal moisturisers and lubricants can also be useful, particularly for sexual activity or additional symptom relief.

Can testosterone help during menopause?

Testosterone is sometimes discussed as an additional treatment during menopause, but it is important to understand what the evidence actually supports.

Testosterone is not a routine treatment for all menopause symptoms.

Current British Menopause Society guidance states that the evidence-based indication is persistent low sexual desire in postmenopausal women when other contributing factors have been considered and HRT alone has not been sufficient.

Testosterone should therefore not routinely be promoted as a treatment for brain fog, fatigue, weight gain or general wellbeing.

Where testosterone is prescribed, appropriate assessment, dosing and monitoring are important.

What if I don't want HRT?

HRT is not the only approach to managing menopause symptoms.

Some women cannot take HRT, while others prefer not to use hormones. There are several non-hormonal approaches that may be considered depending on symptoms and individual circumstances.

These can include:

Lifestyle measures

Regular physical activity, resistance exercise, adequate protein intake, a balanced diet, good sleep habits and limiting smoking and excessive alcohol can support overall health during and after menopause.

Cognitive behavioural therapy

Menopause-specific CBT can be useful for some women, particularly for symptoms such as low mood, anxiety, sleep difficulties and the impact of vasomotor symptoms.

Non-hormonal medicines

Depending on symptoms and medical history, certain non-hormonal medicines may be considered for vasomotor symptoms or other specific problems.

The appropriate option depends on the individual rather than simply choosing the newest treatment.

Menopause, weight gain and changes in body composition

Changes in weight and body composition are common concerns during the menopause transition.

However, weight gain during midlife is not necessarily caused by menopause alone. Ageing, reduced physical activity, changes in muscle mass, sleep, diet, stress and metabolic factors can all contribute.

A sustainable approach should focus on overall metabolic health rather than simply the number on the scales.

This may include:

• Adequate protein
• Resistance training
• Regular movement
• Fibre-rich foods
• Appropriate calorie intake
• Sleep optimisation
• Management of metabolic risk factors
• Personalised weight-management support where appropriate

HRT should not be prescribed simply as a weight-loss treatment. However, appropriately managed menopause care can form part of a broader strategy for maintaining health and quality of life during midlife.

Why personalised menopause care matters

There is no single "best" menopause treatment for everyone.

Two women of the same age can have completely different symptoms, medical histories and treatment requirements.

Personalised menopause care considers:

Your symptoms
What is affecting your quality of life most?

Your medical history
Are there conditions or previous treatments that influence which options are appropriate?

Your risk factors
These may include cardiovascular risk, blood-clot risk, breast health, migraine history and other relevant factors.

Your reproductive history
Whether you still have a uterus, previous hysterectomy, ovarian surgery and other factors can influence treatment decisions.

Your preferences
Some women prefer patches or gels rather than tablets. Others may prefer non-hormonal approaches.

Your response to treatment
Menopause treatment should be reviewed and adjusted when necessary rather than simply prescribed and left unchanged.

What happens during a menopause consultation?

A thorough menopause consultation should look beyond a single symptom.

At 121 Clinic, a consultation may include discussion of:

• Your current symptoms
• Menstrual and menopause history
• Previous treatments
• Medical and surgical history
• Current medicines
• Relevant family history
• Cardiovascular and metabolic risk factors
• Breast health
• Bone health
• Sexual and genitourinary symptoms
• Lifestyle and wellbeing
• Your treatment goals

Where appropriate, investigations may be recommended to exclude other causes of symptoms or to assess specific health risks.

The aim is to develop a treatment plan that is safe, evidence-informed and individualised.

When should you seek medical advice?

You should consider speaking to a healthcare professional if menopause or perimenopause symptoms are affecting your:

• Sleep
• Work
• Relationships
• Mood
• Sexual health
• Physical health
• Confidence
• Quality of life

You should also seek medical assessment for symptoms that are unusual, severe, new or unexplained rather than assuming they are caused by menopause.

Any unexpected or persistent bleeding while using HRT should be discussed with a healthcare professional and assessed according to the clinical circumstances. Guidance on unscheduled bleeding has specific assessment pathways.

Frequently Asked Questions About Menopause Treatment

What is the best treatment for menopause?

There is no single best treatment for everyone. HRT is an effective option for many women with troublesome menopause symptoms, but treatment should be personalised according to symptoms, medical history, risk factors and preferences.

Can you start HRT during perimenopause?

HRT can be considered during perimenopause when symptoms are troublesome and there are no contraindications. A clinical assessment can help determine whether it is appropriate.

Do I need a blood test to start HRT?

Not necessarily. In many women aged 45 and over, menopause can be diagnosed clinically without routine hormone testing. Blood tests may be appropriate in selected circumstances.

What is the difference between HRT and vaginal oestrogen?

Systemic HRT is absorbed throughout the body and is used to treat symptoms such as hot flushes and night sweats. Vaginal oestrogen is applied locally to treat vaginal and urinary symptoms associated with menopause.

Some women may benefit from using both.

Can testosterone help with menopause?

Testosterone may be considered for persistent low sexual desire in postmenopausal women when HRT alone has not been sufficient and other contributing factors have been addressed. It is not a general treatment for all menopause symptoms.

How long can I take HRT?

There is no universal fixed duration that applies to every woman. The decision to continue HRT should be reviewed according to ongoing benefits, risks, symptoms and individual circumstances.

Is menopause treatment only about HRT?

No. Menopause care can include lifestyle measures, psychological support, vaginal treatments, non-hormonal medicines and HRT where appropriate. The best approach depends on the individual.

Take control of your menopause with personalised care

Menopause is a normal stage of life, but struggling with severe or disruptive symptoms does not have to be considered normal or something you simply have to endure.

Modern menopause care is about understanding your symptoms, assessing your individual circumstances and choosing treatment options based on the best available evidence.

At 121 Clinic, we provide personalised, doctor-led menopause care designed around your individual needs and treatment goals.

If menopause or perimenopause symptoms are affecting your quality of life, arrange a consultation to discuss your symptoms and explore the treatment options that may be appropriate for you.

121 Clinic – personalised healthcare for every stage of life.

Medical information in this article is for general educational purposes and does not replace an individual medical consultation. HRT and other menopause treatments are not suitable for everyone. A qualified healthcare professional should assess your individual circumstances before treatment is started or changed. Book your consultation today!