Women's Health

Menopause and HRT

Menopause is the transition caused by declining ovarian follicular activity and fluctuating or low oestrogen; diagnose typical cases clinically, then tailor symptom treatment, HRT risks, contraception, bone health and follow-up to the person's stage and comorbidities.

Definition

Menopause is the permanent cessation of menstruation from loss of ovarian follicular activity. Perimenopause is the transition before menopause, with fluctuating ovarian hormones and cycle change; early menopause occurs between 40 and 44, and premature ovarian insufficiency before 40.

First principles

Follicular depletion changes the hypothalamic-pituitary-ovarian axis

As ovarian follicular activity declines, oestradiol and inhibin feedback falls and FSH rises. During the perimenopause hormone production fluctuates, so symptoms and bleeding patterns can vary; after menopause, sustained loss of ovarian activity produces a stable low-oestrogen state. The mechanism explains why a single hormone result is usually unhelpful in typical presentations over age 45.

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