Hormone replacement therapy update and practical prescribing

Peri-menopause and menopause are not a disease or disorder but a natural change that occurs at midlife, and a normal part of the aging process.¹ The average age of menopause in the UK is 51, although symptoms usually start prior to this, around the age of 47-48.² This time is called the perimenopause. This is defined as the time when a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period.³ Menopause is defined as a biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life.³ Usually, it is defined as having occurred when a woman has not had a period for 12 consecutive months (for women reaching menopause naturally). The changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen and progesterone.³ These definitions are medical in nature and it is important to remember that ‘menopause is a major clinical event that is universally experienced by women, but affects each individual woman uniquely’.⁴