Menopause is a natural stage of life that marks the end of menstrual cycles. Before this stage, during the reproductive years, women typically have regular menstrual cycles in which an egg is released each month. These cycles involve natural fluctuations in several hormones, including estrogen and progesterone.
As women enter perimenopause, usually in their mid to late 40s, these cycles begin to change. Periods may become irregular — sometimes heavier or lighter, closer together or further apart — as hormone levels fluctuate. This stage can last on average 4 to 8 years, though it may be shorter or longer for some women. Symptoms of perimenopause may begin years before a woman is deemed to have reached menopause. Menopause is reached when periods stop completely, and a woman is considered menopausal once 12 months have passed without a period. The average age of menopause is around 51.
During this transition, many women experience symptoms such as hot flashes, night sweats, difficulty sleeping, mood changes, vaginal dryness or urinary symptoms. Some may also notice shifts in energy levels, memory, concentration, or weight. For some women, these symptoms can be severe, and can have a negative impact on quality of life. If this is the case, there are a range of strategies available to help manage menopause, ranging from lifestyle approaches to medical therapies. For many women, the most effective option for medical management of menopause symptoms will be hormone replacement therapy (HRT).
This clinic takes a patient centered, evidence-informed approach to menopause care, with the goal of ensuring that management is safe and tailored to each woman’s individual needs.
Early menopause and Premature Ovarian Insufficiency
For most women, menopause occurs around the age of 51, but for some it happens at a younger age. When periods stop between the ages of 40 and 45, this is called early menopause. If this change happens before the age of 40, it is referred to as premature ovarian insufficiency (POI). In both situations, the ovaries stop releasing eggs and producing hormones earlier than expected.
The experience of symptoms can be similar to those of a typical menopause, including hot flashes, night sweats, and changes in mood or sleep. What makes these conditions different is the timing. Because hormone levels drop at a younger age, there can be added health concerns, especially for bones and the cardiovascular system.
Management focuses not only on relieving day-to-day symptoms but also on protecting long-term health. Treatment options may include hormone therapy as well as lifestyle approaches, with plans tailored to the individual.
Evidence-based Menopause Management
Throughout the history of medicine, there have been many examples where treatments were offered with the best of intentions but later proven to be ineffective, or even harmful. In addition, there are those who seek to capitalize on patients’ needs by promoting therapies or products that lack evidence and may offer little benefit. For these reasons, menopause care in this clinic is grounded in evidence — focusing on approaches that have been shown to be both safe and effective, in good quality scientific trials.
It is recognized that some patients explore other options beyond evidence-based medicine. While these alternative therapies are not promoted in this clinic, and some may be discouraged if they pose risks, it is also understood that individual patients may feel they benefit from them. The goal is not to dismiss those experiences but to discuss them openly and place them in the context of what is known to be safe and effective.
At times, patients may also come in with expectations about certain prescriptions, such as testosterone. Some of these medications have very specific evidence bases and may not work in the way that patients anticipate. These options will be discussed in detail, along with their potential benefits and limitations, to find the safest and most effective way to manage each individual situation.
The priority of this clinic is always to improve each patient’s well-being while respecting their beliefs and preferences. Patients can be assured that any advice or prescriptions offered are guided solely by what is in their best interest, with no financial incentives or pressure to pursue services that are unlikely to help. The aim is to work together to create a safe, evidence-based, and personalized plan for managing the menopause transition.
What to expect at a menopause review
A menopause review is an opportunity to look at the full picture of a woman’s health during this stage of life. A detailed history will be taken, along with any relevant examination, to help guide care. Just as importantly, time will be spent discussing the patient’s own impressions — which symptoms are most troublesome, how they affect daily life, and what goals the patient has for treatment.
Management strategies will then be reviewed together, including the benefits and any risks that may be associated with them. Once a plan is agreed upon, therapy can be started, with follow-up arranged to see how well it is working. Treatment may be adjusted over time to better suit the patient’s needs.
As with many areas of medicine, lifestyle changes can make a meaningful difference and will also be discussed as part of the review. This clinic follows an evidence-based approach to menopause care, which means that not all treatments will be appropriate for every patient. In these situations, alternatives will be explored to ensure that management remains safe, effective, and patient-centered.
Referrals for menopause, perimenopause and premature ovarian insufficiency
This clinic accepts referrals from family physicians. After receiving a referral, a consultation will be arranged to review the concerns in detail. Follow-up visits may be scheduled as needed to adjust and tailor a management plan.
Once treatment has been established and things are stable, a letter will be sent back to the referring family physician outlining the management plan and how to continue therapy. This ensures care remains coordinated and patients are supported both here and within their regular family practice.
Reputable sources of information on the menopause
There is a large amount of information about menopause available online, but the quality can vary widely. Some advice is accurate and helpful, while other information may be misleading or even unsafe. Care should always be taken when deciding which sources to trust.
The resources most often relied upon in this clinic are those developed by the British Menopause Society (BMS). I trained within the BMS and am a current member. The BMS has a patient facing organization called Women's Health Concern, where women can acquire reliable information on menopause. I have included some other reputable resources below:
While the above are trusted references, this does not mean that other sources are without value — but it is important to approach all information with a critical eye.
In addition, more information will be made available here over time, highlighting key topics and resources that may be of benefit to patients.