Background

Definition: Menopause begins one year after the last menstrual period. Symptoms often begin in the perimenopausal years.

Incidence/prevalence: In the United Kingdom the mean age for the menopause is 50 years 9 months. The median onset of the perimenopause is between 45.5 and 47.5 years. One Scottish survey (of 6096 women aged 45 to 54 years) found that 84% had experienced at least one of the classic menopausal symptoms, with 45% finding one or more symptoms a problem.1

Aetiology/risk factors: Urogenital symptoms of menopause are caused by decreased oestrogen concentrations, but the cause of vasomotor symptoms and psychological effects is complex and remains unclear.

Prognosis: Menopause is a physiological event. Its timing may be genetically determined. Although endocrine changes are permanent, menopausal symptoms such as hot flushes, which are experienced by about 70% of women, usually resolve with time.2 However, some symptoms, such as genital atrophy, may remain the same or worsen.

Aims: To reduce or prevent menopausal symptoms, and to improve quality of life with minimum adverse effects.

Outcomes: Frequency and severity of vasomotor, urogenital, and psychological symptoms; quality of life.

Methods: Clinical Evidence search and appraisal December 1999. We included only randomised controlled trials (RCTs) and systematic reviews that met Clinical Evidence quality criteria.