Menopause, Perimenopause & POI
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Menopause care should address symptoms, long-term health and patient preferences. Typical menopause, early menopause and premature ovarian insufficiency require different diagnostic conversations.
Assessment & interpretation
- In otherwise healthy people aged at least 45 with typical symptoms and menstrual changes, diagnosis is usually clinical; routine FSH or ovarian-reserve tests are not needed.
- Assess symptoms, bleeding pattern, contraception, personal medical risks and whether symptoms began before age 40.
Decisions that change management
- Discuss HRT and nonhormonal options with their individual benefits and risks. Systemic oestrogen generally needs endometrial protection when the uterus is present.
- Genitourinary symptoms may need local treatment even when systemic symptoms are controlled. HRT is not contraception.
- Suspected premature ovarian insufficiency requires its own investigation and replacement-hormone discussion, rather than being treated as ordinary midlife menopause.
Follow-up & safety-netting
- Review treatment at 3 months and annually thereafter, earlier for adverse effects or inadequate response.
- Investigate concerning bleeding. NICE’s 2026 advice highlights unscheduled bleeding beyond the first 6 months of systemic HRT or beyond 3 months after changing its preparation or dose.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Heavy bleeding/instability, severe acute pain, suspected VTE or another serious acute illness requires urgent assessment rather than attributing it to menopause.
When clinic, day care or home care may be suitable
- Menopause/perimenopause/POI assessment usually does not require hospital admission.
Before going home
- Any acute concern has been excluded/addressed; the treatment choice, bleeding advice and review plan are clear.
Discharge medicines and treatment changes
- Reconcile the selected HRT formulation and whether endometrial protection is required; discuss risks, contraindications and review. Do not stop or duplicate hormones without a plan.
Tests, pending results and their reviewer
- Postmenopausal or otherwise concerning bleeding needs appropriate investigation/referral; assign outstanding tests and results.
Home care and counselling
- Discuss symptom management, bone/cardiovascular health, sexual/urogenital concerns and contraception when still relevant.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
3 months after starting treatment, then annually (NICE); sooner if needed | Assess symptom response, adverse effects and unscheduled bleeding; provide the actual booked date. |
Earlier for concerning bleeding or symptoms | Investigate rather than waiting for a routine medicine review. |
Return urgently
- Heavy bleeding, chest pain, sudden breathlessness, unilateral leg swelling or neurological symptoms requires urgent care.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
| Domain | Options |
|---|---|
Vasomotor | HRT first-line (transdermal preferred vascular-risk profiles); non-hormonal: SSRI/SNRI/gabapentin/clonidine |
Genitourinary syndrome | Topical vaginal estrogen long-term safe / lubricants |
POI <40 y | Estrogen-progestogen until ~51 y |
Bone health | Ca/vit-D + exercise; bisphosphonates when indicated |
- Menopausal symptoms after individual assessment; intact uterus also needs adequate progestogen
- The dose is a RELEASE RATE per 24 hours; it does not mean applying a new patch every day. HRT is not contraception.
- Symptom response, bleeding, BP and changing breast/VTE/liver risk
- Endometrial protection with standard-dose systemic oestrogen in a patient with a uterus
- Choose sequential or continuous treatment according to menopausal phase and clinical assessment; never omit protection because a patch is used.
- Sedation, adherence to the full monthly course and new/persistent unscheduled bleeding
- Endometrial protection with standard-dose systemic oestrogen in a patient with a uterus
- Choose sequential or continuous treatment according to menopausal phase and clinical assessment; never omit protection because a patch is used.
- Sedation, adherence to the full monthly course and new/persistent unscheduled bleeding
Definitive treatment
Symptom-based duration; no arbitrary stop dates - annual benefit-risk reviews.
Monitoring
- BP; weight; bleeding-pattern surveillance; mammography per programme
Response assessment
- Symptom relief without unscheduled bleeding (after adaptation window)
Treatment failure
- Unscheduled bleeding >6 months -> evaluate endometrium
Second-line treatment
- Non-hormonal switches; compounded alternatives discouraged
Rescue treatment
Not applicable.
Procedure / surgery
Endometrial biopsy page linked for PMB workups.
⑮ Complications & their management
VTE risk with oral estrogen
Prefer transdermal in risk profiles
Post-treatment care
- Bone/BP/lipid lifestyle programmes continue lifelong
Diagnosis & assessment
Principles & follow-up
Management principles
Sources (9)
12 November 2015 · updated 15 April 2026 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for menopause. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge check …
· checked 2026-10-17 · verified-live
Open source ↗
50-microgram/24-hour patch starting example, replaced every three/four days; application site/rotation, progestogen need with uterus, ongoing benefit-risk review and contraindications.
· checked 2026-10-17 · verified-live
Open source ↗
Micronised progesterone 200 mg for 12–14 days/month sequentially or 100 mg daily continuously at standard oestrogen doses; higher oestrogen requires proportional protection; unscheduled bleeding review. Does not certify all menopause therapy.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendation page read for postmenopausal bleeding, cervical/ovarian/endometrial concern and referral/result follow-through. Supports triage/referral only; it does not supply chemotherapy or tumour-specific postoperative discharge regimens.
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.