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This guideline covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause.

For information on related topics see our women's and reproductive health summary page.

In December 2019, in response to an MHRA safety alert on hormone replacement therapy (HRT) and the risk of breast cancer, we replaced the table in the recommendation on breast cancer risk with a link to the MHRA's advice on HRT risks and benefits. We will also update this recommendation as part of the planned update to the guideline.

Recommendations

The guideline includes recommendations on:

Who is it for?

Healthcare professionals who care for women in menopause.

Women in menopause, and their families and carers

Is this guideline up to date?

We checked this guideline in December 2019 and September 2021, and are updating it. The update will focus on managing urogenital atrophy, the long-term benefits and risks of hormone replacement therapy, and cognitive behavioural therapy for managing menopausal symptoms. See the guideline in development page for progress on the update.

Guideline development process
How we develop NICE guidelines
Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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This guideline covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause

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The Endocrine System - Glands and Hormones

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Menopause: the essentials for non-specialists | RCN Magazine | Royal College of Nursing

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From symptoms to treatments, here’s what nursing staff need to know about menopause

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Addison's SOS - Sanctuary of Support for people with Adrenal Insufficiency. Here when you feel lost, concerned, puzzled or poorly.

Our charity has developed a range of clinical guidance publications in collaboration with our Clinical Advisory Panel (CAP) to inform and advise healthcare professionals.

Our bi-annual members' magazine is packed with news and information to live well with Addison's Disease.

Our impact

Make a donation

For Addison's Disease Day 2022, publishers Springer are generously giving you exclusive access to the 'Advanced Practice in Endocrinology Nursing' and two of their chapters on adrenal insufficiency, by Sofia Llahana, Irene Mitchelhill, Phillip Yeoh and Marcus Quinkler. Read more

New standalone guidelines regarding steroid-dependent patients have been issued by JRCALC for paramedic use. We explain how ADSHG worked with the team to make this vital addition, improving patient safety. Read more

Do you have Addison's or adrenal insufficiency? Please consider completing this new research questionnaire looking at post-traumatic growth (PTG), led by Rachel Berryman, final year BSc Psychology student at the University of Hull. Read more

Our Members-only ADSHG AGM 2022 will be held on Saturday 16th July 2022 from 11am. We'll be welcoming members to gather together to share experiences and friendship, mark our achievements over the past year, vote on charity matters and listen to a range of talks from experts in the field of adrenal insufficiency. Read more

Run anywhere and complete the Virtual TCS London Marathon 2022 within 24 hours, raising much-needed funds and awareness for Addison's Disease Self-Help Group. Read more

The Great South Run returns on 16 October 2022 in Portsmouth! Whether this is your first running event, or you're a seasoned pro, put on your trainers for our charity, join #TeamAddisons and help make a difference to people's lives. Read more

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Addison's SOS - Sanctuary of Support for people with Adrenal Insufficiency. Here when you feel lost, concerned, puzzled or poorly. Our charity has developed a range of clinical guidance publications in collaboration with our Clinical Advisory Panel (CAP) to inform and advise healthcare professionals.

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Homeostasis - negative and positive feedback (thermoregulation and lactation)

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Hypothalamus

Pituitary gland

Pineal

Thyroid gland and parathyroid glands

Thymus

Adrenal glands

Pancreas (Islets of Langerhans)

Testes

Ovaries

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Endocrinology is the study of hormones – chemical messengers - secreted by endocrine glands, which circulate in the blood to critically regulate many aspects of the body’s functions. Most glands are under the control of the master gland, the pituitary. Disease occurs when these glands make either too much (hyperfunction) or too little (hypofunction) of their respective hormone. The diagram below shows the location of the different glands. Click on each gland to learn more about its function and associated diseases.

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Society for Endocrinology | A world-leading authority on hormones

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The Society for Endocrinology aims to promote the advancement of public education in endocrinology

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The British Thyroid Foundation supports the thyroid community to live better with thyroid disease through evidence-based information, support and research

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Diabetes UK - Know diabetes. Fight diabetes. | Diabetes UK

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We are Diabetes UK, the leading charity for people living with diabetes in the UK. Our vision is a world where diabetes can do no harm.

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The Pituitary Foundation - UK national charity. Telephone: 0117 370 1333 Fax: 0117 933 0910 E-mail: enquiries@pituitary.org.uk Registered Charity No: 1058968, Registered Company No: 3253584. Head Office: 86 Colston Street, Bristol, BS1 5BB Copyright © 2018

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Pituitary Foundation home | The Pituitary Foundation

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The Pituitary Foundation - UK national charity. Telephone: 0117 370 1333 Fax: 0117 933 0910 E-mail: enquiries@pituitary.org.uk Registered Charity No: 1058968, Registered Company No: 3253584. Head Office: 86 Colston Street, Bristol, BS1 5BB Copyright © 2018

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Polycystic Ovary Syndrome (PCOS) is a very common endocrine condition that affects 1 in every 8 in the UK. It manifests differently in each person and can be incredibly devastating to an individuals self esteem and quality of life. There is no known cause or cure.

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Verity is the UK's only Polycystic Ovary Syndrome charity.

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Manisha Vadgama Head of Design & Technology, diagnosed with type 1 at age 21

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Breakthrough T1D UK | Type 1 Diabetes Research

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Join us in our mission to discover better treatments, expand access, and work towards a cure for type 1 diabetes.

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The Endocrine Clinic - Consultant Endocrinologists, for the treatment of all endocrine disorders including diabetes, thyroid and pituitary

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Information about all endocrine disorders, their diagnosis, treatment and management

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The endocrine system and associated disorders - British Journal of Nursing

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All glandular tissues produce secretions. Exocrine glands are arranged so they secrete theirs via a central duct, which directs the secretions (hormones) to the desired location, for example sweat from glands in the skin (Khan et al, 2022). In contrast, endocrine glands release their secretions into the bloodstream, as part of their primary function.

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NHS commissioning » Specialised endocrinology

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This Respond and Advise Clinical Reference Group (CRG) covers covers specialised endocrinology services. Endocrine glands secrete hormones directly into the blood stream. The main endocrine glands are the pituitary gland, thyroid gland, pancreas, ovaries, testes and adrenal glands. Many endocrine conditions may be treated in local hospitals, but patients with complex or co-morbid conditions may […]

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Cushing's syndrome is a condition caused by having too much of a hormone called cortisol in your body. It can be serious if it's not treated.

Who gets it and why

Cushing's syndrome is uncommon. It mostly affects people who have been taking steroid medicine, especially steroid tablets, for a long time. Steroids contain a synthetic version of cortisol.

Very rarely, it can be caused by the body producing too much cortisol.

This is usually the result of:

a growth (tumour) in the pituitary gland in the brain

a tumour in 1 of the adrenal glands above the kidneys

The tumours are usually non-cancerous (benign). They're most common in young women.

Symptoms of Cushing's syndrome

Symptoms of Cushing's syndrome can start suddenly or gradually. They tend to get slowly worse if not treated.

One of the main signs is weight gain and more body fat, such as:

increased fat on your chest and tummy, but slim arms and legs

a build-up of fat on the back of your neck and shoulders, known as a "buffalo hump"

a red, puffy, rounded face

Other symptoms include:

skin that bruises easily

large purple stretch marks

weakness in your upper arms and thighs

a reduced sex drive (low libido) and fertility problems

depression and mood swings

Cushing's syndrome can also cause high blood pressure, which can be serious if not treated.

When to get medical advice

See a GP if you have symptoms of Cushing's syndrome, especially if you're taking steroids.

Do not stop taking your medicine without getting medical advice.

Lots of things can cause similar symptoms to Cushing's syndrome, so it's a good idea to get checked to find out what the problem is.

Tests and diagnosis

Your doctor may suspect Cushing's syndrome if you have typical symptoms and are taking steroid medicine.

If you're not taking steroids, it can be difficult to diagnose because the symptoms can be similar to other conditions.

If Cushing's syndrome is suspected, the amount of cortisol in your body can be measured in your:

If these tests show a high level of cortisol, you may be referred to a specialist in hormone conditions (endocrinologist) to confirm or rule out Cushing's syndrome.

You may also need other tests or scans to find out the cause.

Treatment for Cushing's syndrome

Cushing's syndrome usually gets better with treatment, although it might take a long time to recover completely.

Treatment depends on what's causing it.
If it's caused by taking steroids:
your steroid dose will be gradually reduced or stopped

If it's caused by a tumour, treatment may include:

surgery to remove the tumour

radiotherapy to destroy the tumour

medicines to reduce the effect of cortisol on your body

Speak to your doctor about the benefits and risks of the different treatment options.

More information
Read more about Cushing's syndrome and the main treatments from the Pituitary Foundation

Page last reviewed: 25 March 2021
Next review due: 25 March 2024

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Cushing's syndrome is a condition caused by having too much of a hormone called cortisol in your body. It can be serious if it's not treated. Cushing's syndrome is uncommon. It mostly affects people who have been taking steroid medicine, especially steroid tablets, for a long time.

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Addison’s disease, also known as primary adrenal insufficiency or hypoadrenalism, is a rare disorder of the adrenal glands.

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Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman's ovaries work.
The 3 main features of PCOS are:

irregular periods - which means your ovaries do not regularly release eggs (ovulation)

excess androgen - high levels of "male" hormones in your body, which may cause physical signs such as excess facial or body hair

polycystic ovaries - your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)

If you have at least 2 of these features, you may be diagnosed with PCOS.

Polycystic ovaries

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size.

The follicles are underdeveloped sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.

It's difficult to know exactly how many women have PCOS, but it's thought to be very common, affecting about 1 in every 10 women in the UK.

More than half of these women do not have any symptoms.

Symptoms of polycystic ovary syndrome (PCOS)

If you have signs and symptoms of PCOS, they'll usually become apparent during your late teens or early 20s.

They can include:

PCOS is also associated with an increased risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS is unknown, but it often runs in families.

It's related to abnormal hormone levels in the body, including high levels of insulin.

Insulin is a hormone that controls sugar levels in the body.

Many women with PCOS are resistant to the action of insulin in their body and produce higher levels of insulin to overcome this.

This contributes to the increased production and activity of hormones like testosterone.

Being overweight or obese also increases the amount of insulin your body produces.

Treating polycystic ovary syndrome (PCOS)

There's no cure for PCOS, but the symptoms can be treated. Speak to a GP if you think you may have the condition.

If you have PCOS and you're overweight, losing weight and eating a healthy, balanced diet can make some symptoms better.

Medicines are also available to treat symptoms such as excessive hair growth, irregular periods and fertility problems.

If fertility medicines are not effective, a simple surgical procedure called laparoscopic ovarian drilling (LOD) may be recommended.

This involves using heat or a laser to destroy the tissue in the ovaries that's producing androgens, such as testosterone.

With treatment, most women with PCOS are able to get pregnant.

Community content from HealthUnlocked

Page last reviewed: 01 February 2019
Next review due: 01 February 2022

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Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman's ovaries work.

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THE ENDOCRINE SYSTEM EXPLAINED UNDER 4 MINUTES!!!!

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Find out about overactive thyroid (hyperthyroidism), including what the symptoms are, when to see a GP, how it’s treated and why it happens.

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Read about an underactive thyroid gland (hypothyroidism), which is when your thyroid gland does not produce enough hormones.

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Find out about type 2 diabetes, a condition where a hormone called insulin does not work well or not enough is made. This makes your blood glucose (sugar) levels too high.

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Endocrine - hormone secreted into the bloodstream.

Very good blood supply to these glands.

Exocrine - Product secreted from the gland/duct (sweat / saliva / breastmilk / tears)

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Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier.

It affects anyone who has periods.

Menopause can happen naturally, or for reasons such as surgery to remove the ovaries (oophorectomy) or the uterus (hysterectomy), cancer treatments like chemotherapy, or a genetic reason. Sometimes the reason is unknown.

Perimenopause is when you have symptoms of menopause but your periods have not stopped. Perimenopause ends and you reach menopause when you have not had a period for 12 months.

Menopause and perimenopause can cause symptoms like anxiety, mood swings, brain fog, hot flushes and irregular periods. These symptoms can start years before your periods stop and carry on afterwards.

Menopause and perimenopause symptoms can have a big impact on your life, including relationships and work.

There are things you can do to help with symptoms. There are also medicines that can replace the missing hormones and help relieve your symptoms.

Page last reviewed: 17 May 2022
Next review due: 17 May 2025

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Find out about menopause symptoms, causes and treatments, and things you can do to help.

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For healthcare professionals The British Menopause Society (BMS) is the specialist authority for menopause and post reproductive health in the UK. Established in 1989, the BMS educates, informs and guides healthcare professionals, working in both primary and secondary care, on menopause and all aspects of post reproductive health.

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Overview | Menopause: identification and management | Guidance | NICE

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This guideline covers identifying and managing menopause, including in people with premature ovarian insufficiency. It aims to improve the consistency of support and information provided to people experiencing menopause

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Doctor to doctor
Dr Ben Sinclair, with nearly two decades' experience as a British GP and Founder of Dr Finlay's Private Practice, interviews a range of extraordinary people from all walks of life and recently he spoke with our very own Dr Heather Currie MBE about menopause, her career and life.
" Listen here

Have you experienced memory issues in menopause?
Lexi is a PhD researcher at University College London (UCL). She is looking for research participants who have experienced memory issues during menopause for a focus group study. If you have experienced memory or concentration problems during your menopause, she would like to hear from you! Please contact her by email if you are interested.
" Email Lexi here

Episode 4 of our Let's Talk Podcast: The psychological & emotional symptoms
Thankfully there has been increased awareness about these symptoms in relation to the menopause in recent years. They are incredibly common and can be some of the most debilitating symptoms that people will experience...but don't forget, not everyone will experience these symptoms. It can be challenging for some people to identify the cause of these symptoms, as it's not always related to hormones - there can be many contributory factors. We discuss the range of options which can help to manage these symptoms. Is it right to take antidepressants, should you take HRT, is a combination acceptable? We go through alternative options for you to consider, either on their own or in combination with the above, but remember taking an individualised approach is always important. We also continue the conversation about HRT.

A new weekly podcast will be available from 6pm every Tuesday or you can listen now via the link below and catch up with those you may have missed.

Menopause Matters information is available via Amazon Alexa
Menopause Matters will be providing answers to some of the most commonly asked questions around menopause via Amazon's cloud-based voice service, Alexa.
" Read more

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Menopause Matters, menopausal symptoms, remedies, advice

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Menopause and treatment options. An independent, clinician-led site aiming to provide accurate information about the menopause.

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Early menopause

Primary ovarian insufficiency (POI), also known as premature ovarian failure, occurs when a woman's ovaries stop functioning normally before she turns 40. It's caused by early egg loss or follicular dysfunction. POI differs from early or premature menopause. Short-term effects may include hot flushes, night sweats, headaches, or heart palpitations. Long-term risks include infertility, osteoporosis, cardiovascular and neurological diseases, and a higher risk of early death.

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Charity for Women with POI | The Daisy Network

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More than 1% of women under 40 go through early menopause. Daisy Network is a charity offering information, advice and support. Make contact with other members, chat to specialist doctors online and receive news, videos and fact sheets.

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Menopause and the Workplace

Workplaces are failing menopausal women, change is urgently needed.

Our report, Menopause and the Workplace, sponsored by construction firm Wates Group, delves into women's experiences at work and is the largest representative survey of menopausal women conducted in the UK.
Our key findings show:

One in ten women who worked during the menopause have left a job due to their symptoms.

Eight out of ten women say their employer hasn't shared information, trained staff, or put in place a menopause absence policy.

Almost half of women haven't approached their GPs and three in ten have seen delays in diagnosis.

Only four in ten women were offered HRT in a timely fashion.

Read Menopause and the Workplace here.

Our Calls for Change

Urgent change is needed to harness the skills, experience and talents of menopausal women, so our workplaces don't lose out. We are calling on the Government to:

Require employers to have menopause action plans

Make flexible work the default

Implement a public information campaign and invite every woman in to speak with her GP about menopause at an appropriate age

Ensure GPs receive mandatory training to help diagnose menopause earlier.

Get involved

Your voice has power. Call for change and join the conversation online - you can download our Menopause and the Workplace digital toolkit . But don't stop there! By becoming a Fawcett member , you'll be part of a powerful movement advocating for real, lasting change. As a member, you'll support campaigns like this one, helping us to push for better workplace policies, drive Government action, and ensure that the needs of menopausal women are heard at every level. and make your voice count in the fight for gender equality.

Read our previous work Menopause in the Workplace: Impact on Women in Financial Services with Standard Chartered Bank and the Financial Services Skills Commission .

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Our new landmark report reveals a lack of basic support and damaging stigma which means the needs of menopausal women are being ignored both in the workplace and by healthcare providers.

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1. Understand the endocrine system.

1.1 Outline the structure and function of the endocrine system.

1.2 Describe the function of five key hormones.

1.3 Explain the principles of homeostasis in terms of receptors, effectors and negative feedback.

1.4 Explain how homeostasis is maintained using negative feedback mechanisms.

2. Understand the effects of hormones.

2.1 Evaluate the effects of the imbalance of hormones.

2.2 Discuss the effect of the natural decline in hormones in the Menopause and the value of HRT.

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Natural menopause takes place when the ovaries become unable to produce the hormones estrogen and progesterone.

Menopause can also occur when the ovaries are damaged by specific treatment such as chemotherapy or radiotherapy, or when the ovaries are removed, often at the time of a hysterectomy.

Ovaries naturally fail to produce estrogen and progesterone when they have few remaining egg cells; the maximum number of egg cells in the ovaries is present before birth, with a reduced number already at birth, gradual reduction from puberty, and a rapid decline from 40 onwards.

With less egg cells, the ovaries become less able to respond to hormones from the pituitary gland in the brain: follicle stimulating hormone (FSH) and luteinising hormone (LH) and less oestrogen is produced.

Levels of FSH and LH subsequently rise and a measurement of FSH is sometimes used to diagnose menopause. The resulting low, and changing levels of ovarian hormones, particularly estrogen, are thought to be the cause of menopausal symptoms and later consequences in many women.

The term climacteric refers to the time in which the hormone levels are changing, up to the periods stopping; reducing and changing hormone levels can cause early menopausal symptoms.

At this stage, there may still be enough hormones produced to stimulate the lining of the womb (endometrium) to produce monthly periods (menstruation).

Perimenopause is the stage from the beginning of menopausal symptoms to the postmenopause.

Menopause means the last menstrual period. Periods stop because the low levels of estrogen and progesterone do not stimulate the lining of the womb (endometrium) in the normal cycle.

Hormone levels can fluctuate for several years before eventually becoming so low that the endometrium stays thin and does not bleed.

Postmenopause is the time following the last period, and is usually defined as more than 12 months with no periods in someone with intact ovaries, or immediately following surgery if the ovaries have been removed.

The average age of the natural menopause is 51 years, but can occur much earlier or later. Menopause occurring before the age of 45 is called early menopause and before the age of 40 is premature menopause.

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Menopause: facts and figures

Menopause usually affects those aged 45 to 55, but can happen earlier. The average age is 51, says The Menopause Charity.

Around 3% to 8% of those experiencing menopause are aged between 40 and 44, according to the National Institute for Health and Care Excellence (NICE).

1% have premature ovarian insufficiency with perimenopause starting before 40 years old. It may be triggered by surgery, cancer treatment, an underlying condition, or an autoimmune disease.

Menopause symptoms have a median duration of 7 years, according to NICE.

According to a report by the Fawcett Society, 1 in 10 women have left work because of menopause symptoms, while 77% describe one or more menopausal symptoms as ‘very difficult’.

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- is the growth and development of female/male reproductive characteristics

Oestrogen and testosterone - main hormones involved in the development of the female and male reproductive characteristics.

Oestrogen is often called the female sex hormone

Testosterone is often called the male sex hormone.

However, both hormones are found in males and females.

Females have much higher levels of oestrogen, while males have much higher levels of testosterone.

Puberty is initiated by secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus.

GnRH acts on the anterior pituitary and stimulates the secretion of FSH and LH.

GnRH in both females and males - responsible for stimulating ovaries and testes to begin secreting the sex hormones.

Leads to development a) female and male reproductive organs, b) secondary sex characteristics such as pubic and underarm (axillary) hair in both sexes, facial hair and increased muscle mass in males, and widening of the hips and breast development in females.

Females are born with hundreds of thousands of ova (egg cells) in their ovaries.

Secretion of FSH and LH by the anterior pituitary leads to the onset of the menstrual cycle.

In males, LH stimulates secretion of testosterone by the testes.

FSH makes cells in the testes more receptive to testosterone which leads to sperm production.

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The menopause in pictures - One Woman Health

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The menopause in pictures. Covering symptoms, the transition through perimenopause and the hidden changes to the body affecting bone, heart and blood vessels.

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Suicide rates in women of menopausal age rise | ITV News

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Many women going through menopause have their symptoms, including anxiety and depression, dismissed or misdiagnosed, leaving many to cope on their own. | ITV National News

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Watch Oprah’s New Menopause Special with Halle Berry, Naomi Watts, Maria Shriver, and More

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The impactful conversation is now streaming.

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Endocrine - hormone secreted into the bloodstream.

Very good blood supply to these glands.

Exocrine - Product secreted from the gland/duct (sweat / saliva / breastmilk / tears)