Menopause is not an illness. It is a normal stage of life — but it can bring symptoms that are genuinely difficult to live with, and there is a great deal that can be done about them. This guide explains what happens, what treatments are available in Sri Lanka, and how to decide what is right for you.

What menopause actually is

Menopause means your periods have stopped for good. It is confirmed once you have gone 12 months without a period. Most women reach it between the ages of 45 and 55.1

The years leading up to it are called the perimenopause. This is when most symptoms begin, often while you are still having periods — though they may become irregular, heavier, lighter, or further apart.

If your periods stop before the age of 40, this is called premature ovarian insufficiency and needs proper assessment, so please do see a doctor rather than assume it is simply an early menopause.2

Common symptoms

Every woman's experience is different. The most common symptoms are:

  • Hot flushes and night sweats
  • Disturbed sleep, and tiredness during the day
  • Mood changes — low mood, irritability, anxiety
  • Difficulty concentrating or remembering things
  • Vaginal dryness, discomfort during sex, and urinary symptoms
  • Reduced interest in sex
  • Joint aches and general stiffness

Symptoms usually settle over a few years, but for some women they last much longer. Vaginal and urinary symptoms are the exception — these tend to persist or worsen with time unless treated.2

Do you need a blood test?

Usually, no. If you are over 45 and have typical symptoms with changing or absent periods, the diagnosis is made on your symptoms alone. Blood tests are not needed and can be misleading, because hormone levels swing about from week to week during perimenopause.2

Hormone tests are useful in younger women, and your doctor will arrange them if they are appropriate for you.

Hormone replacement therapy (HRT)

HRT replaces the oestrogen your ovaries have stopped making. It is the most effective treatment there is for hot flushes and night sweats, and it also helps with mood, sleep and vaginal symptoms.2,3

If hot flushes and night sweats are severe, HRT may be the right treatment even when they are the only symptom you have. Severity matters more than the number of symptoms.

There are two basic types:

  • Oestrogen-only HRT — for women who have had a hysterectomy.
  • Combined HRT (oestrogen plus a progestogen) — for women who still have a womb. The progestogen protects the lining of the womb.

What is available here: in Sri Lanka, HRT is taken as tablets. Skin patches and gels are widely used in some other countries but are not available locally, so this guide describes the oral options you can actually obtain.

Vaginal dryness and urinary symptoms

These symptoms respond very well to vaginal oestrogen — a low-dose cream or pessary used locally rather than a tablet taken by mouth. Very little is absorbed into the bloodstream, so it can often be used by women who cannot or do not want to take HRT tablets, and it can be used alongside them.2

Availability in Sri Lanka: vaginal oestrogen cream is available here, though only from selected outlets rather than every pharmacy. Ask us where to obtain it rather than assuming it cannot be had.

Simple vaginal moisturisers and lubricants, available from pharmacies, also help a great deal and can be used by anyone.

What about the risks?

This is the question women ask most often, and it deserves a straight answer.

Breast cancer: combined HRT carries a small increase in breast-cancer risk. That risk falls again after you stop. Oestrogen-only HRT carries little or no increase.2

The important point is that this is a small risk to be weighed against real benefits, in the context of your own health and family history. That is a conversation to have with your doctor rather than a decision to make from a leaflet.

There are other, less common risks — including blood clots with tablet HRT — and there are situations where HRT is not suitable at all. Your doctor will go through these with you before you start.

If HRT is not suitable, or not what you want

You still have options.

  • Non-hormonal medicines. Certain antidepressants (SSRIs or SNRIs) and gabapentin can reduce hot flushes. These are not the first choice for hot flushes on their own, but they are genuinely useful where HRT cannot be used.2
  • Cognitive behavioural therapy (CBT). Now recommended as an option for hot flushes, night sweats and low mood around menopause.2
  • Practical measures. Layered clothing, keeping the bedroom cool, cutting down on spicy food, caffeine and alcohol, and regular exercise all help some women.

Please be cautious with over-the-counter herbal remedies. Their strength varies a great deal, some interact with other medicines, and the evidence behind them is weak.

Staying well after menopause

After menopause, bone thinning (osteoporosis) and heart disease become more important. Simple things matter:

  • Weight-bearing exercise — walking, climbing stairs, light weights
  • Enough calcium and vitamin D in your diet
  • Not smoking, and keeping alcohol low
  • Keeping blood pressure, blood sugar and cholesterol checked

How often should HRT be reviewed?

If you start HRT, I review you at 3 months, to check that the dose suits you and that side effects have settled. After that, reviews are every 6 months to a year, depending on your circumstances.

Do not simply continue year after year without review — and equally, do not stop on your own because of something you have read. Come and discuss it.

When to see a doctor sooner

Please make an appointment if you have:

  • Bleeding after your periods have stopped for 12 months
  • Bleeding between periods, or after sex
  • Unusually heavy bleeding during perimenopause
  • New breast lumps or changes
  • Symptoms that are affecting your work, sleep or relationships — you do not have to put up with them

The takeaway

Menopause is a normal transition, but difficult symptoms are not something you simply have to endure. HRT tablets are effective and available here; vaginal treatments help local symptoms; and there are good non-hormonal options if HRT is not right for you. The risks are real but small, and they are best weighed up in conversation with your own doctor.

References

  1. NHS. Menopause [Internet]. London: NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/conditions/menopause/
  2. National Institute for Health and Care Excellence. Menopause: identification and management (NG23) — Recommendations [Internet]. London: NICE; updated 2026 [cited 2026 Jul 22]. Available from: https://www.nice.org.uk/guidance/ng23/chapter/recommendations
  3. NHS. Hormone replacement therapy (HRT) [Internet]. London: NHS; [cited 2026 Jul 22]. Available from: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/