Postmenopausal Management

After the menopause women are sometimes at greater risk of some conditions including vaginitis, overactive bladder, osteoporosis and pelvic organ prolapse.


A fall in oestrogen levels after the menopause can cause a thinning of the vagina's lining and is called atrophic vaginitis or vaginal atrophy. Symptoms include vaginal dryness, itching or discomfort (particularly during sex).

Hormone replacement therapy (HRT) may be recommended to replace the female hormones, oestrogen and progesterone. Alternatively, creams, pessaries or vaginal tablets that contain oestrogen may be advised.

Overactive bladder (OAB)

Women are at a greater risk of an overactive bladder after the menopause. The symptoms of OAB include: increased frequency of needing to urinate including during the night, a sudden urge to urinate and difficulty getting to the bathroom without leaking. Lower oestrogen levels may be part of the reason the supportive pelvic and bladder tissues sometimes weaken as a woman ages.

Behavioural interventions such as strengthening exercises and bladder retraining, medications and surgery in severe cases are treatment options available.


Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. Women also lose bone rapidly in the first few years after the menopause (when monthly periods stop and the ovaries stop producing an egg). Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45).

Hormone therapy, medications, supplements and weight beating exercises may be recommended.


Pelvic organ prolapse occurs when the pelvic organs such as the womb, rectum and bladder slips out of their normal position and into the vagina. This happens because the supporting tissues and ligaments have weakened. It can happen as a natural result of the menopause as the muscles thin and become weaker.

Hormone replacement therapy is often recommended to help restore the strength in your ligaments and muscles. Surgery for pelvic organ prolapse is relatively common and includes surgical repair, vaginal mesh and hysterectomy.


Contraception is required during a woman’s reproductive life. There are many different types and your decision will depend on your individual health, circumstances and preferences, such as if you smoke, how old you are, if you prefer to take a pill, or if you prefer a contraception you don’t have to remember each day.

We provide many contraception methods including pills, patches, injections, implants, vaginal diaphragm and coils. We’ll discuss with you the pros and cons of all of the most appropriate contraceptive options for you and provide detailed information and advice for you to consider before you make the decision.

Heavy periods and other bleeding problems

Heavy periods, also called menorrhagia, are a very common condition, when a woman loses an excessive amount of blood during consecutive periods which can affect their quality of life.

Menorrhagia can be caused by fibroids, endometriosis, polyps, polycystic ovaries or changes prior to the menopause. We’ll perform diagnostic tests to determine the cause of your menorrhagia. These might include blood tests, an ultrasound scan, an endometrial biopsy and/or hysteroscopy (using a camera to examine the uterus).

Often medical treatment is offered for menorrhagia but surgery may be recommended. We will talk through the best options for your personal treatment. We use the latest keyhole surgery so that you can recover quickly with minimal scarring.

Premenstrual syndrome

Premenstrual syndrome (PMS) is a disorder marked by physical, psychological and behavioural symptoms that can occur in the two weeks before a woman's monthly period. It’s sometimes referred to as pre-menstrual tension (PMT). Typical symptoms include: bloating, breast pain, mood swings, feeling irritable and loss of interest in sex.

The cause of PMS is unknown but it’s thought to be linked to the changing hormone levels during the menstrual cycle. Some women have severe PMS that affects their normal lives. A healthy lifestyle may help alleviate these symptoms. We offer advice and a wide range of medical treatments including: a combined oral contraceptive pill, oestrogen-only patches and implants, selective serotonin reuptake inhibitors (SSRIs) and gonadotrophin-releasing hormone (GnRH) analogues.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a condition which affects how your ovaries work. The three key features of PCOS are: your ovaries become enlarged and have many tiny cysts, your hormones are out of balance with high levels of male hormones and you have irregular periods. Symptoms include: irregular periods or no periods at all, difficulty getting pregnant, excessive hair growth on the face, chest, back or buttocks, weight gain, thinning or loss of hair from the head and oily skin or acne.

The cause of PCOS is unknown, but it’s related to abnormal hormone levels in the body, including high levels of insulin and can run in families. There’s no cure for PCOS but we can offer treatment to control the symptoms. Our experienced consultant gynaecologists will discuss the treatment options with you. We can also offer nutritional advice to support you.

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