Menopause marks the end of periods, usually around the late forties or early fifties. Falling oestrogen levels can cause hot flushes, night sweats, poor sleep, mood changes, vaginal dryness and bone loss. Symptoms vary widely, and some women experience few of them.

The doctor reviews symptoms, general health, family history of cancer and heart disease, and bone health. Lifestyle measures such as exercise, calcium and vitamin D intake and stopping smoking help many women. Hormone therapy relieves symptoms in suitable women, and the decision is individual.

Any bleeding after menopause needs prompt assessment, because it can be caused by conditions ranging from thinning of the womb lining to cancer. Older women also face prolapse and urinary problems that respond to treatment.

Menopausal and geriatric gynaecology services at Apex include:

• Menopause Symptom Management: Evaluation of hot flushes, sleep and mood changes, with options ranging from lifestyle advice to hormone therapy when it is safe for the woman.
• Bone Health Assessment: Review of risk factors for osteoporosis, advice on calcium, vitamin D and exercise, and referral for bone density testing where indicated.
• Postmenopausal Bleeding Evaluation: Ultrasound, endometrial sampling or hysteroscopy to find the cause of any bleeding after periods have stopped.
• Vaginal and Urinary Care: Treatment of dryness, painful intercourse, recurrent urinary infections and leakage, including local oestrogen where appropriate.