About menopause and hormone imbalance
Hormone symptoms are not limited to menopause. Men can develop low testosterone with age or with pituitary or testicular conditions. Both men and women can have symptoms from thyroid disease, high prolactin, adrenal problems or, less often, a pituitary condition. Part of the endocrinologist's job is to work out which, if any, of these is responsible.
An endocrinology review is particularly useful when symptoms are severe or unusual, when menopause happens early (before 45) or is brought on by surgery or cancer treatment, when standard hormone replacement has not helped, or when another medical condition complicates the choice of treatment.
Symptoms we assess
Common reasons for referral include:
- Hot flushes and night sweats
- Sleep disturbance, fatigue and brain fog
- Low mood, anxiety or irritability out of character
- Irregular or heavy periods, or periods stopping before 45
- Vaginal dryness, urinary symptoms and low libido
- Joint aches, palpitations and weight change
- In men: low energy, low libido, erectile problems and loss of muscle
How we diagnose it
Menopause in a woman over 45 with typical symptoms is a clinical diagnosis and does not need a blood test. Tests are useful when symptoms start early, when periods are absent for another reason, or when another hormone problem might be mimicking menopause: thyroid function, prolactin, FSH and oestradiol, and in men a morning testosterone repeated on two occasions, with LH and FSH to locate the cause.
The consultation covers symptoms, periods, contraception, medical and family history, and the factors that shape treatment choice, such as a history of breast cancer, clots, migraine or liver disease. A DEXA scan is arranged where bone density is a concern, for example after early menopause.
Treatment and follow-up
For most women with troublesome menopausal symptoms, hormone replacement therapy (HRT) is the most effective treatment and, for most, the benefits outweigh the risks when it is started around the time of menopause. The consultant explains the options: oestrogen as a patch, gel, spray or tablet, with progesterone to protect the womb where needed, and local vaginal oestrogen for genitourinary symptoms. Doses are adjusted at follow-up.
Where HRT is not suitable or not wanted, there are effective non-hormonal medicines for flushes and sleep, and specific advice on bone, heart and weight. Early or surgical menopause needs hormone replacement to protect bones and heart until at least the natural age of menopause.
Low testosterone in men is treated with testosterone replacement only when levels are confirmed low on repeated testing and symptoms fit; the consultant monitors blood counts, prostate markers and response. Where the cause is a pituitary or thyroid problem, that condition is treated instead.
When to see a GP, and when to see a consultant
Your GP can start HRT for most women. See a consultant for early or premature menopause, symptoms that persist on treatment, a complicated medical history that makes treatment choice difficult, suspected low testosterone in men, or where blood tests point to another hormone problem.
