You might book a menopause appointment because night sweats keep waking you. Once you start talking, other concerns may surface: vaginal dryness, discomfort during sex, changes in your mood, or questions about your bone health. Each concern deserves attention. Together, they show why menopause care needs to look beyond one symptom.
A peer-reviewed review published online in Climacteric in February 2025 explored key clinical themes from the International Menopause Society’s 19th World Congress on Menopause. Held in Melbourne in October 2024, the congress brought together more than 2,600 delegates and experts. The publication reviewed existing evidence and clinical approaches; it did not report the results of a single new trial.
For women, its relevance lies in a broader conversation about menopause: what is affecting you now, what your medical history tells us, and which treatments fit your needs.
Key takeaways
- Your wider health matters. Menopause care can include sexual wellbeing, sleep, mood, vaginal and urinary symptoms, and longer-term health concerns.
- A broader assessment should still be individual. It does not mean every woman needs more tests or medication.
- Treatment benefits and risks need clear explanation. HRT can relieve symptoms and help protect bones, but it should not be prescribed solely to prevent heart disease.
- This review does not prove better long-term outcomes. It does not establish that comprehensive menopause consultations prevent heart attacks or fractures.
What does holistic menopause care mean?
Here, “holistic” means considering your health and circumstances together. You may have few hot flushes but find sex painful. You may struggle with sleep while also managing work, caring responsibilities, or an existing health condition. Your priorities may differ from those of a friend going through menopause at the same time.
A useful consultation gives you space to explain those differences. Treatment decisions should follow your symptoms, medical history, preferences and risks.
Importantly, taking your experience seriously also means avoiding assumptions. A symptom that appears during midlife should not automatically be attributed to menopause.
What the evidence means for your care
Heart health: treatment and prevention have different roles
Menopause can be an opportunity to discuss cardiovascular health, particularly if you already have concerns about blood pressure, cholesterol or family history.
One distinction is essential: HRT is not a treatment for preventing cardiovascular disease. NICE advises against prescribing either combined or oestrogen-only HRT for primary or secondary prevention of heart disease.
If you are considering HRT for symptoms, your clinician should explain how your health history and the type of treatment affect its suitability.
Bone health: consider your individual risk
Falling oestrogen levels around menopause contribute to bone loss. HRT can help prevent osteoporosis, but the decision to use it should include its benefits and risks for you.
Women with osteoporosis or a higher fracture risk may need medicines specifically used to protect bones. A menopause consultation can help identify whether a separate bone-health assessment is appropriate.
Figures describing average bone loss in research cannot predict your own rate of change. Your individual circumstances matter more than a headline percentage.
Vaginal and urinary symptoms: effective options are available
Vaginal dryness, irritation and pain during sex can affect everyday comfort and intimacy. Menopause-related changes can also contribute to urinary symptoms.
For women without a history of breast cancer, NICE recommends vaginal oestrogen for menopause-associated vaginal and urinary symptoms, including when systemic HRT is already being used. Only a small amount reaches the bloodstream. NICE advises against vaginal laser treatment outside a randomised controlled trial.
Local vaginal treatment and systemic HRT have different roles. Your clinician can explain which approach best suits your symptoms.
Sexual wellbeing: assessment comes before treatment
Low sexual desire deserves a sensitive conversation, particularly when it is causing distress. The strongest evidence for testosterone treatment is in postmenopausal women with hypoactive sexual desire disorder, following appropriate assessment. This involves low sexual desire that causes personal distress; low desire alone does not necessarily represent a medical disorder.
Evidence does not support testosterone as a general treatment for mood, cognition, wellbeing, or muscle and bone health. Long-term safety evidence is also limited, so prescribing requires discussion and monitoring.
Sleep and mood: related, but not interchangeable
Night sweats can disrupt sleep, and treating menopause symptoms may help. NICE also supports menopause-specific cognitive behavioural therapy for sleep problems associated with menopause.
Low mood needs similar care. NICE distinguishes depressive symptoms arising alongside menopause symptoms from a diagnosis of depression, which requires appropriate assessment and management.
You deserve help with persistent sleep or mood difficulties, whether menopause is the main contributor or part of a more complicated picture.
Perimenopause: remember contraception
Irregular periods do not mean pregnancy is impossible.
HRT does not provide contraception. If pregnancy prevention matters to you, discuss contraception alongside symptom treatment. Some contraceptive methods can also help manage menopausal symptoms or bleeding, depending on your circumstances.
After cancer: distinguish local treatment from systemic HRT
Menopause care after cancer needs to account for the cancer type, treatment history and current medicines. NICE advises that systemic HRT should not routinely be offered to women with a history of breast cancer.
Local vaginal oestrogen requires a separate discussion. NICE allows it to be considered when symptoms persist despite non-hormonal treatment. For women taking an aromatase inhibitor, decisions should involve a breast cancer specialist because uncertainty about recurrence risk remains.
A history of cancer therefore calls for careful, specific advice rather than a blanket assumption about every hormonal treatment.
HRT decisions should include benefits and risks
HRT can be valuable, but its suitability varies.
Combined HRT increases breast cancer risk, with risk rising with longer use. Oral HRT increases blood-clot risk; patches, gels and sprays have a different clot-risk profile. These differences should form part of an individual discussion, alongside the benefits you hope to achieve.
The aim is to help you make an informed choice that can be reviewed as your needs change.
What this review cannot prove
The Climacteric publication summarises clinical themes and existing research. It does not compare comprehensive menopause care with standard consultations.
It therefore cannot establish that a broader consultation leads to fewer future heart attacks, fractures or other illnesses.
Peer review is valuable, but it does not make every recommendation equally certain. You still need to consider the evidence for each treatment separately, including its limitations and relevance to the woman receiving care.
Making the conversation useful for you
Before an appointment, it may help to note:
- The symptoms affecting your life most.
- When they started and how often they occur.
- Your medicines, contraception and relevant medical history.
- What you hope treatment will help you do or feel.
You do not need to arrive with a diagnosis or a preferred prescription. Clear examples—such as waking several times a night or avoiding sex because it hurts—can help explain what support you need.
Conclusion
Menopause care should consider the whole picture while staying focused on what matters to you. That may mean treating one troublesome symptom, reviewing contraception, discussing bone health or seeking specialist advice. It should also mean clear explanations of what a treatment can offer, its risks, and where evidence remains uncertain.
Your experience deserves to be heard. Good care brings that experience together with reliable evidence and thoughtful clinical judgement.
This article provides general health information and does not replace an individual medical assessment.
