Gynae

Gynaecological Health at Menopause

Creator: Dr Nadira Awal
Published: 2026-01-15

General gynae care, screening and midlife checks.

By Dr Nadira AwalBMS Specialist4 min readMedically reviewed 9 July 2026

Single pink peony and dried grasses in a glass vase

Cervical screening, pelvic health and bleeding investigations remain important in midlife. This guide summarises what UK guidelines currently recommend.

Menopause does not close the book on gynaecological care — in some ways it opens a new chapter. The falling oestradiol that drives hot flushes also thins vulvovaginal tissue, weakens pelvic floor support, changes the microbiome, and shifts the pattern of what any new bleeding, pain or lump might mean. Cervical, breast and bowel screening continue on their national timetables; pelvic floor problems become far more common; and any bleeding after 12 months without a period is treated as a red flag until proven otherwise. Staying engaged with routine gynaecological care through and after the transition is one of the most protective, life-extending things you can do for the next 30 years of health. This is where a menopause specialist and your GP work best as a team.

UK screening to keep up with

Cervical screening every 3 years age 25–49, then every 5 years 50–64; intervals extend if HPV-negative on the primary HPV test.
Breast screening every 3 years age 50–71; you can self-refer beyond 71 and should if you're at higher risk.
Bowel cancer screening (FIT test) every 2 years from age 54, rolling down towards 50 across the UK.
Ovarian cancer has no national screening programme — symptom awareness (persistent bloating, early satiety, pelvic pain, urinary urgency for more than 2–3 weeks) is the way it is caught early.
Register with a GP even if you rarely go — screening invitations depend on it.

Post-menopausal bleeding — never ignore

Any bleeding 12+ months after your last natural period is post-menopausal bleeding (PMB) and requires a 2-week-wait NHS gynaecology referral.
Around 10% of PMB is caused by endometrial cancer — highly treatable when caught early, which is precisely why the pathway is urgent.
Common non-cancer causes: atrophic vaginitis (thin, dry tissue that bleeds on contact), endometrial or cervical polyps, HRT-related bleeding pattern shifts.
Unscheduled bleeding on continuous combined HRT beyond 6 months, or new bleeding on stable HRT after a period-free stretch, both warrant review.
Do not attribute bleeding to a coil, HRT or vaginal oestrogen without imaging and clinical assessment.

Pelvic floor health at menopause

Urinary incontinence, urgency, prolapse and faecal urgency are extremely common and highly treatable — do not accept them as inevitable.
Supervised pelvic floor physiotherapy (Squeezy app, NHS-referred women's health physio, or private) is first-line and works for the majority.
Vaginal oestrogen (cream, pessary or ring) supports the tissues underneath the pelvic floor and materially improves physiotherapy outcomes.
Vaginal pessaries, sacrospinous fixation and modern minimally-invasive prolapse surgery are options if physiotherapy alone isn't enough.
Chronic constipation, high-impact exercise without core preparation, and heavy lifting technique all matter — small changes protect the floor.

Vulval and vaginal health

GSM (Genitourinary Syndrome of Menopause) affects the majority of women — dryness, burning, itching, painful sex, recurrent UTIs (see dedicated GSM guide).
Vulval skin conditions (lichen sclerosus, lichen planus) can present in midlife with itching, white patches and splitting — this needs dermatology or specialist gynae review, not lifelong emollient alone.
Painful sex is not something to soldier through in silence — vaginal oestrogen, moisturisers, lubricants, physiotherapy and psychosexual support all have roles.
Any new lump, non-healing ulcer, or persistent itch on the vulva warrants a same-week GP examination.

Contraception and fertility around menopause

Contraception is still needed until 12 months post-last-period if over 50, or 24 months if under 50 (FSRH guidance).
Combined hormonal contraceptives should usually stop by 50; progestogen-only pills, implants and Mirena are safe to continue.
HRT is not contraceptive — pregnancy remains possible in perimenopause even while on HRT.

Fibroids, endometriosis and adenomyosis after menopause

Most fibroids shrink after menopause as oestrogen falls — new growth of a 'fibroid' on scan post-menopause needs specialist assessment to exclude sarcoma.
Endometriosis can be quieter after menopause but doesn't always disappear — HRT choice needs care in women with prior endometriosis.
Adenomyosis-related heavy bleeding often improves at menopause; unresolved symptoms after transition merit review.

When to book a specialist review

Any post-menopausal bleeding, however light.
New pelvic pain, a lump, non-healing vulval skin change, or persistent bloating.
Symptoms of GSM or pelvic floor dysfunction that are interfering with sex, exercise, work or sleep.
Overdue screening tests — a menopause appointment is a good moment to catch up on smear, breast screening and FIT.
Complex history (endometriosis, previous hysterectomy for adenomyosis, familial cancer risk) that would benefit from joined-up care.

Key takeaway

Menopause changes gynaecological priorities but doesn't retire them — screening, pelvic floor care, GSM treatment and prompt investigation of any new bleeding remain central to healthy midlife.

How Dr Awal approaches this in clinic

Every consultation starts with your full story — symptoms, cycle, medical history, family history and what you've already tried. From there we look at whether hormonal treatment, non-hormonal options, lifestyle changes or a combination will give you the best result, and we tailor the plan to your age, risk factors and preferences.

A detailed 60 minute first appointment — no rushed 10-minute slots.
Evidence-based recommendations aligned with NICE NG23 and BMS guidance.
Body-identical HRT considered first-line where appropriate.
Shared-care letters sent to your NHS GP so treatment can continue affordably.
Follow-up at 3 months to fine-tune your regimen and address side effects.
Ongoing annual reviews so your plan evolves with you.

Common questions we hear about this

Do I need to be at a certain age to be seen?

No. We see women in early perimenopause (often late 30s and 40s), through post-menopause and beyond. Age alone doesn't decide whether treatment is right — symptoms, health history and goals do.

Will my GP continue the prescription?

In most cases yes. After your consultation we send a detailed shared-care letter with the diagnosis, treatment plan and rationale so your NHS GP can prescribe on the NHS. Not every practice accepts shared care — we'll discuss this in your appointment.

What if I've tried HRT before and it didn't suit me?

Very common — often the type, dose or route wasn't right rather than HRT itself. We review what you've tried, why it didn't work, and adjust accordingly. Many women who thought HRT wasn't for them do well on a different preparation.

How long will I need to stay on treatment?

There is no set upper time limit for HRT. Current BMS and NICE guidance supports continuing HRT for as long as the benefits outweigh the risks for you personally. We review this together every year so you stay in control of the decision.

Where do you see patients?

All consultations at Pause and Co Healthcare are conducted securely via video, allowing us to support patients anywhere in the UK. Prescriptions and shared care arrangements are managed in the same way, regardless of your location.

About the author

Dr Nadira Awal is a British Menopause Society Advanced Menopause Specialist with 15+ years' NHS and private experience. She holds the BMS Advanced Certificate in Menopause Care, sits on the BMS Programme Planning Group, and advises the UK Government Menopause Strategy Group. Read her full profile.

Sources & further reading

General information only — not a substitute for personalised medical advice. Always speak to your GP or a menopause specialist about your own situation.

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