The menopause literally refers to a woman's last menstrual period occurring, on average, between 50 and 51 years of age. Cessation of menstruation is preceded by a gradual reduction in output of oestrogen by the ovaries and fewer ovulatory cycles (see Richardson, 1993). The menopause transition is characterized by hot flushes and night sweats, or vasomotor symptoms, which are experienced by between 50 and 70% of women in western cultures. For the majority of women these are not seen as problematic. It is estimated that between 10 and 15% of women find them difficult to cope with, mainly because of their frequency or their disruptive effects upon sleep. The average duration of the menopause transition, assessed by menstrual changes and hot flushes, is estimated to be four years but there is considerable variation between women (McKinlay et al., 1992).

The menopause has for centuries been associated with emotional and physical pathology, and myths about its impact upon sexual function, femininity, ageing and women's sanity abound. Menopause was even once postulated to cause psychosis (involutional melancholia) but there is no evidence to support this. The commonly used term ‘change of life’ reflects the view that the menopause is closely associated with general emotional and social adaptations of mid-life.

The development of hormone replacement or oestrogen therapy (HRT) has had a major impact upon definitions of the menopause and the development of health services. The menopause is now seen as a cluster of symptoms caused by hormone deficiency and treatable with HRT.