Menopause: “My hot flushes stopped, so it’s working” – is that the whole picture?
It’s a reasonable instinct to judge treatment by the symptom that bothered you most. But a fuller picture of whether menopause treatment is actually working looks at several things together — and, just as importantly, how much those things are affecting your life, not just whether they’re present.
What to actually track
Symptoms, broadly — and their impact on you. Not just the symptom that first drove you to seek treatment, but the full range: hot flushes, sleep, mood, brain fog, joint aches, vaginal symptoms. What matters isn’t only whether a symptom is there, but how much it’s getting in the way of your work, your sleep, your relationships, your sense of yourself. A symptom that’s “still there a bit” but no longer running your day is a real improvement, even if it hasn’t disappeared completely.
Sleep quality, specifically how you feel on waking. Not just whether night sweats have reduced, but whether you’re actually sleeping better as a result, and whether that’s changed how you function the next day.
Mood and general wellbeing, so whether you feel more like yourself, not just whether a specific anxiety symptom has gone, but whether day-to-day life feels more manageable.
Bleeding patterns, if relevant. Bleeding can be a normal part of adjustment to treatment, so it’s important to note whether any breakthrough bleeding has settled as expected, or whether it needs a closer look.
Sexual health and intimacy, if this was part of what you hoped to address. It’s easy for this to go unmentioned at a review unless you specifically raise it, and the impact on relationships and confidence can be significant.
Side effects, whether anything bothersome from starting treatment has settled, or still needs addressing, like headaches, bloating and breast tenderness, and how much they’ve affected you day to day.
Your own treatment goals. Specifically, what you originally hoped treatment would help with, since this can get lost if a review only covers generic checklist items.
Why this matters more than a single symptom check
Treatment can genuinely help with one symptom while another remains unaddressed — for example, hot flushes resolving well while vaginal symptoms, which weren’t mentioned, continue quietly in the background. A thorough review catches this; a quick “are your hot flushes better?” doesn’t — and it misses the broader question of whether your quality of life has actually improved.
How Evaro tracks this: the Menopause Rating Scale
Rather than relying on an informal “how are you feeling?” at each review, Evaro uses the Menopause Rating Scale (MRS) — a structured, validated way of capturing your symptoms and how much they’re affecting you, at the same points in your care. The MRS looks across three areas: physical symptoms (like hot flushes, sweating, sleep, and joint or muscle aches), mood and energy (including low mood, irritability, anxiety, and tiredness), and bladder and intimate health (vaginal dryness, bladder symptoms, and sexual wellbeing) — so nothing important gets missed just because it wasn’t the symptom on your mind that day.
What “working” should ultimately mean
Treatment is working well when your overall symptoms are meaningfully improved, side effects are manageable, and your quality of life has genuinely improved — not simply when the single symptom you first complained about has quietened down, while other things go unaddressed and unmentioned.
The bottom line
Knowing whether your treatment is working means looking at the whole picture — your symptoms, and how much they’re affecting your life — not one symptom in isolation. And it means this gets checked regularly, using a consistent, structured approach, rather than relying on how you happen to feel on the day of a review.
Treatment for menopause isn’t one-size-fits-all. Evaro offers online menopause assessments if you’d like to explore your symptoms and treatment options. Try our new service.
References: NICE guideline NG23, Menopause: diagnosis and management (2015, updated 2019); British Menopause Society, Tools for Clinicians — reviewing and adjusting HRT; Heinemann LAJ, Potthoff P, Schneider HPG. International versions of the Menopause Rating Scale (MRS). Health and Quality of Life Outcomes. 2003;1:28.
