Menopause occurs at an average age of 51 in France. Beyond hot flashes, it speeds up bone loss and increases cardiovascular risk, two silent changes. The prevention check-up, at 45–50 and again at 60–65, is the time to talk about it, measure blood pressure and cholesterol, assess bone health and discuss the options with your doctor.
What is menopause, and when does prevention begin?
Menopause is the permanent end of ovulation and menstrual periods, when the ovaries stop producing estrogen and progesterone. According to French National Health Insurance (Assurance Maladie), the diagnosis is based on 12 months without a period in a woman of about 50 (between 45 and 55), and no testing is needed in the usual situation. In France, the average age is 51.
Perimenopause refers to the few years before, when cycles become irregular and the first symptoms appear, while contraception is still needed. This is often the 45–50 age range, the age of the prevention check-up. We see two issues here: immediate quality of life, and health over the next twenty years, which is exposed on the heart and bone fronts.
Menopause before age 40 is called premature and calls for specialized care, which is beyond the scope of this article.
What are the symptoms of menopause, and which ones warrant a consultation?
The most common symptoms are hot flashes and night sweats, sleep problems, fatigue, irritability and mood swings, vulvovaginal dryness, urinary problems, headaches and joint pain. Not every woman has all of them, and their intensity varies a great deal.
| Symptom | What it reflects | What can be done |
|---|---|---|
| Hot flashes, night sweats | Disrupted temperature regulation linked to falling estrogen levels | Suitable clothing, a cool bedroom, limiting alcohol and heavy meals in the evening; treatment to discuss if quality of life is affected |
| Sleep problems, fatigue | Night sweats, anxiety, waking during the night | Regular schedules, physical activity during the day, less screen time and fewer stimulants; see a doctor if insomnia persists |
| Mood, irritability, anxiety | Hormonal fluctuations, disrupted sleep, life circumstances | Talk about it; psychological support, including through Mon soutien psy (France’s program of reimbursed psychologist sessions); hypnosis and cognitive behavioral therapy appear to be effective, according to French National Health Insurance |
| Vulvovaginal dryness, pain, recurrent cystitis, urinary leakage | Genitourinary syndrome of menopause | Moisturizers and lubricants; local treatment to discuss; don’t keep the symptom to yourself |
| Weight gain, abdominal fat | Slower metabolism, muscle loss | Adjusted diet, enough protein, strength training |
| Joint pain | Falling estrogen levels, sedentary lifestyle | Regular physical activity; see a doctor if there is swelling or persistent stiffness |
Two signals warrant a consultation without delay: bleeding after confirmed menopause, which must always be investigated, and intense, frequent hot flashes, which French National Health Insurance associates with increased cardiovascular risk. French National Health Insurance also notes that between 42 and 50, average weight gain is 0.8 kg a year, and 1.5 kg for 20% of women, with fat shifting toward the abdomen.
Why does cardiovascular risk increase after menopause?
Before menopause, women have a lower risk of heart attack than men; afterward, their risk catches up. French National Health Insurance puts it bluntly: “Cardiovascular risk increases after menopause,” through an altered lipid profile, higher blood pressure and more frequent diabetes. Cardiovascular disease is the leading cause of death in women.
What changes are the measurable risk factors: LDL cholesterol and non-HDL cholesterol rise, as do triglycerides, blood pressure goes up, blood sugar becomes more easily unbalanced, and abdominal fat settles in. None of these changes can be felt. That is why, at this stage, we ask for a recent blood pressure reading and a lipid panel, and assess risk using the SCORE2 score (European Society of Cardiology, 2021), which estimates the probability of a cardiovascular event within ten years from age, sex, smoking, systolic blood pressure and non-HDL cholesterol. We explain how to interpret it in 10-year cardiovascular risk and SCORE2.
Smoking worsens cardiovascular risk and is among the contraindications to hormone therapy cited by French National Health Insurance: at 50, quitting is the prevention step with the biggest payoff.
Menopause and osteoporosis: what happens to your bones?
Osteoporosis is a diffuse skeletal disease characterized by decreased bone density; the bone becomes fragile and breaks from minor trauma. According to French National Health Insurance, bone loss accelerates for 5 to 10 years at menopause, and “osteoporosis affects one in four postmenopausal women.” Around age 65, 39% of women have it; at 80 and older, 70%. In 2019, nearly 4 million people in France had osteoporosis, and 484,000 fragility fractures occurred.
Typical fractures affect the wrist, the vertebrae (compression fractures) and the hip (femoral neck). Bones do not hurt before a fracture: prevention relies on identifying risk factors and on habits adopted from perimenopause onward.
The factors that lead us to consider a bone density scan (a measurement of bone density using low-dose X-rays) are: a previous fracture from minor trauma, early menopause, high-dose corticosteroid treatment for at least three months, a body mass index below 19, a family history of hip fracture, and excessive tobacco or alcohol use. The test is reimbursed under certain conditions. Without risk factors, it is not routine.
Bones are also protected by avoiding falls: after 65, a fracture is almost always the combination of a fragile bone and a fall. We devote an article to this: preventing falls in older adults.
What does the prevention check-up do at ages 45–50 and 60–65?
Menopause is one of the official topics of Mon bilan prévention, France’s national prevention check-up program: a 30- to 45-minute consultation fully covered (100%) by French National Health Insurance, with no upfront payment, once per age range. Two appointments bracket menopause: the prevention check-up at ages 45–50, during perimenopause, and the prevention check-up at ages 60–65, about ten years later.
| Topic | Check-up at 45–50 | Check-up at 60–65 |
|---|---|---|
| Symptoms | Identify perimenopause, name the symptoms, refer to your regular doctor, a gynecologist or a midwife | Persistent symptoms (hot flashes, genitourinary syndrome), sleep, mood |
| Heart | Blood pressure, lipid panel, blood sugar if there is a risk factor; smoking; first SCORE2 calculation | Reassessment of risk; age weighs more heavily, modifiable factors matter just as much |
| Bones | Osteoporosis risk factors; calcium, vitamin D, weight-bearing activity | Bone density scan if there are risk factors; fall prevention |
| Screenings | Last cervical screening test; prepare for breast and colorectal screening at 50 | Mammogram and colorectal test up to date; last HPV test before 65 |
| Treatment | Information on the options, including hormonal ones, with no decision made during the check-up | Reassessment of ongoing treatment with the prescriber; alternatives |
| Lifestyle | Physical activity, diet, alcohol, sleep, contraception still needed | Strength training, balance, protein, social life |
In both cases, the appointment ends with a Personalized Prevention Plan: one or two goals, dated actions, and a copy sent to your regular doctor (médecin traitant) unless you object. The three organized (national) cancer screening programs are reviewed in detail in organized cancer screening.
Which options should you discuss with your doctor, rather than decide alone?
Menopausal hormone therapy (MHT) combines an estrogen and a progestogen. It is neither prescribed nor refused wholesale: the French National Authority for Health (HAS) (fact sheet of July 16, 2014) reserves it for women whose climacteric symptoms are “troublesome enough to impair their quality of life,” “at the most appropriate doses and for the shortest possible time, reassessed at least once a year,” with clear information about its risks. French National Health Insurance adds that a clinical exam and a mammogram precede the prescription, that the regular doctor or gynecologist is the prescriber, and that every woman on treatment should have an annual reassessment.
The documented risks are breast cancer (which increases with duration), endometrial cancer in the absence of a progestogen, ovarian cancer with long-term use, venous thrombosis and stroke, especially in the first year. The contraindications cited by French National Health Insurance include a history of breast cancer, high cardiovascular risk and smoking. In 2025, 496,245 women were being treated in France, or 4.4% of women aged 45 to 60.
We do not give individual advice here: the balance between benefits and risks depends on your age, how long ago menopause began, your medical history and your symptoms. The check-up helps you prepare your questions for the consultation where the decision will be made.
There are also non-hormonal options: moisturizers and lubricants for dryness, non-hormonal treatments for hot flashes, hypnosis and cognitive behavioral therapy, psychological support. On November 18, 2025, the HAS began work on the care of women during perimenopause and menopause in primary care; the resulting recommendation will update these guidelines.
Physical activity and diet: what should you change in practice?
Physical activity is the only lever that acts on symptoms, the heart, bones, weight, sleep and mood all at once. French National Health Insurance sums it up: it “is a way to ease perimenopausal symptoms, stay physically fit, and prevent loss of muscle mass and bone loss.”
For bones, the useful exercises are those “in which the feet and legs support the full weight of the body” (brisk walking, stairs, dancing, tennis) and resistance exercises with weights or resistance bands. For the heart, regular endurance activity and strength training at least twice a week, according to international guidelines.
On the diet side, French National Health Insurance recommends a varied diet rich in calcium (dairy products, calcium-rich mineral waters), with vitamin D intake (oily fish, egg yolk) and enough protein to preserve muscle; if you are overweight, a moderate reduction in intake rather than a drastic diet. For alcohol, the guideline is no more than 10 standard drinks a week and no more than 2 a day, with some alcohol-free days (in France, a standard drink contains 10 g of alcohol). Smoking worsens osteoporosis and cardiovascular risk; nicotine replacement is reimbursed by French National Health Insurance.
We start from what you already do: going from nothing to thirty minutes of walking three times a week changes more than an ideal you never reach.
Key takeaways
- Menopause occurs at an average age of 51; the diagnosis is based on 12 months without a period, with no testing needed in the usual situation.
- After menopause, cardiovascular risk catches up with men’s and bone loss accelerates for 5 to 10 years: blood pressure, lipid panel and osteoporosis risk factors should be checked.
- The prevention check-up at 45–50 and again at 60–65 makes time for symptoms, measures risk and leads to a Personalized Prevention Plan sent to your regular doctor unless you object.
- Hormone therapy is an individual decision, framed by the HAS: symptoms that impair quality of life, an adjusted dose, the shortest duration, annual reassessment.
- Weight-bearing activity, strength training, calcium, vitamin D, protein, quitting smoking: the levers that protect both the heart and the bones.
What Sokrate lets you do
The Sokrate service offers an online preparation questionnaire that covers perimenopause and menopause among its dimensions: symptoms, sleep, cardiovascular and bone risk factors, screenings. You arrive at the check-up with your priorities already identified; the Personalized Prevention Plan is signed by a doctor, a letter is sent to your regular doctor unless you object, and a coordinating nurse provides follow-up. You can prepare your prevention check-up now; the overall framework is explained in the prevention check-up.