ASK THE DOCTOR: send the Times doctor questions on the menopause for answer online on Wednesday and read other topics Dr Stuttaford has answered recently

Menopause the Musical opens at the Shaw Theatre in London on March 27. It may not sound a promising title, but has already been seen by more than 8.7 million people in the US, Canada, Australia and New Zealand. Tone deaf and without any sense of rhythm, I am not the ideal judge of its merit. However, a lifetime in medical practice has taught me that going through the menopause means more in a woman’s life than passing a small roadside milestone. It is more the equivalent of passing Antony Gormley’s Angel of the North .

Now that the average life expectancy of a woman is 83, there are plenty of post-menopausal years to compensate for the restrictive duties of rearing a family.

In cultures where contraception has either been frowned on or is unavailable, the menopause was often welcomed, as it removed the fear of further pregnancies. A woman could then assume the role of elder or councillor within the family or community — she could even embark on love affairs without fear of having more children.

However, Dr Sally Hope, a founding member of the British Menopause Society and a member of the NICE osteoporosis guidance group, warned a conference last week at which Menopause the Musical was introduced, that the postmenopausal woman must bear in mind that the greatest rate of increase in sexually diseases is being observed in older women. This statistic doesn’t mean, as some of the audience may have thought, the speaker was implying, that all grannies are as rampant as rabbits or that there is more sexually transmitted disease among them than there is in their grandchildren.

In Britain, more than in any other Western country, we worship the culture of youth and the menopause isn’t welcomed. Women politicians in the United States, France, the Low Countries, Germany and Italy are grey and distinguished, and female writers experienced and worldlywise. But in this country youth is a highly-prized commodity. Not surprisingly, as the menopause is the obvious sign of the end of a woman’s reproductive life, but not necessarily her sexual life, it has profound significance and is not greeted with much pleasure.

The message from the London conference was that once women were freed from many of the responsibilities that had limited their activities during the previous 30 years, they should now seize the opportunity to make the most of the rest of their lives.

The conference was chaired by Maryon Stewart, whose expertise is lifestyle, nutrition and the psychological approach to the menopause. No conventional doctor should object to supplementary medicine of this sort, provided that it doesn’t result in delay in seeking medical help for pathological problems that respond to orthodox medicine.

The average age of the menopause is now 51 or 52. This has increased little — probably no more than a year to 18 months — over centuries, despite higher standards of living. Paradoxically, in one of the more deprived areas of Great Britain, the Highlands and Islands, the average age of the menopause is up to five years later. This may be because the arduous life of fishing in tricky waters meant that those families that were genetically conditioned to have a long reproductive life have survived, whereas those in which the reproductive life was short have died out.

In conventional medicine, HRT, not favoured by many at last week’s conference, still has an important role as a short-term treatment for severe menopausal symptoms. It isn’t any longer recommended as prophylactic treatment for women with either few symptoms or mild symptoms because it is now known to be one of many risk factors for breast cancer.

Two physical symptoms ascribed without argument to the menopause are vaginal dryness, sometimes with pain on intercourse, and hot flushes. During a hot flush the woman feels a sudden sensation of a burning face, neck and chest, her body temperature rises by up to 3F and she may sweat profusely. Hot flushes begin before the menopause and usually are at their worst one or two years after it. In just a third of patients is medical advice needed or sought.

The vaginal dryness is related to oestrogen loss; that can be overcome by taking HRT by mouth or patch. Usually this is needed only for a short time, after which local measures are adequate.

Sexual libido is unchanged in 60 per cent of women, sexual desire increases in 20 per cent and reduces in 20 per cent. Long-term medical problems of the postmenopausal years include osteoporosis and the increased risk of heart disease.