menopause
treatment
AN APPROACH TO NAVIGATING OPTIONS
MENTAL HEALTH
& EMOTIONAL WELLBEING
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A vital part of managing perimenopause & menopause is protecting your mental health & emotional wellbeing.
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Building strong social supports
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Engaging in activities that nurture joy, purpose and meaning
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Practicing mindfulness and relaxation
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Seeking professional supports including counselling & psychological therapies
LIFESTYLE
APPROACH
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The foundation of menopause care and your future health & wellbeing.
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Prioritising regular physical activity, nutrition, good sleep and our optimising our environment can improve overall wellbeing and help manage symptoms.
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Small, sustainable changes often have the biggest impact, and these approaches can empower you to feel more in control of your health during this transition.
HORMONAL
THERAPIES
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Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT) is the most effective treatment for replacing hormonal deficiencies in menopause.
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Treatment is individualised, with careful consideration of medical history, personal preferences, and risk factors.
-
Hormonal therapy can be safely and effectively used by many women when guided by an informed discussion with a healthcare provider.
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Medicines that do not contain hormones. ​
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Complementary therapies.
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Physical therapies, allied health.
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Many of options are targeted toward specific symptoms such as hot flushes, sleep disturbance, mood changes or vaginal dryness.
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Non-hormonal options are especially important for women who cannot take hormones.
NON - HORMONAL
THERAPIES
LIFESTYLE
APPROACH
-
The foundation of menopause care and your future health & wellbeing.
-
Prioritising regular physical activity, nutrition, good sleep and our optimising our environment can improve overall wellbeing and help manage symptoms.
-
Small, sustainable changes often have the biggest impact, and these approaches can empower you to feel more in control of your health during this transition.
Nutrition,
Nourishment
& Hydration
Body Movement
& Exercise
Body changes in Menopause
& Weight neutrality
Alcohol
Smoking & Vaping
Optimise your Environment
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Aim for 1.5 – 2L water intake daily.
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Limit dehydrating drinks - caffeine, alcohol & energy drinks.
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Focus on a balanced and varied diet to support overall health and wellbeing.
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A thriving and diverse gut microbiome (the bacteria living in the gut) relies on a variety for nutritional foods to support gut health.
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Ensure adequate calcium intake (aim for 1300mg/day) to maintain bone health.
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Prioritise sufficient protein (around 0.6g per kg of body weight daily) to preserve muscle mass and support metabolism.
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To help regular blood sugar levels, choose slow-release, low-GI carbohydrates such as oats, quinoa, barley, sweet potatoes, lentils, legumes.
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Include foods rich in omega-3 such as salmon, sardines, flaxseeds, chia seeds, and nuts to support brain function.
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Eat to maintain energy, reduce irritability, and support overall wellbeing.
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Limit refined sugars which can cause sugar spikes and crashes in energy and mood.
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Limit processed foods and unhealthy saturated fats, and keep salt intake below 2g/day.
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Avoid excess caffeine (max 300mg/day or about 2 cups of coffee) to reduce sleep disturbances and hot flushes.
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Some people find including phytoestrogen-rich foods in their diet (such as soy, flaxseeds, and tofu) may help mimic some effects of oestrogen.
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Be mindful of triggers for vasomotor symptoms (hot flushes etc).
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Spicy foods, alcohol & caffeine may worsen hot flushes.
​
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A Mediterranean-style approach provides great nutritional nourishment & variety. Its great for energy, heart & bone health
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Lean protein sources - lean red meats, poultry, fish legumes, help to maintain muscle & support metabolism.
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Encourages Low-GI Carbohydrate sources such as oats, brown rice, quinoa and whole grains.
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Focuses on whole foods
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Encourages vegetables, legumes, fruits, nuts, seeds, and wholegrains.
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Includes healthy fats
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Includes fibre to help your gut health, gut microbiome, help you feel sustained, full and support balanced energy levels.
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Avoids over processed foods.
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Limits added sugars
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Prioritise movement not only for physical health, but also for mental health & emotional wellbeing, focus and energy balance.
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Choose activities you enjoy = long-term consistency and motivation.
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Start small and build gradually if new to exercise—small, regular movement is better than none.
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Include incidental movement—take the stairs, walk during phone calls, park further from the shops—to increase daily activity.
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Consistency matters more than perfection. Aim for a balanced mix of aerobic, strength, flexibility, and balance training each week.
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Small daily actions add up to protect bone health, muscle strength, heart health, and emotional wellbeing during menopause and beyond.
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Listen to your body. Adapt intensity and rest when needed to avoid injury.
​
BENEFITS
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Regular exercise helps manage vasomotor symptoms (such as hot flushes and night sweats) for some women.
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Supports mental health and wellbeing by reducing anxiety, depression, and improving mood through endorphin release.
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Enhances cognitive health, supporting memory, focus & reducing brain fog.
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Improved sleep quality, reducing night-time waking & insomnia.
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Improves cardiovascular health—reducing blood pressure, improving circulation, lowering triglycerides and cholesterol levels.
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Helps regulate blood sugar control and supports healthy weight management during midlife changes.
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The right exercises can support your pelvic floor health & improve bladder & bowel health.
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Group activities (classes, walking groups, dancing) can enhance social connection and reduce feelings of isolation.
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Outdoor exercise = vitamin D, fresh air, and added mental health benefits.​
​
WHAT SHOULD I BE DOING?
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Aim for at least 150 minutes of moderate-intensity aerobic activity per week - This is "Huff-and-Puff" exercise; e.g. brisk walking, cycling, swimming. Most people find breaking it up into 30 minute lots more achievable.
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Include strength/resistance training 2–3 times per week to maintain muscle mass, support metabolism, and reduce the risk of osteoporosis.
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Focus on weight-bearing activities such as walking, dancing, or light jogging.
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Balance and coordination exercises (yoga, tai chi, pilates, single-leg work) help improve core stability and reduce falls.
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Incorporate flexibility training (stretching, yoga, mobility exercises) to maintain joint health and reduce stiffness.
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High-intensity training may be beneficial but should be balanced with adequate recovery.
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Low-impact options (swimming, cycling, Pilates, yoga) are excellent for joint-friendly movement.
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Many people notice physical changes in their body around menopause. This is largely due to hormonal changes that affect metabolism, insulin sensitivity and fat distribution.
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Shifting hormone levels can lead to a change in the distribution of adipose tissue (fat tissue) in the body. Commonly this becomes stored around the waist, and around organs (visceral fat) - which may increase cholesterol, blood pressure, and the risk of developing diabetes.
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It is important to focus on increasing health enhancing behaviours, without necessarily focusing on the scales.
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A combination of lifestyle choices - balanced nutrition and regular physical activity is more sustainable long-term than strict weight-loss fads.​
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Talk with your health professional if you have concerns regarding your body, including if you have any current (or risk factors for chronic conditions), to ensure appropriate management planning specific to your personal needs.
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If you feel that changes in your body are significantly affecting your body confidence, self-esteem and relationship with your body, and/or if this is encouraging suboptimal self care choices or behaviours (including any current or past disordered eating traits), its important to speak with your health care provider for more support.
​
THE HAES APPROACH
Health at Every Size (HAES) in Perimenopause & Menopause​
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Perimenopause and menopause bring natural shifts in how our bodies feel, function, and look. Hormones change, metabolism slows, and body shape often redistributes—particularly around the waist. In a society that often praises youthfulness and thinness, many experiencing perimenopause & menopause find themselves struggling with body discomforts, body confidence & self-esteem.
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Instead of striving to “get your old body back,” the HAES approach offers perspective - one that focuses on wellbeing, self-respect, and compassionate care, no matter your size.
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HAES is a weight-inclusive, evidence-based framework that shifts the focus from numbers on a scale to what truly matters in the pursuit of good health and quality of life.
​
At its heart, HAES encourages:
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Respect for all bodies – recognising that good health can come in many shapes and sizes.
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Focus on behaviours, not weight – nourishment, movement, rest, and stress management matter more than appearance or numbers on scales.
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Weight stigma-free care – ensuring all people are treated with dignity.
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Practical ways to embrace HAES in midlife
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Move in ways that feel good — movement is about energy, strength, and enjoyment, not calorie burning.
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Eat with balance and kindness: Nourish your body with wholesome nutrition—without rigid rules or diet fads.
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Be kind to your body —Wear clothes that feel comfortable, rest when you need it, and acknowledge what your body allows you to do each day.
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Support your mental wellbeing — Movement, mindfulness, therapy, journaling, or connecting with supportive others can help.
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Seek respectful healthcare: You deserve care that focuses on your whole self, overall wellbeing and quality of life - not just a number on a scale
​
Key Takeaways
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HAES focuses on health behaviours and wellbeing, not the number on the scales or appearance.
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Movement, balanced nutrition, rest, and self-compassion support health at every size.
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Shifting the narrative, the HAES approach moves away from comparison & criticism and moves toward self-compassion, acceptance, and body confidence.
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Menopause brings biological changes consistent with the natural continuum of aging — it is not personal failings.
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​Respectful, weight-inclusive care matters
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Menopause is a new chapter: a chance to build confidence, strength, and peace in your body.
​
The Australian Alcohol Guidelines advise that
healthy adults should
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Have no more than 10 standard alcoholic drinks a week to reduce their risk of developing cancer and other diseases.
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Have no more than 4 standard drinks on any one day to reduce their risk of an injury from alcohol use.
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Alcohol can cause high blood pressure, increasing the risk of cardiovascular disease.
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Alcohol can damage the liver and cause liver disease.
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Drinking alcohol can cause or worsen mental health problems.
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Lowers estrogen, leading to earlier menopause and worse symptoms.
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Makes hot flushes & sweats worse.
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Increases risk of osteoporosis, heart disease, stroke and lung cancer.
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Linked with higher breast cancer risk.
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Quitting improves symptom control, bone strength, cardiovascular health and cancer risk reduction at any age.
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Talk to your trusted health professional on options to help you quit
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Dress in layers and choose breathable fabrics to stay comfortable.
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Keep your environment cool—fans, lower room temperature, cool packs, gel pillows.
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Limit exposure to environmental toxins
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Practice hand hygiene to reduce transmission of infections.
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Encourage your workplace to become menopause friendly
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A vital part of managing perimenopause & menopause is protecting your mental health & emotional wellbeing.
-
Building strong social supports
-
Engaging in activities that nurture joy, purpose and meaning
-
Practicing mindfulness and relaxation
-
Seeking professional supports including counselling & psychological therapies
MENTAL HEALTH &
EMOTIONAL WELLBEING
Social Supports
& Networks
Stress
Management
Mindfullness
Sleep
Mindful Movement
Therapeutic Strategies
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Share your experiences with trusted friends or family, and seek help where needed.
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Joining a support group may provide a sense of community and reduce isolation.
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Link in with your trusted health care providers, surrounding yourself with your own multidisciplinary team specific to your own needs & goals.
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Engage in activities that bring joy and connection.
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Take up relaxing hobbies like gardening, knitting, journaling, painting, reading.
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Spend time outdoors in nature.
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Practice deep breathing or short mindfulness breaks during the day to ease tension.
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Prioritise tasks and set realistic expectations to reduce overwhelm.
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Practicing meditation, mindfulness exercises, and breathing exercises can reduce stress and enhance emotional well-being.
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Try short daily sessions, even 5–10 minutes, to build a consistent habit.
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Use guided apps or recordings to support your practice and focus
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Establish a calming ‘wind-down’ bedtime routine like reading a book or practicing meditation.
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A cool, dark, quiet & comforting sleeping space.
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Avoid heavy meals, excessive fluid intake, alcohol consumption before bed.
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Limit caffeine late in the day
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Reduce screen time prior to bed
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Avoid showering too late as it can wake you up.
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Engage in yoga, tai chi, pilates, swimming or other gentle movement to promote flexibility, balance, and mental calm.
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Use gentle movement as a way to check in with your body and reduce tension.
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Combine movement with mindful breathing for added stress relief.
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Consider speaking with a counsellor, psychologist, or other mental health professional
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Professional support is a proactive way to build strategies and maintain emotional wellbeing.
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Strategies like Cognitive Behavioural Therapy (CBT) can help manage anxiety, mood, and negative thoughts patterns and behaviours.
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Medicines that do not contain hormones. ​
-
Complementary therapies.
-
Physical therapies, allied health.
-
Many of options are targeted toward specific symptoms such as hot flushes, sleep disturbance, mood changes or vaginal dryness.
-
Non-hormonal options are especially important for women who cannot take hormones
-
There is no strong scientific evidence for non-prescription remedies, but they may work for some.
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If you are considering over-the-counter, non-prescription remedies from the pharmacy, please discuss these with you doctor prior to purchasing them, to ensure they do not interact with other medications you may be taking.
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There is evidence that some anti-depressants, gabapentin & clonidine reduce hot flushes.
NON-HORMONAL
THERAPIES
Complementary
Therapies
Herbal Remedies
Supplements
Genito - Urinary
Symptom Treatments
(Non-Hormonal)
Prescription
Non-Hormonal
Symptom Specific
Treatments
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Acupuncture – may help symptoms.
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Yoga / Tai Chi / Qi-gong – gentle movement for flexibility, balance, and musculoskeletal aches.
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Massage therapies – supports relaxation, eases muscle tension, and may improve sleep quality.
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Aromatherapy – calming scents can aid relaxation and sleep. Use with caution.
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Mindfulness - Optimises mental health & emotional wellbeing.
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High quality evidence for herbal remedies varies, and quality differs between products.
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Unclear what doses are needed to produce good effect - symptom relief can be unpredictable.
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Most are not effective for hot flushes.
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Placebo effect is common
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Cost is a consideration
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Always check for safety and drug interactions.​
​
Promensil®
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Red Clover Isoflavones (phytoestrogen)
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May reduce hot flushes
Remifemin®
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Cimicifuga racemosa (Black Cohosh)
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Has been shown in some small trials to reduce hot flushes in peri-menopausal women.
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However, there have been some reports of liver damage with its use which is likely to be due to contaminants in certain products.
Other Plant-based Phytoestrogens
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Evening Primrose
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Ginseng
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Flaxseed (Linseed)
St Johns Wort
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May reduce hot flushes
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Must be used with extreme caution. Interacts with many prescription medications.
Vitamin E
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A very tiny amount of efficacy in reducing hot flushes (may reduce by 1 hot flush a day).
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Dosage = 800 to 1000 IU per day in divided doses with food.
​
​Sleep
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Valerian, Hops, Passionflower, for sleep
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Melatonin an alternative.
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Limited evidence. May interact with some prescription medications
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Only needed if low diet intake or a deficiency.
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Aim to improve your dietary intake as a first-line measure
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It is recommended to discuss your needs with your health professional & assess whether you need supplements, their indication and also, always check for safety and drug interactions.
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Evidence varies in regards to efficacy.
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Side-effects exist & all supplements come with caution.
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Calcium & Vitamin D – support bone health (no more than 600mg Calcium supplementation daily - but aim for 1300mg total including diet).
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Omega-3s – support mood and heart health
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Magnesium glycerinate – support sleep & muscles (cramping). Can also use topical magnesium to rub into the skin.
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Iron – if low, i.e. heavy periods, vego diet. Can cause constipation & dark stools.
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Vitamin B - if low (tested), may help to support brain, energy, vego diet. Be very careful, as certain B Vitamins can cause neuropathic symptoms at high doses.
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Vitamin E – negligible benefit for hot flushes. A very tiny amount of efficacy in reducing hot flushes (may reduce by 1 hot flush a day). The dose range for Vitamin E = 800 to 1000 IU per day in divided doses with food.
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Melatonin – may help to support sleep. Varied doses. Consult your care provider.
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Vaginal, vulval and urinary tract symptoms around the time of menopause are caused by falling oestrogen levels
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These symptoms are common and they can affect between 40% and 90% of menopausal women.
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Urinary incontinence can develop in up to 50% of postmenopausal women
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If you experience irritation, make sure to check in with your doctor, to exclude other skin and vulva & vaginal conditions.
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Vaginal moisturisers and lubricants can ease dryness, discomfort & irritation.
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Replens®, YES VM®, Sliquid®, Multi-Gyn® products, or Olive&Bee® are great options. Use as needed or for daily comfort & during sexual activity.
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Oil based options are not condom friendly.
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Safer sex practice & get screened for sexually transmitted infections if required
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Pelvic floor physiotherapy - strengthens muscles, supports bladder control & improves sexual function.
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Bladder retraining, continence strategies & select prescription medications can help reduce urgency, frequency, and leakage.
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General Vulva-Vaginal Care Tips
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Use underwear made of natural fibres.
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Limit the time spent, wearing tight-fitting underwear, pantyhose/tights, jeans or trousers as this may lead to sweating and skin irritation.
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Limit time in damp or wet swimming costumes or exercise clothing.
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Wash clothing with non-perfumed or low-allergenic washing products.
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Avoid using fabric softeners and consider double-rinsing underwear in clear water if symptoms persist.
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Avoid the use of feminine hygiene washes, sprays, perfumed wipes
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Avoid scented panty-liners and toilet paper.
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Change liners or pads including continence aids regularly
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Avoid douching
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Soap alternatives are gentler than soap. Bubble baths, shower gels, bath bombs are best avoided.
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Always pat dry as opposed to rubbing after showering
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There are several non-hormone prescription medications for relief of menopause symptoms. Not all of them have strong evidence for effectiveness, but all are able to help some women.
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Always consult with your health care professional who has access to your full medical history before taking any of these medications. Some have serious side effects if used with any other medications or supplements.
​
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Veoza/Fezolinetant:
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Works on thermoregulatory centre in the brain to reduce hot flushes.
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Monitor liver function.
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Veoza is a relatively new non-hormonal drug, which can be used for the treatment of moderate to severe hot flashes.
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This drug is the first non-hormonal neurokinin 3 (NK3) receptor antagonist approved to treat hot flashes.
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Neurokinin 3 (NK3) is a brain chemical that is linked to the experience of hot flashes. As circulating levels of NK3 increase relative to estrogen levels, hot flashes develop.
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Veoza works by blocking (antagonising) the uptake of NK3 in the body’s temperature control system, reducing the number and the intensity of hot flashes.
​
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Antidepressants: (ie Venlafaxine, Escitalopram, Paroxetine)
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Neuromodulating effect on hot flushes, mood, sleep.
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Several studies have identified improvement in hot flushes when taking them.
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Usually effective within a month of taking them.
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Need to be prescribed by your doctor.
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Side-effects vary but may include dry mouth, nausea, sleep disturbances, loss of appetite and constipation, loss of libido. Blood pressure should be monitored.
​
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Gabapentin: Anticonvulsant & nerve pain med.
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Several studies have identified improvement in hot flushes.
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Side effects vary but may include rash, dizziness and excessive sleepiness which tends to improve over time. The drug can also cause swelling of the lower limbs and weight gain.
​
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Clonidine: Blood pressure & migraine medication. Reduces hot flushes. Side effect: Dryness, dizziness, contipation.
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Several studies have identified improvement in hot flushes.
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Side effects vary but may include dry mouth, drowsiness, dizziness, constipation and difficulty in sleeping. Advice is to stop clonidine if there is no benefit after four weeks. High doses should be tapered gradually to avoid side-effects like raised blood pressure.
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Treat specific issues independently.
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Chat with your doctor about the symptoms you are experiencing for a holistic approach to your care & discussion about treatment & management options specific to the issues you have.
​
Some Examples:
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Muscles & joints: physiotherapy, exercise physiology, myotherapy etc.
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Bone health: bone-protective therapies (other than menopause hormone treatment) if indicated.
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Skin & hair: Many varying treatments to manage.
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Cardiometabolic: medications for blood pressure, cholesterol, or blood sugar if risk factors present.
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Bladder: Medications to help with urinary incontinence
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Menopausal Hormone Therapy (MHT), or, Hormone Replacement Therapy (HRT) is the most effective treatment for replacing hormonal deficiencies in menopause.
-
Treatment is individualised, with careful consideration of medical history, personal preferences, and risk factors.
-
The most popular MHT is body-identical hormone therapy
-
Occasionally synthetic options are utilised to optimise the treatment for some people
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Hormonal therapy can be safely and effectively used by many women when guided by an informed discussion with a healthcare provider.
HORMONAL
THERAPIES
Common Definitions
Estrone – weak form of oestrogen, the main oestrogen in the body after menopause
​
Estradiol – strong form of oestrogen, the main oestrogen in the body before perimenopause & menopause​
​
Conjugated MHT – MHT containing a mix of different oestrogens
​
Micronised – the particle size has been reduced making it easier to be absorb by the body
​
​Progesterone – naturally occurring hormone​
Progestin – synthetic progesterone​
Progestogen – a class of molecules that act like progesterone
​​
Learn more about Progesterone & Progestogen here.
Throughout our website, we will generally refer to progesterone/progestin/progestogen as 'progesterone' for simplicity of education, however, it's important to discuss specifics with your doctor when considering your prescription & treatment plan.
​
Menopause Hormone Treatment
ABOUT
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Body identical hormones are the most common MHT and they are naturally derived from plant sources, including soy/soya or wild yam. They have the same molecular structure as hormones the body naturally produces. They are the most common form of MHT & the safest.
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MHT comes in many different forms, which gives people choice - gels, creams, tablets, capsules, patches etc.
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It is properly dosed and subject to regulatory conditions to ensure monitoring of safety and efficacy,
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In this way, women can avoid the potential dangers of compounded products, maintain appropriate monitoring of safety and efficacy, and in most cases, save money.
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It is the most effective treatment for menopausal symptoms such as hot flushes & night-sweats.
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The health benefits are best if commenced within the first 10 years of menopause or before age 60 (ie. bones, cardiovascular health etc) .
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Duration of use is personalised.
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There are generally minimal side effects & low risks.
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The risks of MHT differ depending on the type of hormones, their dose, duration of use, route of administration, timing of initiation, and whether progesterone is used.
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Treatment should be individualised to identify the most appropriate MHT type, dose, formulation, route of administration, and duration of use.
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MHT is prescribed by a qualified, treating medical doctor.
BENEFITS
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MHT is the most effective treatment for menopausal symptoms such as hot flushes & night-sweats, improving quality of life.
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The benefits of are best if commenced within the first 10 years of menopause or before age 60.
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It prevents bone loss & progression to Osteoporosis & risk of hip fractures
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It is not associated with weight gain
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There are some protective benefits including better cardiovascular health when commenced early.
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In women who no longer have a uterus, Oestrogen alone has not been shown to increase breast cancer risk in high quality randomised controlled trials.
TYPES
​MHT is available as
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Tablets (Oral)
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Patches, which you stick onto your skin (Transdermal)
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Topical gels/creams absorbed via the skin (Topical Transdermal)
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Vaginal treatments, usually topical gels/creams (Ovestin®, Vagifem®, Intrarosa®)
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Intra-uterine devices, such as the Mirena​® (lasts 5 years for MHT treatment)
​
MHT comes in
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Oestrogen & Progesterone preparations (Combined HRT)
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Oestrogen only preparations
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Progesterone only preparations​
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Testosterone only preparations (Androfeme® for Hypoactive Sexual Desire Disorder)
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Tibolone (Synthetic hormone with estrogen, progestogen & androgenic effect)
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DHEA (vaginal preparation Intrarosa®)
​
Regimens
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Cyclical therapy - often recommended if you still have periods. Sometimes this is also called Sequential therapy.
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Oestrogen is taken every day
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Progestogen added for part of the cycle, therefore having a regular monthly bleed.
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There are still other options available if you need bleeding control
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Continuous therapy - for post-menopause. This is used when you have not had a period for a year. Oestrogen and progestogen are taken every day, aiming for no bleeding.
​​
The type of MHT needed varies according to:
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Your age
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Whether you have had a hysterectomy (uterus removed)
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Whether you have other health conditions
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The best combo for your lifestyle
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Cost is also a consideration
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What sort of preparation you prefer for your lifestyle ie tablets, topical, patches
​​
Your doctor can discuss your options to help tailor the type of hormone treatment best suited to you.
DURATION
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Essentially, there is no true cut-off for how long to take MHT.
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However, you should discuss this with your doctor to determine the best cut-off time frame for you.
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Treatment goals, including degree of symptom relief alongside minimising risk should be individualised.
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After the age of 60, there are some increased risks of using MHT
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Women who go through menopause before 45 years are advised to take HRT at least up until the average age of menopause, i.e. around 51 years.
-
MHT can be continued in discussion with your doctor.
SIDE EFFECTS
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Break-through vaginal bleeding - Is not uncommon in first 3-6 months of starting treatment, but if continues for greater then 6 months, see your doctor. Any abnormal bleeding should be investigated by your doctor before starting any HRT.
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Nausea, Breast tenderness, Bloating
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Patch or topical irritation (If you are using these)
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Weight gain is NOT a side effect of HRT - a study showed that weight gain was less in women on HRT then those not on HRT. Weight gain can be due to age & lifestyle, not HRT
RISKS
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Here is an outline of some of the risks often asked about.
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Overall, MHT is considered low-risk. However, risk must be individualised, meaning your trusted health provider takes into account your current health status, any condition you have and your family history. ​
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Nothing ever comes without risks, but for most people the whole benefits of MHT outweighs the low risks of MHT.
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The risks of hormone therapy differ for women, and depend on:
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The type of hormone therapy.
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The dose of hormone therapy.
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The duration of use.
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The route of administration (oral, patch, etc.).
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The timing of initiation.
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Whether a progestogen is used & the type of used if needed. If the woman has a uterus, she should receive a combined oestrogen plus progesterone treatment to reduce the risk of endometrial cancer.
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​
Endometrial cancer
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If you still have your uterus, unopposed oestrogen therapy alone increases the risk of endometrial hyperplasia and cancer.
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However, when prescribed oestrogen WITH progestogen, this provides endometrial protection to thin the uterus lining & prevent endometrial cancer.
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This is why we always prescribe combined HRT (Oestrogen & Progesterone) for people who have a uterus.​​​
​
Clots
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If you are age less than 60 years and commencing within 10 years of menopause, the risk is very low.
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Commencing after this age comes with some risks as often people's health as we age develops risk features (ie cardiovascular health issues).
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Blood clots – MHT patches and gels have minimal to no risk & are the preferred form of oestrogen replacement
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When using tablets the risk doubles, but is still very low (1 extra case per 1,000).
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The risk increases with age and other risk factors such as obesity, previous thromboembolism, smoking and immobility.
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The risk is less with with the use of oestrogen alone in women who do not have a uterus.
​
Stroke (Venous Thromboembolism)
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Low to no increased risk for people without underlying stroke risk factors who are in their 50s or during the first 10 years of menopause (so, generally up to the age of 60).
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Oral treatment increases the risk of stroke, however, the risk is less with the use of transdermal preparations (topical or patches). Women with risk factors (blood pressure issues, smokers etc) may prefer to use a patch or gel form of treatment.
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Transdermal HRT has not been associated with an increase in risk of clots at doses ≤50mcg/24 hours.
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The absolute risk on oral HRT is low, 2-3 per 1,000 women-years (compared to 1 per 1,000 women-years in non-users). The absolute risk will be higher in people with co-existing risk factors eg. smoking, obesity.
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Transdermal preparations (topical or patches) are recommended for women with a history of stroke.
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If you have a history of a blood clotting disorder, you should speak to your doctor for individualised advice.
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​Cardiovascular disease
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The timing MHT is initiated, referred to as the ‘timing hypothesis’ and ‘the cardiovascular window of opportunity’, can have an impact on the risk of CVD with MHT intake
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No increased risk if MHT begins within 10 years of the onset of menopause or before the age of 60.
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In fact, There are actually some protective benefits including better cardiovascular health when commenced early! Cochrane data-analysis shows that MHT initiated within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.
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Breast Cancer
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Overall 1 in 8 will develop breast cancer during their lifetime regardless of using MHT or not. The added risk of breast cancer with MHT is very small. The risk increases the longer you take MHT and decreases after stopping.
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Studies have predicted that when prescribed MHT close to the menopause and for short-term use (less then 5 years), there are only approximately 4 extra cases per 10,000 women-years for oestrogen alone and 9 extra cases per 10,000 women-years for combined (oestrogen plus progestogen) use.
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Perspective is key!
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The risk of breast cancer from MHT is lower than the risk of breast cancer caused by being overweight or drinking alcohol (without taking any MHT)!
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For example, without taking any MHT, a weight where your BMI greater than 30 is actually a higher risk factor for developing breast cancer with approx. an extra 24 cases over a five year period.
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For example, without taking any MHT, drinking 2 or more alcoholic drinks per day is actually a higher risk factor for developing breast cancer with approx. extra 5 cases over a five year period
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With MHT, there are only approx. extra 4 cases over a five year period developing breast cancer.
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There is no further increased risk of breast cancer in those with a positive family history of breast cancer. But if you do have a family history, you should talk to your doctor to ensure your breast health is reviewed, screening mammogram up to date & a personalised screening program has been considered.
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Recent studies demonstrate no increased risk of breast cancer with vaginal oestrogen. There is also evolving safety data on the use of vaginal oestrogen for women who has had treated breast cancer in the past.
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If you have had breast cancer, we generally do not prescribe hormone replacement therapy, but will offer you other evidence-based non-hormonal options to help manage your symptoms
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STARTING MHT
FAQS
How long does MHT take to work?
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Symptoms often improve within weeks, but it can take up to 3 months for full effect.
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Improvements may be subtle – you might notice the difference only when looking back.
What if I don’t feel better?
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Allow 4–6 weeks for MHT to settle if possible.
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If symptoms persist after 3 months, review your treatment plan with your doctor.
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Dose or type of MHT may need adjusting.
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Common side effects
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See above information on side-effects.
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Temporary: breast tenderness, nausea, bloating, headaches, feeling “off” or unsettled.
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Usually improve within the first 3 months.
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Persistent, severe, or unusual symptoms (e.g. constant bloating, pain, bleeding) should be reviewed by your GP.
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Progestogen-related effects
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Some women feel PMS-like: bloating, headaches, irritability.
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Micronised progesterone is often better tolerated, but may initially cause:
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Low mood or “foggy” mornings (often improves with time).
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Try taking it at night, which can help with sleep. If morning drowsiness is an issue, take it earlier in the evening.
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If side effects don’t settle, your doctor may suggest a different option.
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Bleeding on MHT
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Light or irregular bleeding is not common in the first 3–6 months but should still be reviewed by your doctor
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Cyclical (monthly bleed) MHT may cause changes in flow or pattern.
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Continuous (“no bleed”) MHT can still cause spotting early on.
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See your GP if bleeding is heavy, painful, triggered by sex, or continues beyond 6 months.
Testosterone
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Available in Australia as a cream (AndroFeme® 1%), made from yam/soy (body-identical).
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Approved use: treatment of Hypoactive Sexual Desire Disorder (HSDD).
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There is still limited (& evolving) data on the role of Testosterone specifically for Menopause, but many women with Menopause & HSDD use Testosterone effectively.
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Applied daily to the skin
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Contains almond oil – avoid if allergic/anaphylactic.
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Monitoring: blood tests are required to guide safe dosing & to ensure optimisation of treatment.
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Cost: around $105 per tube, which lasts ~100 days (≈$1/day).
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Why it’s used
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Supports sexual desire and pleasure when low testosterone is contributing to loss of libido.
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May take 3–6 months to notice benefits.
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Other symptoms (energy, mood, cognition, joints) are sometimes reported but not well-proven.
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Side effects
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Most are rare or very mild and dose-related. Any side-effects experienced typically improve by lowering or stopping the dose.
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Skin changes (acne, oily skin, unwanted hair growth).
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Rare: voice deepening, clitoral enlargement, hair loss.
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Safety
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Short-term studies show no increased risk of heart disease, stroke, or breast cancer
Tibolone
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Tibolone, often called Livial ®, is a synthetic hormone with a combination of oestrogen, progestogen & androgenic effects
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Available as a tablet
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Helps hot flushes, low mood, libido, and bone health
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Only suitable if periods have stopped (>12 months)
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Not suitable if you have a history of breast cancer
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Is a non-hormonal treatment for menopause, which acts similarly to combined HRT.
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Several studies have identified improvement in menopausal symptoms.
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It has been found to be effective in the prevention of bone loss
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Tibolone can be used by those who have an intact uterus and have not experienced a natural period for at least one year. If taken sooner, irregular bleeding may be experienced.
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Women can also transition from cyclical, or continuous HRT onto Tibolone.
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Tibolone has the same contraindications as any oral combined HRT.
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Side-effects may include headache, dizziness, nausea, abdominal pain, swollen feet and itching. Breast tenderness is uncommon. Slight bleeding or spotting may commonly occur initially but tends to subside after a few months.
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Risk Profile
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Heart disease – no increase in risk.
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Breast cancer – reduces breast density/tenderness and no increase in breast cancer risk with three years of use.
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Stroke – increase in risk if started after the age of 60. Studies have demonstrated an increase among those in their 50s (4 extra cases per 1000) and those in their 60s (13 extra cases per 1000).
Bio-identical Hormones
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Beware of compounded hormone replacement therapy sold as ‘Bio-identical’ Hormone Therapy. They are not recommended.
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Bio-identical hormone therapy is NOT the same as Body-identical hormone replacement therapy (HRT/MHT). ​
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It often refers to compounded products which are marketed as 'more natural' or 'naturopathic' options. It is important to realise that no hormone used in any preparation of pharmaceutical grade body-identical menopausal hormone replacement therapy OR compounded “bio-identical therapy” is ‘natural’. Even when stated that they are 'made from plants', they are all synthesised in some form in a laboratory from some precursor by enzymatic manipulation. ​​
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The production of these products are NOT subject to the regulatory conditions of approved pharmaceutical products.
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There are some safety concerns around compounded bio-identical hormones
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Unknown side-effects & risks
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Unknown risk of interaction with other drugs you may be taking
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Risk of endometrial cancer, breast cancer, cardiovascular disease, stoke and clots.
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Risk of endometrial cancer, especially if there are insufficient or sub-therapeutic doses of progesterone in the preparations
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Production safety - Quality control, including content, purity, preparation pharmacokinetics, safety of products used.
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Contaminants or impurities which may compromise the treatment
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Lack of regulation around production of the compounds
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Lack of evidence-based research to suggest robust drug efficacy (that it will work), including lack of large-scale studies and supportive peer-reviewed research
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Unnecessary Cost. Some Bio-identical therapies are sold at magnified costs.
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There may be an unknown estimate of the compounded formulation doses that are bio-equivalent to conventional body-identical HRT.
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You may be paying a lot of money for potentially very little optimised drug effect.​
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Misinformation that ‘bioidentical’ is synonymous with ‘safe’
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The lack of reliability of salivary testing to titrate doses and formulations
​Quoted statistics on this webpage come from reputable resources reviewed in 2025, including The Australian Menopause Society & Jean Hailes.
This is general information only. Everyone’s journey through perimenopause & menopause is different.
When it comes to treatment options, please ensure you discuss your needs and evaluate the benefits, risks & side-effects with a trusted health professional.