Menopause and Perimenopause
Your final period, confirmed after 12 months without one, usually around 51. The years before (perimenopause) can bring hot flushes, poor sleep, mood changes and irregular periods. Very treatable.
The menopause ladder
No one has to just put up with it. Hormone therapy is the most effective treatment for most women; good options exist for those who can’t or don’t want to use it.
- Step 1 · Self-careLifestyle and symptom trackingRegular exercise, cutting back alcohol, stopping smoking, layered clothing and a cool bedroom. Track symptoms to see your patterns.
- Works
- Helps general health, sleep and coping; hot flushes improve less than with treatment
- Cost
- Free
- How long
- Ongoing
- Watch for
- Weight-bearing and strength exercise also protects bones and heart, which matter more after menopause.
A fan, a symptom diary and a strength session: unglamorous, effective.
- Step 2 · Allied healthCognitive behavioural therapy (CBT)A structured talking therapy, one-on-one, in a group or online, aimed at hot flushes, sleep and mood.
- Works
- Reduces how often hot flushes happen and how much they bother you, and helps sleep and low mood
- Cost
- Psychologist fees vary; some online and group programs are low cost
- How long
- A short course of sessions
- Watch for
- CBT doesn’t mean it’s ‘all in your head’. It’s a recommended treatment, alongside or instead of hormones.
Not ‘just think cooler thoughts’. It genuinely helps.
- Step 3 · PrescriptionMenopausal hormone therapy (MHT, also called HRT)Oestrogen as a patch, gel, spray or tablet, plus progestogen (if you have a uterus) to protect the womb lining.
- Works
- Cuts hot flushes by about three-quarters more than a dummy treatment; also helps sleep, joint aches and mood, and protects bones
- Cost
- Many options under the $25 PBS co-payment; some cost more
- How long
- As long as benefits outweigh risks for you; review yearly
- Watch for
- Combined MHT adds about 1 extra breast cancer per 1000 women a year in their 50s. Tablets roughly double clot risk (to about 1 extra per 1000); patches and gels carry little or none. Not for people with breast or womb cancer.
For most healthy women under 60 or within 10 years of menopause, the benefits outweigh the risks.
- Step 4 · PrescriptionVaginal oestrogenA low-dose cream, pessary or ring for dryness, painful sex and urinary symptoms.
- Works
- Very effective for vaginal and bladder symptoms, with little hormone absorbed into the body
- Cost
- Under the $25 PBS co-payment for many products
- How long
- Long term, as long as symptoms need it
- Watch for
- Safe for long-term use for most; ask your specialist if you’ve had breast cancer. Moisturisers and lubricants help too.
The most under-used good treatment in menopause.
- Step 5 · PrescriptionNon-hormonal medicinesFezolinetant, certain antidepressants (low-dose venlafaxine, escitalopram), or gabapentin, for people who can’t or don’t want to use hormones.
- Works
- Fezolinetant: about 2–3 fewer moderate to severe hot flushes a day than a dummy pill in trials. Others help less than MHT
- Cost
- Fezolinetant: not PBS-subsidised as of late 2025, so a private script that can be pricey. Others: under the $25 PBS co-payment
- How long
- As long as needed, with review
- Watch for
- Fezolinetant: liver blood tests before starting and monthly for 3 months. Antidepressants: nausea, sleep changes. Gabapentin: drowsiness.
Good back-up options when hormones aren’t the right fit.
- Step 6 · SpecialistMenopause specialist or gynaecologistFor early menopause, symptoms after cancer, complicated health conditions or treatment that isn’t working.
- Works
- No trials of referral itself; helps tailor tricky cases
- Cost
- Specialist fees vary; Medicare rebates with a GP referral
- How long
- As needed
- Watch for
- Menopause before 40 or 45 needs treatment to protect bones and heart, usually until at least 51.
Early menopause is a medical issue, not just a symptom issue.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Compounded ‘bioidentical’ hormonesCustom-made creams and lozenges aren’t tested for strength or safety, and have been linked to womb cancer. The Australasian Menopause Society doesn’t recommend them. Approved body-identical hormones exist.
- Saliva hormone testsNot standardised or reliable. Hormone levels swing wildly in perimenopause, so diagnosis is based on your age and symptoms.
- Black cohosh, red clover and evening primrose oilEvidence is inconsistent or negative, and black cohosh has possible liver safety concerns.
- Wild yam or progesterone creamsNo evidence they work for hot flushes, and they don’t protect the womb lining with oestrogen.
- Acupuncture for hot flushesNo better than fake acupuncture in trials, though some find it helps sleep.
What you can do
- Fill in a symptom checklist (see resources) and take it to your GP.
- Keep using contraception until 12 months after your last period, or as your GP advises.
- Do strength and weight-bearing exercise most days for bones, heart and mood.
- Check your blood pressure, cholesterol and cervical and breast screening are up to date.
- Try vaginal moisturisers for dryness, and ask about vaginal oestrogen if they’re not enough.
See your GP if
- Symptoms are affecting work, sleep, relationships or mood
- Your periods become very heavy, much more frequent, or you bleed between periods or after sex
- Your periods stop before 45, or you have menopause symptoms before 40
- You get unexpected bleeding while on MHT
See your GP promptly for any bleeding after 12 months without a period: it’s usually harmless but must be checked. Get urgent help for chest pain, a painful swollen leg, sudden breathlessness, or stroke signs (face drooping, arm weakness, slurred speech): call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
Common questions
What are the symptoms?
Hot flushes, night sweats, poor sleep, irregular periods, low mood, anxiety, irritability, brain fog, joint aches, vaginal dryness, lower libido and urinary symptoms. Symptoms often start before periods stop and can last 5–10 years.
When does it happen?
Most women in Australia reach menopause between 45 and 55, at an average age of 51. Perimenopause often lasts 4–8 years. Menopause before 45 is early; before 40 is called premature ovarian insufficiency. Surgery to remove the ovaries and some cancer treatments cause it suddenly.
Do I need a blood test?
Usually not if you’re over 45 with typical symptoms; hormone levels go up and down too much to be useful. Blood tests help if you’re under 45, have had a hysterectomy, or other causes need ruling out.
Does a hysterectomy cause menopause?
Not on its own. If the ovaries stay, they keep working. Removing both ovaries causes menopause straight away.
Helpful resources
- Jean Hailes: Symptom checklistPrintable 16-symptom checklist to rate and take to your GP. Free, Australia.
- Australian Government: Perimenopause and menopausePlain-English hub on symptoms, treatments, contraception and bone health, with personal stories. Free.
- Australasian Menopause Society: Is MHT safe?Clear fact sheet on benefits and risks of hormone therapy. Free.
Evidence and more information
- Healthdirect: Menopause
- Healthdirect: Menopause treatments
- Australasian Menopause Society: MHT safety
- Australasian Menopause Society: Bioidentical hormone therapy
- Australasian Menopause Society: Complementary medicine options
- NICE: Menopause guideline update (NG23)
- Cochrane: Hormone therapy for hot flushes
- NIHR: Breast cancer risk with HRT (BMJ 2020)
- PBAC (2025): Fezolinetant public summary
maladywise.com/menopause/