Menopause typically occurs between ages 45 and 55 and can cause symptoms including hot flushes, sleep disruption, mood changes, brain fog, and joint pain. Treatment options include Menopausal Hormone Therapy (MHT), non-hormonal medications, and lifestyle modifications. Your GP can develop a personalised treatment plan; Nuvo Health offers women’s health consultations across 22 Sydney locations.
What Is Menopause and Perimenopause?
Menopause is the point when a woman has not had a menstrual period for 12 consecutive months. Perimenopause is the transition phase; it can begin 4 to 8 years before the final period, sometimes in the early 40s. This is often the most symptomatic phase. Average age of menopause in Australia is 51. Premature menopause (before 40) affects approximately 1 in 100 women and may require longer-term hormone therapy for bone and cardiovascular protection.
Common Menopause Symptoms
Vasomotor: Hot flushes, night sweats
Sleep and fatigue: Insomnia, waking unrefreshed, daytime fatigue
Mood and cognition: Anxiety, irritability, low mood, brain fog, reduced concentration
Physical: Joint and muscle aches, vaginal dryness, urinary frequency, reduced libido, weight gain, dry skin, heart palpitations
Long-term: Bone density loss (osteoporosis risk), increased cardiovascular risk
Menopausal Hormone Therapy (MHT)
MHT (previously called HRT) remains the most effective treatment for vasomotor symptoms. The Australasian Menopause Society supports MHT for symptomatic women initiated under 60 or within 10 years of menopause.
Types available:
- Oestrogen-only: For women with hysterectomy. Available as patches, gels, or tablets.
- Combined (oestrogen + progestogen): This combination is used for women with an intact uterus and protects the lining of the uterus. Progesterone may be taken as a tablet or delivered via a hormonal IUD.
- Local vaginal oestrogen: Used for vaginal dryness, painful sex, recurrent urinary symptoms and genitourinary symptoms of menopause. It is low-dose and can often be used even when systemic MHT is not suitable. Intrarosa is another local hormone therapy option for these symptoms.
- Tibolone: A synthetic hormone therapy with oestrogenic, progestogenic and androgenic effects. It may be considered for some postmenopausal women, particularly where low libido is also a concern.
- Testosterone: May be considered for postmenopausal women with persistent low sexual desire after other causes have been assessed. It is not a general treatment for hot flushes, mood changes or fatigue.
TGA-approved body-identical MHT such as oestradiol patches or gels with micronised progesterone, is often preferred due to a more favourable risk profile than some older oral formulations. This differs from compounded “bioidentical” hormones, which are not recommended because of concerns regarding safety, regulation, and dose consistency.
Benefits: Relief within 4 to 6 weeks for hot flushes and night sweats. MHT can also improve vaginal and urinary symptoms, support bone health and decrease fracture risk, may improve sleep, mood, sexual wellbeing, and overall quality of life when symptoms are hormonally driven. When started within 10 years of menopause or before age 60, MHT may also provide cardiovascular benefits in selected women.
Risks: Small increase in breast cancer risk with combined MHT after 5+ years (lower with body-identical progesterone). Small blood clot increase with oral oestrogen.
Non-Hormonal Treatment Options
For women who cannot take MHT or prefer not to, several non-hormonal options have evidence supporting their use. Your GP can discuss which approach may be suitable for your symptoms, including structured psychological therapies, certain prescription medications used off-label for hot flush management, vaginal moisturisers, and newer targeted non-hormonal therapies. All treatment decisions are made in consultation with your doctor based on your individual circumstances.
Lifestyle Modifications That Help
- Regular exercise: 150 minutes per week of moderate-intensity exercise plus resistance training 2 to 3 times per week for bone health
- Balanced diet: Calcium-rich foods, vitamin D, phytoestrogen-containing foods (soy, lentils, chickpeas)
- Limit alcohol and caffeine: Both can trigger or worsen hot flushes and disrupt sleep
- Stress management: Mindfulness, yoga, and meditation
- Sleep hygiene: Cool bedroom, consistent schedule, layered bedding
- Stop smoking: Associated with earlier menopause and worsened symptoms
Mental Health Support During Menopause
Your Nuvo Health GP can create a GP Mental Health Treatment Plan; providing Medicare-subsidised access to up to 10 psychologist sessions per year. MHT can also improve mood symptoms if hormonally driven.
Frequently Asked Questions
Q: Is MHT safe?
A: For most women under 60 or within 10 years of menopause, benefits outweigh risks. Your GP will assess your individual risk profile including breast cancer and blood clot history.
Q: What age does menopause usually start?
A: Average age 51, range 45 to 55. Perimenopause can begin 4 to 8 years earlier. Periods stopping before 40 is classified as premature ovarian insufficiency; see your GP.
Q: Can I get a referral to a menopause specialist?
A: Yes. Your GP can refer to an endocrinologist or gynaecologist for complex cases. Referral required for Medicare specialist rebate.
Q: Does Medicare cover menopause treatment?
A: GP menopause consultations are Medicare-rebatable. Some medications may be PBS-listed depending on the product and indication. Blood tests are Medicare-rebated when clinically indicated, but many women over 45 with typical symptoms do not need hormone testing to diagnose menopause or perimenopause.
Q: What blood tests are needed?
A: Over 45 with typical symptoms, blood tests are not always needed. When ordered, they may include FSH, oestradiol, thyroid function, lipids, blood glucose and a bone density scan (DEXA).
Q: How long does menopause last?
A: Vasomotor symptoms persist on average 4 to 7 years after the final period. Some women experience them for over 10 years. Ongoing GP review is important.
Q: Can I use MHT with a family history of breast cancer?
A: Not automatically excluded. Your GP will assess individual risk. Oestrogen-only MHT carries lower risk than combined. Breast specialist or genetic counsellor referral may be appropriate.
Q: Is telehealth available?
A: Yes. Nuvo Health offers telehealth for menopause consultations, follow-ups, and prescription renewals.
