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Menopause management options

There are many ways to manage and treat menopausal symptoms, depending on your own unique experience. You might try different options before finding a treatment that works for you. It’s important to seek accurate and reliable information before you start any treatment.

Many women cope with mild menopausal symptoms and don't need to take any medication or use therapies. Some women manage their symptoms with a healthy lifestyle, such as eating well and doing regular exercise. Other women with symptoms that affect their quality of life might choose to use medicines and therapies.

Your doctor will consider your individual situation and explain different treatment options so you can make an informed decision. For example, they may discuss:

  • your symptoms
  • any risk factors
  • your options, including MHT (most effective treatment), non-hormonal therapies and complementary therapies.
Topics on this page

Menopausal hormone therapy (MHT)

What is MHT?

Menopausal hormone therapy (MHT), formerly known as hormone replacement therapy (HRT), helps manage menopausal symptoms when they interfere with your life. Menopausal symptoms are caused by lowering levels of oestrogen hormones. MHT is the medical replacement of female hormones oestrogen and progesterone, and sometimes testosterone.

Types of MHT

Oestrogen and progesterone therapy

Oestrogen is the main hormone prescribed to relieve menopausal symptoms. If you’ve had a hysterectomy, this may be all you need.

If you haven’t had a hysterectomy, oestrogen and progesterone are used together, as progesterone reduces the risk of endometrial cancer (cancer of the uterus).

Other combinations of oestrogen and progestogen (including progesterone and other progesterone-like hormones) may also be recommended.

How does MHT work?

MHT replaces oestrogen to help control menopausal symptoms.

There are many ways to treat hot flushes and vaginal dryness, but no other treatment has been shown to be as effective as oestrogen replacement therapy.

How do you take MHT?

MHT can be prescribed in different dosages and methods, depending on your needs and responses. For example, you might be prescribed pills, patches, gel, vaginal creams or an intrauterine device (IUD).

You may need to try different dosages or methods to find the right combination. Your doctor must supervise this process.

What are the benefits of MHT?

MHT can relieve common symptoms of menopause, such as:

  • hot flushes
  • vaginal dryness
  • sleep disturbance with night sweats
  • joint pain
  • itchy skin.

MHT can reduce the risk of:

  • osteoporosis
  • heart disease
  • bone fracture
  • endometrial cancer
  • colon cancer
  • type 2 diabetes
  • cataracts.

MHT can also improve:

  • skin and hair health
  • headaches
  • aches and pains
  • irritability
  • sleeplessness
  • sex drive
  • balance
  • dizziness and vertigo.

What are the risks of MHT?

Many studies have investigated whether MHT increases the risk of cancers, further illness and disease. The results of some studies led to a significant drop in the use of MHT.

A recent comprehensive review of evidence on MHT found it is an effective and safe treatment for the relief of menopausal symptoms for healthy women. The data showed that MHT had low risks for women aged between 50 and 60 years, but more research is needed to understand how MHT might affect other women’s health issues.

Research shows there are some risks associated with MHT. The risks of hormone therapy differ depending on:

  • the type of medication
  • the dose given
  • how long the medication is used for
  • how the medication is given (e.g. patch or tablet)
  • when medication is started
  • whether a progestogen is used
  • the type of progestogen used.

It is not recommended you start MHT if you are older than 60 years or if you’ve been postmenopausal for 10 years or more.

Your doctor may advise you not to use MHT if it could increase your health risks.

For example, if you have:

  • cancer (e.g. breast or uterine)
  • undiagnosed vaginal bleeding
  • heart disease.

Possible side effects of MHT

Everyone responds differently to MHT. Some women may not experience any side effects, while others may have:

  • nausea
  • fluid retention
  • bloating
  • breast enlargement and discomfort
  • vaginal bleeding
  • weight gain.

Most symptoms settle within the first three months.

How long do you need to take MHT?

You can take MHT at low doses for as long as you need. Many women have symptoms for around eight years and one in four women have symptoms into their 60s and 70s. The benefits of MHT far outweigh the risks in healthy women within 10 years of reaching menopause.

When using MHT in midlife:

  • start low
  • go slow
  • review often.

It can take around six months to find the right MHT. Once you’ve found an MHT that works for you, it’s important to review it with your doctor each year.

If you have premature menopause, your doctor will prescribe a higher dose of MHT until the age of expected menopause (around 50–52 years).

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Jean Hailes endocrinologist Dr Rosie Worsley talks about menopause, including the benefits and risks of MHT.

Non-hormonal options

Non-hormonal prescription medication

Some women are told they can’t use hormone-based treatments for menopausal symptoms, such as hot flushes and sweats.

Some women don’t want to take MHT and prefer different treatment options, like non-hormonal prescription medications. These medications take around four weeks to be effective.

Antidepressants

Some antidepressants have been shown to relieve hot flushes. For example, venlafaxine, paroxetine, escitalopram and fluoxetine. Side effects may include nausea, dry mouth, hot flushes, sweats and insomnia.

Note: Paroxetine and fluoxetine can reduce the effectiveness of some cancer treatment medications.

Gabapentin

Gabapentin is a medication that prevents seizures and relieves pain for some conditions of the nervous system. It has also been shown to reduce hot flushes. Side effects may include a rash, dizziness and sleepiness, so it should be taken at night.

Clonidine

Clonidine is a medication for high blood pressure and migraines. It has been shown to reduce hot flushes. Side effects may include dry mouth, dizziness and drowsiness.

Natural therapies (complementary medicine and therapies)

Natural therapies are part of complementary medicine and therapies (CMT). Women have commonly used herbs to manage menopausal symptoms and improve their overall quality of life. Herbs may be used to manage symptoms of menopause including hot flushes, night sweats, mood changes, insomnia (sleeplessness), fatigue, sexual dysfunction and vaginal dryness.

The use of herbs in menopause is based on longstanding traditional use, some of which is supported by scientific evidence (e.g. a recent study into the effectiveness of red clover). But more research is needed regarding the effectiveness and safety of some herbal therapies for the management of menopausal symptoms.

The types of herbs used to manage menopausal symptoms include: black cohosh, dong quai, evening primrose, hops, Korean ginseng, linseed (flaxseed), red clover, St John's wort and wild yam. Some herbs are used more specifically for low sex drive (libido), such as tribulus, maca and horny goat weed, whereas others are more commonly used for insomnia, anxiety and fatigue, such as lemon balm, valerian and passionflower.

Herbs or herb mixtures may be dried and combined with boiling water to make teas (infusions or decoctions), concentrated in alcohol and water to make tinctures or extracts, or made into tablets and powders. Herbs can also be used externally as a poultice (herbs made into a paste and applied to the skin) or made into creams and ointments.

Over-the-counter products

There are many complementary and alternative medicine products available over the counter and online, with various formulations of herbs and nutrients for treating the symptoms of menopause. The effectiveness of these preparations can vary greatly due to the combination of herbs used, as well as the quality or amounts of herbs used.

The best way to seek guidance about these herbal remedies is to consult a health practitioner trained in herbal medicine use, such as a herbalist, naturopath or Chinese medicine practitioner.

Learn more about menopause and herbs, including an informative herbal medicine glossary, and scientific evidence where relevant.

Other complementary therapies

Other complementary therapies may help to manage menopausal symptoms, but evidence about their effectiveness is varied.

For example:

  • hypnotherapy
  • mindfulness therapy
  • acupuncture
  • traditional Chinese medicine
  • nutrition.

Pharmacy-compounded hormones (bioidentical hormones)

Some doctors prescribe pharmacy-compounded hormones, which are also known as ‘bioidentical’ hormones. These are mixtures of different hormones made up in compounding pharmacies. The hormones are promoted as ‘natural’ and 'exactly like our own', which is not true.

Pharmacy-compounded preparations can contain oestrogens, progesterone and sometimes other hormones such as testosterone. The preparations are made into capsules, creams, gels, drops (applied to the tongue), lozenges or troches (soft square-shaped tablets) that are sucked inside the cheek.

All hormone therapies are manufactured synthetically. Hormones are only natural when they are in the human body.

Pharmacy-compounded hormones have no government controls or regulations and little or no high-quality research into their safety and effectiveness.

We do not recommend the use of pharmacy-compounded menopause hormone therapy.

Note: in Australia, doctors can prescribe conventional menopause hormone therapies (MHT) that are identical to those hormones made in your body. These products have been thoroughly tested for safety and effectiveness.

It’s important to have a face-to-face meeting with your health practitioner to discuss the risks and benefits of different treatments for menopause.

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Your questions answered

Download our booklet 'Understanding menopause'.

Download more information on menopause

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2022.

Last updated: 08 September 2022 | Last reviewed: 19 August 2022

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