The main hormones that change as you approach menopause are oestrogen and progesterone. During perimenopause, the amounts of oestrogen and progesterone made by the ovaries swing up and down, causing menopausal symptoms. After menopause, very little oestrogen or progesterone is produced by the ovaries.

MHT reduces menopausal symptoms by adding back some of the hormones that used to be produced inside your body before menopause.

Oestrogen is the main hormone given to relieve menopausal symptoms. If you’ve had surgery to remove your uterus (a hysterectomy), this might be the only form of MHT you need.

If you still have a uterus, oestrogen and progesterone are used together. Progesterone reduces the risk of endometrial cancer (cancer of the uterus).

Other hormone therapies your doctor might suggest are:

• Tibolone, for low sex drive (libido) and to improve bone health
• Testosterone, for low sex drive (libido).

Your doctor will use your medical history, your family history and your symptoms to suggest the best type of hormonal treatment for you.

Everyone’s experience using MHT is different. You may need to try different dosages or methods to find what works for you. Your doctor can help you manage this process.

Common forms of MHT include:

• pills
• patches
• gel
• vaginal creams
• an intrauterine device (IUD).

For healthy women within 10 years of reaching menopause, the benefits of taking MHT usually outweigh the risks.

For most women, MHT relieves these common menopausal symptoms:

• hot flushes
• night sweats
• vaginal dryness
• sleep.

Reducing hot flushes and night sweats probably also improves other symptoms, like sleep problems, tiredness, depression, anxiety, mood and brain fog.

Some women also report that MHT helps their skin and hair health improve and their aches and pains go away.

For some women, MHT might reduce the risk of developing:

• osteoporosis
• bone fracture
• diabetes
• heart disease.

Like all medicines, MHT has risks and benefits that depend on your personal health, your medical history, your family’s medical history and your symptoms.

There are some risks associated with MHT, which include a slightly higher risk of developing:

• breast cancer
• heart disease.

These risks are higher compared to women who do not use MHT.

Whether these risks apply to you or not will depend on:

• the types of hormones used
• the dose given
• how long the medicine is used for
• how the medicine is given (e.g. patches or tablets)
• when medicine is started
• your own medical history
• your family’s medical history.

You should have a careful discussion with your doctor about whether the possible risks outweigh the benefits of using MHT if you:

• are older than 60
• have been postmenopausal for 10 years or more
• have had cancer or a blood clot or stroke
• have a family history of cancer or blood clots or stroke
• have had vaginal bleeding after menopause
• have heart disease
• suffer from a kidney or liver disease
• suffer from migraine with aura.

Your doctor may advise you not to use MHT if your personal risk is higher than the potential benefit you might get from using hormonal therapies to manage your menopausal symptoms.

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

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

Most side effects settle within the first few months with ongoing treatment.

Many women who start MHT will have new vaginal bleeding, like “re-starting” your menstrual periods. This bleeding usually stops after a couple of months. If you have vaginal bleeding more than 6 months after starting MHT, or vaginal bleeding that becomes heavier or goes for longer than a period, you should go back to see your doctor.

You can take MHT at low doses for as long as you need to manage menopausal symptoms that bother you. Most women have symptoms for about 4 to 5 years after menopause (their final menstrual period). One in 4 women have symptoms into their 60s and 70s.

Some doctors prescribe “bioidentical hormones”. These are mixtures of different hormones made up in compounding pharmacies. These hormones are available as:

• capsules
• creams
• gels
• drops
• lozenges.

Bioidentical hormones are often promoted as “natural” or “tailored”, but these are advertising terms.

Hormones compounded in a pharmacy have:

• few to no checks on safety and quality
• little to no good research into their safety and effectiveness.

The MHT prescribed by doctors in Australia have been thoroughly tested for safety and effectiveness.

Some antidepressants have been shown to reduce hot flushes and night sweats, and also help with mood, anxiety and depression. These medicines include:

• venlafaxine or desvenlafaxine
• paroxetine
• citalopram or escitalopram
• fluoxetine.

These medicines can have side effects, including:

• nausea
• dry mouth
• dizziness
• sleep problems
• sexual problems.

Gabapentin is a medicine that prevents seizures and relieves pain for some conditions of the nervous system. It has also been shown to reduce hot flushes and night sweats.

This medicine should be taken at night as it might have side effects, including:

• dizziness
• sleepiness.

Clonidine is a medicine used to treat high blood pressure. It has also been shown to reduce hot flushes and night sweats.

This medicine should be taken at night as it might have side effects, including:

• dizziness
• sleepiness
• constipation.

Fezolinetant (“Veoza”) and elinzanetant (“Lynkuet”) are medicines that reduce hot flushes and night sweats.

These medicines might be recommended by your doctor if you have had a hormone-positive cancer.

Some evidence suggests that the herb, black cohosh, helps to manage hot flushes.

When the herb St John’s Wort is combined with black cohosh or passionflower, it might reduce hot flushes and improve your mood.

Some research has shown that hops, which contains a strong plant-based oestrogen, might help reduce hot flushes. If you have breast cancer, ask your health practitioner before using hops.

Red clover also contains plant-based oestrogen that might help ease hot flushes and night sweats, but it might be more effective for women after menopause.

Some people use different herbs to help with mood, sleep problems and fatigue. But there’s not enough evidence to prove their effectiveness.

Korean ginseng is commonly used to:

• ease fatigue
• lower stress levels.

It’s one of the most commonly self-prescribed herbs for menopausal symptoms in Australia.

Chamomile is a gentle sedative, and its relaxing action may help to:

• improve sleep
• reduce anxiety.

Hops are traditionally used to treat:

• anxiety
• stress
• poor sleep.

Lemon balm, valerian and passionflower might:

• improve sleep
• reduce anxiety.

St John’s Wort is commonly used for menopausal symptoms such as:

• mild to moderate anxiety
• irritability
• depressed mood.

Talk to your health practitioner before taking St John’s Wort, as it can affect other prescribed medicines.

Black cohosh might be useful for treating vaginal dryness. Ask your health practitioner about black cohosh pessaries and vaginal cream.

Your practitioner might also recommend including linseed (flaxseed) in your diet.

Linseed contains phytoestrogens, which act like oestrogens, to ‘plump up’ vaginal cells.

More studies are needed to prove the effectiveness of these natural remedies.

Try our linseed, banana and date muffin recipe.

Many factors influence your sex drive, including:

• your relationship with your partner
• certain medicines
• health and wellbeing
• body image
• vaginal dryness, which can cause painful sex.

Some evidence suggests Korean ginseng may improve sex drive in menopausal women.

Other herbs used for treating low sex drive include tribulus and maca, but there is limited evidence to prove their effectiveness.

If you’re concerned about having a low sex drive, talk to your doctor. Don’t rely solely on herbs to improve your libido.

Some people use other complementary therapies to help manage hot flushes, sleep problems and anxiety, such as:

acupuncture

hypnotherapy

traditional Chinese medicine

nutrition.

But there is little evidence to prove their effectiveness.