Menopause is a natural and inevitable change in hormones, and the effects can have a profound impact on a woman’s ability to live her normal daily life. Symptoms can vary wildly from person to person; symptoms can include hot flushes, sleep disturbances, depression, anxiety, joint aches and weight gain, to name a few.
Despite this, treatment options for the management of menopause have been limited until fairly recently. Innovation in the menopause space – and women’s health in general, has experienced a period of significant growth in recent years, driven in part by the recognition of research gaps in women’s healthcare.
Menopause, historically a very private and almost taboo chapter of a woman’s life, is currently benefitting from a culture of discussion emerging across media, and open conversations from celebrities like Drew Barrymore, Zoe Foster Blake, and Naomi Watts opining on their experiences with menopause and perimenopause.
Menopause Onset
Menopause begins when a woman has not had a period for 12 months and spontaneous pregnancy is not possible, typically between the ages of 45 and 55. However, menopause is unique to each woman; some women experience menopause later, and some much earlier.
The Chapters of Menopause
Perimenopause
The period of time before a woman experiences menopause, when menopausal symptoms begin. Hormone levels become erratic, causing symptoms such as hot flushes and irregular periods. This phase occurs anywhere from two to ten years before menopause.
Menopause
The point when a woman has gone 12 months without having a period and spontaneous pregnancy is no longer possible. Symptoms are the result of lower hormone levels, and along with the typical symptoms, can also increase the risk of some health issues such as heart disease and osteoporosis.
Postmenopause
Hormone levels are now consistently lower, and while some symptoms may have eased, the increase of other health problems remain.
Medically Induced Menopause
Some kinds of menopause are medically induced, meaning that certain medications and treatments trigger menopause, or temporarily cause menopause to occur. Treatments like surgery, chemotherapy, endometriosis therapies, and some hormone therapies for conditions like endometriosis or breast cancer, can cause medically-induced menopause. Just like natural menopause, every experience is unique, and requires personalised treatment.
Early Onset Menopause
Some women experience menopause prematurely, before the age of 40, though early menopause is considered if the final period occurs between the ages of 40 and 45. Around 8% of women experience early menopause.
Treating Menopause Symptoms
Hormone Therapy (Menopausal Hormone Therapy – MHT)
Menopause Hormone Therapy (MHT) refers to a range of hormone therapies that are used to reduce the symptoms of menopause, and is most likely the most well researched treatment protocol for menopause.
MHT replaces the oestrogen that the body gradually produces less of during menopause. By maintaining the oestrogen levels, MHT can significantly reduce hot flushes, night sweats, sleep disturbance, vaginal dryness, and mood symptoms. It may also help prevent bone loss and reduce the risk of osteoporosis in some women.
MHT is available in several forms; tablets, patches, gels, sprays, and vaginal preparations. For women who still have a uterus, progesterone is usually prescribed alongside oestrogen to protect the uterus lining.
Is MHT Safe?
MHT has been available since the 1940s, but it wasn’t until the 1990s that two of the largest ever studies on HRT use in menopausal women were completed; a clinical randomised trial by US based Women’s Health Initiative, and an observational survey study conducted in the UK called the Million Women Study. Published in the early 2000s, these reports highlighted concerning links between MHT use and an increased risk of breast cancer and heart disease. In light of these studies, many doctors and women abandoned MHT immediately, and the amount of women using MHT fell by 66%.
Over the last 25 years, more research, including further conclusions from the 1990 studies, have led major health bodies including the UK’s National Health Service, to revise their guidance on the use of MHT and its suitability for patients with certain medical histories.
However, an analysis of the US study found that women who used hormone therapy for between five and seven years did not have an increased risk of all-cause, cardiovascular or cancer mortality during an 18-year follow up. While women in their 50s experienced a trend towards a reduced risk of mortality.
The Menopause Alliance of Australia describes MHT as menopause treatment that is not suitable for all women, with a focus on those women with a personal history of breast cancer or undiagnosed abnormal vaginal bleeding, certain kinds of cancers, heart disease, blood clots, stroke or liver disease.
Jean Hailes for Women’s Health, one of Australia’s leading independent women’s health bodies, have outlined a lack of specialised knowledge across many GPs, combined with the unique experiences of menopause patients, the variety of MHT protocols available, and short consultation times, may have led to many women missing out on better menopause symptom management via MHT.
In Australia, around 13% of women aged around 50 are on hormone therapy.
Non-Hormonal Medications
For women who cannot take MHT or prefer not to use hormones, non-hormonal medications may be an option. Certain antidepressants, particularly low-dose SSRIs and SNRIs, have been shown to reduce hot flushes and improve mood symptoms, though they do not address vaginal dryness.
Other medications may be used in specific cases to help manage sleep disturbance or anxiety. However, these treatments do not address hormonal changes directly, though they can be effective in managing specific symptoms.
Vaginal and Urogenital Treatments
Vaginal dryness, discomfort during intercourse, urinary urgency, and recurrent urinary tract infections are common during and after menopause. Local vaginal oestrogen therapy is a low-dose treatment that acts directly on vaginal tissues and is considered very safe for most women, including those who cannot take systemic hormone therapy.
Non-hormonal vaginal moisturisers and lubricants can also help relieve dryness and improve comfort.
Lifestyle and Behavioural Therapies
Lifestyle approaches can also play an important role in managing menopausal symptoms and overall health. Regular physical activity can help reduce hot flushes, improve mood, support bone health, and maintain cardiovascular fitness. Strength training and weight-bearing exercises are particularly important for protecting bones.
Good sleep hygiene, stress management, and maintaining a balanced diet rich in calcium, protein, and essential nutrients can also support wellbeing during menopause. Reducing alcohol, caffeine, and smoking may lessen symptom severity for some women.
Psychological therapies such as cognitive behavioural therapy (CBT) have been shown to be effective in managing hot flushes, sleep disturbance, anxiety, and low mood associated with menopause.
Complementary and Alternative Health Therapies
Many women are exploring the benefits of alternative health therapies to ease some of their menopause symptoms, such as sleep disturbances and anxiety. While studies are still in their infancy, many women have reported using alternative therapies to address mood and anxiety issues, and to alleviate poor, disturbed sleep. Some clinicians also reported that their patients experienced relief for the problematic menopausal symptom of vaginal dryness.
Alternative health therapies can target the body’s psychological systems, which can include:
- Pain Perception
- Body Temperature
- Memory
- Mood
- Hunger
- Stress
- Sleep
- Metabolism
- Immunological Response
- Reproduction
As with MHT and other non-hormone therapies, the results for alternative health treatments vary from person to person.
Bone and Cardiovascular Health Management
The drop in oestrogen during menopause increases the risk of osteoporosis and cardiovascular disease. Management may include bone density screening, calcium and vitamin D supplementation, medications to strengthen bones when needed, and strategies to manage blood pressure, cholesterol, and weight.
Preventive health checks become especially important during this stage of life.
More Choice to Support Bespoke Menopause Management
Women today have more choice than ever when it comes to managing menopause to align with their symptoms, personal health history, and individual preferences. From well-established options such as MHT, non-hormonal medications, local vaginal treatments, lifestyle strategies, and emerging alternative health protocols, menopause care is increasingly personalised and evidence-based.
With the guidance of a trusted healthcare professional, women can explore more options with confidence, ensuring their unique menopause management supports both quality of life now and long-term health into the future.
