Menopause and Hormone Replacement Therapy in Australia: A Comprehensive Guide

Menopause is a natural stage of life, marking the end of menstrual cycles and fertility. In Australia, around 1.5 million women are navigating perimenopause or menopause at any given time. This transition can bring a wide range of physical and emotional changes, from hot flushes and night sweats to mood swings, sleep problems, and vaginal dryness. These symptoms can significantly impact daily life, leading many women to seek treatment options, including hormone replacement therapy (HRT) Australia.

HRT can help manage menopausal symptoms and support bone health, but it also carries potential risks, such as a small increase in breast cancer or blood clot risk in certain women. In Australia, hormone replacement therapy remains an evidence based option for women seeking relief.

The decision to use HRT is personal and should always be made with expert medical guidance. This article provides an evidence-based overview of menopause and hormone therapy in Australia, helping women make informed choices about what to discuss in consultation with their doctor.

At Medmate, our award winning Australian telehealth platform offers access to experienced doctors — many specialising in women’s health — available 24/7 for confidential, personalised care.

Understanding Menopause and Perimenopause

• Menopause: The final menstrual period, confirmed after 12 months without menstruation (no more periods).

• Perimenopause: The transitional phase leading up to menopause, lasting on average 4–8 years (periods become irregular).

• Postmenopause: The years after menopause.

Age of Onset

• The median age of menopause in Australia is 51 years.

• Early menopause occurs between 40–45 years.

• Premature ovarian insufficiency (POI) is menopause before age 40.

Prevalence of Symptoms

• Around 75% of women experience symptoms.

• About 1 in 4 report moderate to severe symptoms.

• Symptoms may persist for 7–10 years.

Common Symptoms

• Vasomotor: hot flushes, night sweats.

• Urogenital: vaginal dryness, painful intercourse, urinary frequency or incontinence.

• Sleep disturbance.

• Psychological: anxiety, depression, memory changes.

• Physical: joint pain, breast pain, central weight gain, reduced libido.

Important: Any postmenopausal bleeding must be investigated by a doctor.

Diagnosing Menopause

Most diagnoses are clinical — based on symptoms and age.

• Women aged 45–55 years with irregular cycles and menopausal symptoms usually don’t require blood tests.

• Hormone testing may be useful for:

  • Younger women with suspected POI.

  • Women with unclear menstrual patterns e.g., after hysterectomy (surgical removal of the womb) or on certain contraceptives (birth control medications).

• Anti-Müllerian hormone (AMH) testing is not routinely recommended.

Management of Menopause

The goals are:

1. Relieve symptoms.

2. Prevent osteoporosis.

3. Support overall health and quality of life.

Systemic Menopausal Hormone Therapy (MHT)

• Estrogen-only therapy: suitable for women without a uterus (womb).

• Combined therapy: estrogen plus progestogen, recommended for women with a uterus to protect the lining.

• Other forms: tibolone, or estrogen combined with selective agents.

Delivery methods include tablets, patches, gels, and vaginal preparations. Transdermal (through the skin) options may be safer for women at higher risk of blood clots.

Intravaginal Estrogen

• Best for localised symptoms such as vaginal dryness or recurrent urinary tract infections.

• Minimal systemic absorption, making it suitable for many women who cannot use systemic therapy.

Alternatives to HRT

For women who cannot or choose not to use HRT, several alternatives can help manage menopausal symptoms:

Lifestyle changes: Regular exercise, a balanced diet, stress management, and limiting alcohol or caffeine can reduce symptom severity.

Nonhormonal medications:

• • Antidepressants (e.g., SSRIs, SNRIs) or gabapentin can help with hot flushes, sleep, and mood disturbances. SSRIs and SNRIs may also aid in managing perimenopausal depression.

  • Medications for urinary symptoms (e.g., for stress or urge incontinence).

Complementary therapies: Options like acupuncture or cognitive behavioural therapy (CBT) may reduce hot flushes, though evidence is mixed.

For specific guidance on related symptoms, see:

• Low libido in females

• Sexual pain in females

• Orgasm difficulties in females

• Anxiety disorders and depression (perimenopausal women are at higher risk of depression).

Midlife Health Screening

Menopause is an opportune time to assess and screen for age-related health conditions. A general health check is recommended for all women seeking medical advice about menopause, including cardiovascular disease risk screening, regular breast and cervical screenings, as per Australian guidelines.

Benefits of HRT

Symptom relief: may be an effective treatment for hot flushes, night sweats, and sleep disruption.

Bone health: helps maintain bone density and reduces fracture risk, especially in early menopause or POI.

Vaginal and urinary health: improves dryness, discomfort, and may reduce infections.

Emotional well-being: may improve mood, concentration, and quality of life by reducing disruptive symptoms.

Risks and Considerations

While HRT may provide symptom relief, it’s not without risks. The decision to start HRT should always involve a thorough discussion with a healthcare provider to weigh individual risks against benefits.

Breast Cancer Risk

Long-term use of combined HRT (oestrogen plus progestogen) for more than five years may slightly increase breast cancer risk. Studies, such as those from the Women’s Health Initiative, suggest the risk is small and varies by HRT type, dose, and duration. Oestrogen-only therapy (for women without a uterus) may pose a lower risk.

Blood Clots and Stroke

Oral HRT slightly increases the risk of blood clots (e.g., deep vein thrombosis) and stroke, particularly in women with risk factors like smoking, obesity, or a history of clotting disorders. Transdermal options (patches or gels) are associated with a lower risk.

Heart Health

The impact of HRT on heart disease is nuanced. Starting HRT within 10 years of menopause (the “timing hypothesis”) may offer cardiovascular benefits for some women, while initiating it later may increase risks. In women with  early menopause, systemic HRT may be beneficial for primary prevention of cardiovascular disease.

Side Effects

Common side effects include breast tenderness, bloating, nausea, or irregular bleeding, especially during the first few months. These often subside, but persistent issues should be discussed with your doctor to adjust treatment.

Who is HRT Suitable For?

HRT is not a universal solution, but it may be beneficial for certain groups:

• Women with moderate to severe menopausal symptoms disrupting daily life, work, or relationships.

• Women in early menopause (before age 45) or with premature ovarian insufficiency (before age 40), who may need HRT to manage symptoms and protect against cardiovascular disease and osteoporosis.

• Women at risk of osteoporosis who cannot tolerate other bone-protective treatments.

Who Should Avoid HRT?

HRT may not be suitable for women with:

• A history of breast or endometrial cancer.

• Previous blood clots, stroke, acute myocardial infarction (heart attack), or certain cardiovascular conditions.

• Active liver disease.

• Unexplained vaginal bleeding.

• Systemic lupus erythematosus (SLE) or other conditions where HRT is contraindicated.

A detailed medical history is essential to determine eligibility. Medmate’s doctors can guide you through this process with personalised assessments.

Accessing HRT in Australia

HRT is prescription-only in Australia, requiring a consultation with a healthcare provider. The process typically involves:

Assessment: A doctor evaluates your symptoms, medical history, and risk factors.

Prescription: If HRT is suitable, an electronic prescription can be sent to you or your preferred pharmacy.

Follow-up: Regular check-ins ensure the treatment remains safe.

What to Expect During a Medmate Consultation

Booking a telehealth appointment with Medmate is simple and tailored to your needs:

In-Depth Assessment: Your doctor will explore your symptoms, medical history, and lifestyle to understand your unique needs.

Clear Guidance: You’ll receive detailed explanations of HRT, nonhormonal options, and potential risks and benefits.

Collaborative Decision-Making: Ask questions and discuss concerns to make a confident, informed choice.

Ongoing Support: Medmate provides follow-up care to monitor progress, adjust treatments, and address any side effects.

Practical Tips for Navigating Menopause

• Track symptoms in a diary.

• Prepare questions for your doctor.

• Expect adjustments in therapy — finding the right dose takes time.

• Stay proactive with health checks and screenings.

• Prioritise self-care through diet, exercise, and stress management.

Frequently Asked Questions

How long can I use HRT?
Duration varies. Short-term use (1–5 years) is common for symptom relief, but some women, especially those in early menopause or with early menopause, may benefit from longer use with regular medical supervision.

Does HRT cause weight gain?
Menopause-related hormonal changes can contribute to weight gain, but HRT itself is not a direct cause. Lifestyle factors like diet and exercise have a greater impact.

Can I stop HRT suddenly?
Gradual tapering is recommended to minimise symptom recurrence. Your doctor will provide a tailored plan.

Is HRT safe after a hysterectomy?
Women without a uterus often require oestrogen-only HRT, which may have a different risk profile. Consult your doctor for personalised advice.

Key Takeaways

• Menopause is a natural life stage, but symptoms can be challenging.

• HRT is an evidenced based treatment for many women, but not suitable for all.

• Non-hormonal options and lifestyle changes also play an important role.

• Decisions about HRT should always be made with a doctor, balancing benefits and risks.

• Medmate provides 24/7 access to Australian doctors, ensuring safe, confidential, and personalised care.

How Medmate Can Support You

Menopause is a natural phase, but it doesn’t have to mean discomfort or disruption. Medmate’s award winning service connects you with compassionate, experienced Australian doctors and nurses who prioritise your well-being. Whether you’re exploring hormone replacement therapy in Australia or seeking alternative solutions, we’re here to guide you every step of the way.

Book a confidential online consultation today and take the next step toward managing menopause with the right information.

Disclaimer: This blog is for informational purposes only and does not replace professional medical advice. Always consult a qualified healthcare provider before starting or changing treatments.