MAIN POINTS

• Many of the myths about MHT come from the Women’s Health Initiative (WHI) studies of 2002 and 2004. New information about MHT means doctors better understand the risks and benefits of MHT.
• MHT is the best way to control menopausal symptoms and gives some women health benefits.
• Combined MHT (oestrogen plus progestogen) or oestrogen alone cause no significant increase in breast cancer or heart disease risk in women aged 50 to 59 or in women who start treatment within 10 years of menopause. 

9 myths and misunderstandings about Menopausal Hormone Therapy (MHT)90.28 KB

Menopausal Hormonal Therapy (MHT) is the best treatment to improve hot flushes and quality of life for menopausal women. In the early 2000s, the Women’s Health Initiative (WHI) studies of postmenopausal women caused confusion among women, the media and doctors. New information about MHT and the WHI studies means doctors better understand the risks and benefits of MHT.

1. Misunderstanding – MHT will make you put on weight

Women who use MHT do not gain any more weight than women who do not use MHT. Ageing, social, lifestyle and medical factors are the main causes of midlife weight gain. The hormonal changes of menopause do cause fat to move from the hips to the abdomen.

2. Myth – Breast cancer is the most common cause of death in postmenopausal women

Fear of breast cancer is a major reason why women do not use MHT. Many postmenopausal women believe they are more likely to die from breast cancer than heart disease or stroke. The opposite is true. For example, in Australia in 2014, 12 in every 100 women died from coronary heart disease, nine in 100 from stroke and four in 100 from breast cancer.

3. Misunderstanding – One-quarter of women who take MHT get breast cancer

This misunderstanding came about because some journalists incorrectly reported the early WHI study results. New information combined with better understanding suggests that:

• Five years taking combined MHT (oestrogen plus progestogen) did not increase breast cancer risk in women aged 50 to 59 or in women who started treatment within 10 years of menopause. After 13 years, women had a small increase in breast cancer risk (nine extra cases of breast cancer per 10,000 women)
• Seven years taking oestrogen only MHT did not increase breast cancer risk in women aged 50 to 59 or in women who started treatment within 10 years of menopause. After 13 years, there was still no increased risk of breast cancer.

4. Misunderstanding – MHT increases the risk of heart disease

An analysis of all studies (40,410 women) showed MHT did not increase the number of deaths from heart and blood vessel disease or heart attacks. MHT also did not increase the number of cases of angina in healthy women or in women with pre-existing heart and blood vessel disease.

5. Myth – A blood test is necessary to diagnose menopause

Blood tests for hormone levels and other tests are not needed to diagnose menopause. A woman is considered postmenopausal when she is over the age of forty-five and has had at least 12 months without a period. Blood tests can be helpful for women who are younger than forty years of age or who have had a hysterectomy and have menopausal symptoms.

6. Myth – Complementary medicines and therapies are as effective as MHT and safer

MHT remains the most effective way to control menopausal symptoms. Some complementary medicines and therapies are promoted as natural and safe without evidence that they work. Some products (such as soy) should be avoided if you are unable to take prescribed MHT for safety reasons. Often there is no way to know if complementary therapies are safe or uncontaminated, especially if they are bought online. Speak with your doctor about complementary medicines or therapies. They might not be suitable for your situation.

7. Myth – Compounded bioidentical hormone therapy is safer than conventional MHT

Doctors advise against the use of compounded bioidentical hormone therapy. “Bioidentical hormones” are chemically the same as those produced by the body. Some MHTs prescribed by your doctor are “bioidentical”. There is no evidence that compounded bioidentical hormone therapy is better than prescribed MHT.

Compounded bioidentical hormone therapy offers no advantages and many disadvantages because there are:

• no regulations for their use
• no standards for quality of manufacturing
• no testing of the products for negative effects, quality or safety.
• serious side effects such as endometrial cancer
• possible higher costs

8. Misunderstanding – All progestogens have the same risks

Therapy combining progestogens and oestrogen is used to reduce the risk of cancer of the uterus in women who still have a uterus. Progestogen is a term that covers both progesterone (naturally occurring in humans) and progestins (synthetic progesterones). Different types of progestogens have different risks. Your doctor can discuss the different MHT options available and work with you to reduce your risk.

9. Misunderstanding – Non-hormonal medications are as effective as MHT for hot flushes

Evidence suggests non-hormonal treatments are not as effective as MHT, although more studies are needed. You should ask your doctor about non-hormonal treatment options if you are not able to use MHT for medical reasons or you do not want to use MHT.

Where can you find information about MHT and other treatment options?

If your symptoms are bothering you, your doctor can help. Other AMS fact sheets about treatment options include:

• What is Menopausal Hormone Therapy (MHT) and is it safe?
• Non-hormonal treatment options for menopausal symptoms
• Complementary medicine options for menopausal symptoms
• Lifestyle and behaviour changes for menopausal symptoms.

Information for your doctor to read includes AMS Information Sheets:

• Risks and benefits of MHT/HRT
• Non-hormonal treatments for menopausal symptoms
• Lifestyle and behavioural modifications for menopausal symptoms
• Complementary and herbal therapies for hot flushes

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2018

MAIN POINTS

• Many women wonder if lifestyle and behaviour changes can help with menopausal symptoms.
• Studies have shown mixed results for lifestyle changes, so speak with your doctor if you have any questions.
• Maintaining healthy weight might be helpful as there is evidence that weight gain can increase the severity of menopausal symptoms
• Some evidence suggests yoga can help menopausal symptoms. Other activities such as exercising, breathing and relaxation practices or controlling environmental temperature might not necessarily help your symptoms, but they can help with your overall sense of wellbeing.
• Cognitive behaviour therapy (CBT) can improve wellbeing and decrease the impact of menopausal symptoms.
• Hypnosis might give you some benefit, but there is no evidence that acupuncture, magnetic therapy, reflexology or chiropractic  interventions help menopausal symptoms.

AMS Lifestyle and behaviour changes for menopausal symptoms92.27 KB

Many women are interested in the potential of lifestyle and behaviour changes to manage their menopausal symptoms. Unfortunately, the clinical evidence for the effectiveness of lifestyle changes is mixed and limited.

If your symptoms are bothering you, your doctor can explain how specific lifestyle changes might suit your situation. Everyone should consult their doctor before embarking  on lifestyle and behaviour changes  and this is especially important  if you have menopausal symptoms.

Lifestyle changes

Maintain healthy weight

Women often ask their doctors about menopause and weight gain. It is a myth that menopause causes weight gain and in fact the opposite is true- evidence suggests  that weight gain can make your menopausal symptoms worse.

Ask your doctor for exercise and dietary advice to suit your situation.  General principles  of a healthy diet include consuming:

• 6300 to 6700 kJ (1500 to 1600 calories) per day to maintain weight
• 5450 to 5900 kJ (1300 to 1400 calories) per day to lose weight
• three main meals and two protein-containing snacks per day
• smaller portions
• more oily fish such as salmon, trout, sardines, mackerel
• less meat
• less fat and sugar.

Exercise regularly

Exercise may not directly help your hot flushes and night sweats, but it can help to maintain healthy weight and this can decrease the severity of your symptoms.

Exercise has many mental and physical benefits and builds more muscle mass.  This extra muscle burns more energy even when you are resting. Exercise can also help reduce the risk of osteoporosis, a possibility for some menopausal women.

You will get the best benefit if you incorporate three types of movement into your day:

• aerobic activity for heart health - climbing stairs, walking the dog and gardening all help to build more movement into your day
• flexibility training such as stretching, yoga or pilates improve both flexibility and balance
• strength training helps to build bone and muscle and can include simple body weight  exercises you can do at home. Get advice from your doctor before lifting heavy weights.

Everyone should visit their doctor before starting a new exercise program. For more ideas about exercise, see the AMS information sheet Lifestyle advice for healthy ageing.

Control your environment to improve cooling

Common sense changes to your environment  can help to make you more comfortable, even if such changes do not directly decrease your symptoms.

Changes  you can make include:

•  adjusting clothing
  • dress in layers
  • wear sleeveless blouses or tops
  • wear clothing made of natural fibres that breathe
  • avoid jumpers and scarves
• using a hand fan or electric fan as required
• keeping cooler at night
  • lower the room temperature
  • put a cold pack under the pillow
  • turn the pillow over to the cool side when feeling warm
  • use dual control electric blankets
  • use a bed fan that blows air between the sheets
• drinking cool liquids such as iced water.

Avoid hot flush triggers

If you have noticed that some triggers can increase the frequency or severity of your hot flushes and night sweats, avoiding these triggers might help.

Triggers include:

• spicy foods
• smoking - a risk factor for hot flushes
• alcohol -can trigger hot flushes and you might find your flushes improve if you avoid alcohol

Mind- and body-based therapies and practices

Cognitive behaviour  therapy

Group and individual cognitive behaviour therapy (CB1) can help you to change unhelpful ways of thinking, feeling and behaving. Studies suggest  CBT can help you cope  with the impact  of menopausal symptoms while also increasing your wellbeing.

Yoga, breathing  practices and relaxation

While all of these practices  can help with wellbeing,  only yoga has been shown in some studies to improve menopausal symptoms and sleep.

Other therapies

Hypnosis

Studies have shown varied results, but a recent trial suggested that hypnosis might help with hot flushes and sleep.

Acupuncture

A large Australian trial recently showed that acupuncture has no benefit for menopausal symptoms.

Magnetic therapy,  reflexology, chiropractic interventions

Studies have not shown that any of these therapies help women with menopausal symptoms.

What are the other treatment  options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes  in your body  and offer options for managing your symptoms. Other treatment  options include:

• Menopausal Hormone Therapy (See AMS fact sheet - What is MHT and is it safe?)
• Complementary therapies (See AMS fact sheet­ Complementary medicine options for menopausal symptoms)
• Non-hormonal prescribed medications (See AMS fact sheet ­Non-hormonal  treatment options for menopausal symptoms).
• Cognitive behavioural therapy for menopausal symptoms (see https://www.womens-health-concern.org).

Information for your doctor to read includes AMS Information Sheets:

• Combined menopausal hormone therapy
• Oestrogen only menopausal hormone therapy
• Non hormonal treatments for menopausal symptoms
• Complementary and herbal therapies for hot flushes

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2018

AMS Vaginal health after breast cancer - patient guide366.94 KB

• Women who have had breast cancer treatment before menopause might find they develop symptoms such as hot flushes, night sweats, joint aches and vaginal dryness.
• These are symptoms of low oestrogen, which occur naturally with age, but may also occur in younger women undergoing treatment for breast cancer. These changes are called the genito-urinary syndrome of menopause (GSM), which was previously known as atrophic vaginitis.
• Unlike some menopausal symptoms, such as hot flushes, which may go away as time passes, vaginal dryness, discomfort with intercourse and changes in sexual function often persist and may get worse with time.
• The increased use of adjuvant treatments (medications that are used after surgery/chemotherapy/radiotherapy), which evidence shows reduce the risk of the cancer recurring, unfortunately leads to more side-effects.
• Your health and comfort are important, so don't be embarrassed about raising these issues with your doctor.
• This Information Sheet offers some advice for what you can do to maintain the health of your vagina, your vulva (the external genitals) and your urethra (outlet from the bladder), with special attention to the needs of women who have had breast cancer treatment.

Why is oestrogen important for vaginal health?

• The vaginal area needs adequate levels of oestrogen to maintain healthy tissue.
• The vagina's lining responds to oestrogen which keeps the walls thick and elastic.
• When the amount of oestrogen in the body decreases this is commonly associated with dryness of the vulva and vagina.
• Before menopause the vagina is acidic but after menopause the acidity (pH) changes and this may affect the resistance of the vagina and bladder to infection.
• The vulval area also changes with ageing, as fatty tissue reduces and the labia majora (outer lips of the vagina) and the hood of skin covering the clitoris may contract. If sensitive areas become more exposed, chafing can occur.
• Pelvic floor muscles become weaker and urination may become more frequent and difficult to control.

What symptoms occur with changes in vaginal health?

• Irritation, burning, itching, chafing, or other discomfort.
• Dryness due to decreased vaginal secretions, which may also mean sexual intercourse becomes uncomfortable or painful.
• Light bleeding, because the vagina may injure more easily. Any vaginal bleeding needs to be investigated by your medical practitioner.
• Inflammation, known as atrophic vaginitis, which can lead to pain on urination and infection.
• Persistent, smelly discharge caused by increased vaginal alkalinity (higher pH) which is sometimes mistaken for thrush. Any vaginal discharge needs to be investigated by your medical practitioner.

How are these symptoms related to my breast cancer treatment?

• Chemotherapy: women can develop vulvar and vaginal burning due to inflammation. These are similar to the changes that occur in the lining of the mouth and gastrointestinal tract.
• Tamoxifen: the effects of this medication are variable; some pre-menopausal women note dryness due to the effect of tamoxifen blocking oestrogen in the lining of the vagina while others experience more vaginal discharge. In post-menopausal women, who already have lower levels of oestrogen, the change may be less marked.
• Aromatase inhibitors (post-menopausal women with oestrogen receptor-positive breast cancer are often treated with these drugs – anastrozole (Arimidex®), letrozole (Femara®), or exemestane (Aromasin®)): studies have shown more vaginal symptoms with aromatase inhibitor-only treatment than with tamoxifen-only treatment.
• Raloxifene: this drug (Evista®) originally approved for treatment of osteoporosis, has been approved for breast cancer risk reduction since 2007. In post-menopausal women it has not been associated with adverse vaginal symptoms and does not affect sexual function. There is no good evidence about raloxifene's effects in pre-menopausal women.

How can I minimise irritation to the vagina?

• Wear underwear made of natural fibres such as cotton and change underwear daily. Consider going without underwear when possible e.g. going to bed.
• Avoid, or at least limit, time spent wearing tight-fitting underwear, pantyhose/tights, jeans or trousers as this may lead to sweating. Also limit time in a damp or wet swimming costume or exercise clothing.
• Wash clothing with non-perfumed or low-allergenic washing products. Avoid use of fabric softeners. Consider second-rinsing if symptoms persist.
• Avoid use of feminine hygiene sprays and douching. Avoid pads, tampons and toilet paper which are scented.
• Avoid shaving or waxing the genital area, particularly if irritation is present.
• Gently wash skin of the genital area only with plain water. Or, use soap alternatives such as Cetaphil®, QV wash®, or Dermaveen® and avoid soap, liquid soap, bubble bath and shower gels. Always pat dry (don't rub).
• You can continue to be sexually active and in fact it may improve your symptoms. Sexual activities, whether with a partner or masturbation, improve blood flow and help maintain healthy tissue. Consider using a vaginal lubricant or moisturiser (see What treatments are available? below).
• Practice safe sex in new relationships, in order to reduce sexually transmitted infections (STIs).
• Quit smoking. Smoking increases atrophy by decreasing blood flow to the genital area and directly affecting vaginal cells, as well as threatening your overall health.

What treatments are available?

• Cool washes or compresses may help itching and mild discomfort. Dissolve half a teaspoon of bicarbonate of soda in 1 litre of water and apply gently with a cloth a few times a day. Softly pat dry. Avoid scratching and keep the genital area cool and dry. See your doctor if symptoms persist or if they get worse with this treatment.
• Vaginal moisturisers can temporarily increase the water content of the vaginal cells. Ask your doctor or pharmacist about available products.
• Water or silicone based vaginal lubricants may reduce friction and make intercourse more comfortable. Some products containing alcohol/preservatives may cause irritation. Water-based or silicone-based lubricants can be used safely with latex condoms. However oil-based lubricants should never be used with latex condoms.
• Natural oils (such as sweet almond or avocado oil) may help, but some oils and creams (such as tea-tree oil and paw-paw ointment) can cause contact dermatitis, increasing itchiness and discomfort.
• Vitamin E, either taken orally or applied topically (as ointment) can reduce symptoms.
• Phyto-oestrogens are used by some women but there is a lack of evidence for their effectiveness and safety, and they are not recommended for women who have had breast cancer.
• Pelvic floor relaxation exercises may help and seeing a pelvic floor physiotherapist who may offer advice on the exercises and techniques to make penetration during intercourse easier.

Sexual issues after breast cancer treatment

Sexual problems occur in many women who have had treatment for breast cancer, and you may feel the need to obtain professional help for these difficulties.

Here are some things that might assist:

• Many women benefit from the advice of a physiotherapist who specialises in treatment of the pelvic floor.
• A physiotherapist can recommend techniques for overcoming sexual problems. Using several techniques together (such as relaxation, massage, pelvic exercises and lubricants) can be helpful.
• Tiredness is often a consequence of therapy and a 'turn off' when it comes to sex. Ensure that you have adequate rest, including some mid-day rest if necessary, and try to enlist relatives or friends to help with housework and child-minding.
• Ask your GP about counsellors who specialise in helping people who are experiencing problems in their sexual relationship.

Prescription treatments for vaginal health

• Oral or patch oestrogen or progestogen therapy is not recommended for breast cancer survivors because these hormones may increase the risk of a new breast cancer or cancer recurrence. Tibolone (Livial®) is also not recommended because it has been shown to increase the risk of breast cancer recurrence.
• Vaginal oestrogen, which comes in the form of pessaries or creams inserted with an applicator, may sometimes be recommended because it mainly acts locally, but some oestrogens are also absorbed into the circulation. This decision needs careful consideration.
• Some treatments for breast cancer, such as aromatase inhibitors, are designed to reduce the amount of oestrogen in the body as much as possible. Using vaginal oestrogens may increase the oestrogen in the body, and potentially reduce the benefits of using the aromatase inhibitor. Although no studies have shown that using vaginal oestrogen is more likely to lead to breast cancer recurrence, many oncologists are reluctant to advise women to use vaginal oestrogen after breast cancer. Tamoxifen works differently from aromatase inhibitors and acts like oestrogen in some tissues and blocks it in others. For this reason, oncologists may be more willing to consider vaginal oestrogen use in tamoxifen users compared to aromatase inhibitor users.
• For women with problematic vaginal dryness, it is essential to discuss management options with your oncologist or breast cancer specialist as quality of life issues are considered as part of your overall treatment.

Further reading

1. Portman, D. J., & Gass, M. L. (2014). Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Journal of The Sexual Medicine.
2. Wills, S., Ravipati, A., Venuturumilli, P., Kresge, C., Folkerd, E., Dowsett, M., Hayes, D.F., Decker, D. A. (2012). Effects of vaginal estrogens on serum estradiol levels in postmenopausal breast cancer survivors and women at risk of breast cancer taking an aromatase inhibitor or a selective estrogen receptor modulator. Journal of Oncology Practice, 8(3), 14144-14148.
3. THE INTERNATIONAL SOCIETY FOR THE STUDY OF VULVOVAGINAL DISEASE for patient education

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Fact Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2018

MAIN POINTS

• If your sex life is good before menopause, it is likely to remain good after menopause.
• Sexual wellbeing is complex and many other personal factors in your life could be involved.
• Vaginal dryness can be treated with creams and lubricant.
• Hormonal treatments include oestrogen or testosterone therapy but only use testosterone designed for women.
• Your doctor, a pelvic health physiotherapist or a counsellor may need to work with you to look at the many factors that might be affecting your sexual wellbeing.

AMS Will menopause affect my sex life? 100.03 KB

If your sexual wellbeing is good before menopause, it is likely to remain good after menopause. Although the hormonal changes of menopause can affect some women’s sex lives, sexual wellbeing is often a complex issue involving matters that both you and your partner are experiencing.

Changes in your sexual wellbeing might include:

• lack of interest in sex (low libido)
• difficulty becoming aroused
• difficulty having an orgasm
• vaginal pain during intercourse because of vaginal dryness or pelvic floor muscle problems.

Before you assume that changes in hormone levels are causing any issues, it is important to remember that many other factors could also be affecting your sex life. These include:

• feeling less attractive to your partner
• feeling stressed in your personal life –juggling looking after children, parents, finances or your partner
• having little free time to spend with your partner
• having a partner experiencing their own sexual changes
• taking medications affecting sexual function –for example, antidepressants
• having medical conditions affecting sexual function – gynaecological surgery can cause vaginal pain or affect your ability to become aroused.

It is important to look at all aspects of your sexual health and wellbeing.

If you are experiencing problems, a doctor or counsellor will be able to help you explore issues that are affecting your sex life. Your doctor can explain whether hormonal therapies can help your sex life or if you or your partner need some other help such as counselling or referral to a pelvic health physiotherapist for pelvic floor muscle problems.

Vaginal dryness

Many women experience vaginal dryness because of lower oestrogen and this can make sexual activity uncomfortable or painful. This can be a particular problem for women with breast cancer treated with aromatase inhibitors.

Speak with your doctor, as this can be treated with:

• vaginal oestrogen therapy
• non-hormonal vaginal moisturisers
• lubricant during sex.

Testosterone therapy may improve sexual function in some women

Women’s bodies naturally make testosterone throughout their lives, although they have only one-tenth of the testosterone level of men. Testosterone levels gradually decrease with age, but do not change dramatically because of menopause unless you have entered menopause because of surgery or chemotherapy. In women, testosterone is converted to oestrogen and may also be important in sexual function, bone strength, muscle strength and other body functions. Some studies have suggested that testosterone treatment can improve sexual function in some women. However, the safety and effectiveness of testosterone therapy in women with breast cancer is not known.

Oestrogen tablets and sexual function

Oestrogen tablets can cause testosterone in your blood to become less biologically active and so affect your sex life. If your doctor thinks this might be the case, they can try switching you to an oestrogen gel or patch. This can help testosterone in your blood to become more active and improve sexual function.

DHEA

DHEA (dehydroepiandrosterone) is a hormone that your body produces and then converts to testosterone and oestrogen. For this reason, some people think that DHEA supplements can improve sexual function or have an ‘anti-ageing’ effect. But many studies have failed to find any proof that DHEA can help with menopausal symptoms or sexual function problems except for vaginal dryness. A DHEA vaginal preparation has recently been approved in the USA for vaginal dryness but it is not yet available in Australia/ New Zealand. The Australasian Menopause Society does not recommend other DHEA preparations for women or men.

Where can you find information about treatment options?

If you are worried about your sex life or your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your health and any symptoms. Other AMS fact sheets (www.menopause.org.au) about treatment options include:

• Menopausal Hormone Therapy or Hormone Replacement Therapy (What is MHT and is it safe?)
• Non-hormonal treatment options (Non-hormonal treatments for menopausal symptoms)
• Lifestyle changes and menopause (Lifestyle and behaviour changes to manage menopausal symptoms)

Information for your doctor to read includes AMS Information Sheets:

• Lifestyle and behaviour modifications for menopausal symptoms
• Vulvovaginal symptoms after menopause
• Sexual difficulties in the menopause
• Vaginal health after breast cancer: a guide for patients

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated August 2018

MAIN POINTS

• Complementary medicine is used to describe a wide range of healthcare medicines, therapies (forms of treatment that do not involve medicines) and other products that are not generally considered as part of conventional medicine.
• Some complementary medicines may help with mild symptoms, but there is little evidence that many popular complementary medicines help with symptoms or are safe.
• Speak with your doctor before using complementary medicine because it might affect other medications.
• Avoid buying online products – their safety cannot be guaranteed.
• You should not use soy/phytoestrogen products if you can’t take prescribed hormone therapy for safety reasons such as breast cancer.
• Bioidentical compounded hormone therapy cannot be recommended because their safety is unknown.
• No complementary medicine is as effective as oestrogen therapy for menopausal symptoms.

Download:

Colour version AMS Complementary medicine options for menopausal symptoms84.7 KB 

Black and white print version  AMS Complementary medicine options for menopausal symptoms BW85.2 KB

The term complementary medicine (CM) is used to describe a wide range of healthcare medicines, therapies (forms of treatment that do not involve medicines) and other products that are not generally considered as part of conventional medicine (National Health and Medical Research Council). Some women think about using CM to manage their menopausal symptoms because they do not want to use prescribed medications or are unable to use them. If you are thinking about using CM, ask your doctor if it will affect other medications you might be taking. Some CM are promoted as natural and safe with little evidence the therapy works. Often there is no way to know if CM are safe or uncontaminated, especially if bought online. Your doctor can help you to understand the benefits and risks of a CM. The table provides a summary of commonly used CM for menopausal symptoms.

The traffic light colours indicate:

Red - Do not use (insufficient evidence that it works and/or safety concerns)

Orange - Use with caution (may work but safety concerns)

Green - OK to use (some evidence that it works and safe for most women)

* Rec'n = Recommendation

Information obtained from the Cancer Australia website (https://canceraustralia.gov.au/publications-and-resources/clinical-practice-guidelines/menopausal-guidelines) and the North American Menopause Society (Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society).

For further information about CM see the following websites:

• National Center for Complementary and Integrative Health (www.nccih.nih.gov)
• Better Health Channel (www.betterhealth.vic.gov.au/conditionsandtreatment/complementary-and-alternative-care)
• National Institute of Complementary Medicine (www.nicm.edu.au/health_information/therapeutic_outlines)

The AMS website also has fact sheets for information about other treatment options. For any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Member service on the AMS website. 

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated January 2018

MAIN POINTS

• MHT (also known as Hormone Replacement Therapy or HRT) covers a range of hormonal treatments that can reduce menopausal symptoms.
• MHT is the most effective way to control menopausal symptoms while also giving other health benefits.
• MHT is safe to use for most women in their 50s or for the first 10 years after the onset of menopause.
• The added risk for blood clots, stroke and breast cancer while taking MHT is very small, and similar to that for many other risk factors such as being overweight.
• Different types of MHT are associated with different risks. Your doctor can work with you to reduce your risk by using different hormonal treatment options.

Download Fact Sheet What is Menopausal Hormone Therapy (MHT) and is it safe?93.67 KB 

Download Infographic What is Menopausal Hormone Therapy (MHT) and is it safe?908.66 KB 

At menopause, a decrease in oestrogen levels can cause symptoms such as hot flushes, vaginal dryness, mood and sleep changes. If your symptoms are bothering you and you would like to know more about MHT, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms.

Menopausal Hormone Treatment or MHT (also known as Hormone Replacement Therapy or HRT) is the most effective way of improving menopausal symptoms. MHT can also benefit your health by improving bone density and reducing the risk of fractures. MHT may also reduce the risk of a fracture and heart disease for some women. If you have had hormone-dependent cancer, you should not take hormone therapies. Speak with your doctor about other non-hormonal prescription medications.

Types of MHT (HRT)

MHT is available as tablets, patches, gels or vaginal treatments. The type of MHT needed and the associated risks varies according to:

• your age
• whether you have had a hysterectomy
• whether you have other health conditions.

Your doctor can tailor the type of hormone treatment best suited to you. If you had an early menopause you should continue treatment at least until the average age of menopause (51 years).

Oestrogen plus progestogen

If you still have your uterus (have not had a hysterectomy), then you need a treatment that combines oestrogen and progestogen. Progestogens (including norethisterone, medroxyprogester , one dydrogesterone and micronized progesterone) are added to the treatment to reduce the risk of cancer of the uterus. Safety facts:

• Does not cause weight gain
• Blood clots – patches and gels have minimal or no risk. When using tablets the risk doubles, but is still very low (1 extra case per 1,000 women).
• Heart disease – no increased risk if MHT begins within 10 years of onset of menopause or before the age of 60.
• Breast cancer - overall 1 in 8 women will develop breast cancer during her lifetime. The added risk of breast cancer with MHT is very small. The risk increases the longer you take MHT and decreases after stopping. Using a different progestogen may reduce the risk.
• Stroke – no increased risk for women without underlying stroke risk factors who are in their 50s or during the first 10 years of menopause. Women with risk factors can probably safely use a patch or gel form of treatment. 

Oestrogen alone

Oestrogen alone is suitable for women who have had a hysterectomy.

Safety facts:

• Blood clots – patches and gels have minimal or no risk. When using tablets the risk doubles, but is still very low (1 extra case per 1000 women).
• Heart disease – may decrease the risk of heart disease if started within 10 years of menopause or before the age of 60.
• Breast cancer - overall 1 in 8 women will develop breast cancer during her lifetime. Studies suggest that there is either no increase, or a very small added risk of breast cancer when using oestrogen only MHT. Breast cancer risk is lower with oestrogen only MHT compared with oestrogen plus progestogen.
• Stroke – no increased risk for women without underlying stroke risk factors who are in their 50s or during the first 10 years of menopause. Women with risk factors can probably safely use a patch or gel form of treatment.

Vaginal oestrogen therapy

Vaginal oestrogen therapy is useful for women who have local symptoms such as vaginal dryness. Safety fact:

If used as supplied, vaginal oestrogen therapy is safe to use long-term, except after breast cancer.

Tibolone

Tibolone is taken as a single tablet and has some oestrogen, progesterone and testosterone effects. Many, but not all, women find tibolone helps with symptoms and may also improve sexual function. Tibolone is also suitable to reduce the risk of osteoporosis (thinning of the bones) in post-menopausal women.

Safety facts:

• Blood clots – no increase in risk.
• Heart disease – no increase in risk.
• Breast cancer – reduces breast density/tenderness and no increase in breast cancer risk with three years of use.
• Stroke – increase in risk if started after the age of 60.

Oestrogen combined with a SERM

SERMS (selective oestrogen receptor modulators) are a newer treatment option for menopause. They have anti-oestrogen or oestrogen-like effects that vary in different parts of the body.

A tablet containing conjugate equine oestrogen combined with the SERM bazedoxifene improves menopausal symptoms, bone density and reduces breast density. Bazedoxifene, like progestogen, reduces the risk of cancer of the lining of the uterus in women who have not had a hysterectomy.

Safety fact:

• SERMs can be combined with oestrogen to improve symptoms, improve bone density and reduce the risk of uterine cancer.

Where can you find information about other treatment options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other fact sheets about treatment options include:

• Non-hormonal treatment options (See AMS fact sheet – Non-hormonal treatment options for menopausal symptoms)
• Lifestyle changes and menopause (See AMS fact sheet – Lifestyle and behaviour changes to manage menopausal symptoms)
• Complementary therapies (See AMS fact sheet – Complementary medicine options for menopausal symptoms)

Information for your doctor to read includes AMS Information Sheets:

• Risks and benefits of MHT
• AMS Guide to equivalent MHT/HRT doses Australia only or AMS Guide to equivalent MHT/HRT doses New Zealand only
• Combined MHT
• Oestrogen only MHT
• Tibolone for post-menopausal women

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated December 2019

MENOPAUSE AT A GLANCE

• Every woman is affected by menopause in some way – either they experience symptoms or other physical changes.
• The average age of menopause is 51 years but you can enter menopause earlier.
• Hormonal changes cause menopausal symptoms.
• Most women will have some symptoms.
• Most women have symptoms for 5 to 10 years.

Download Fact Sheet Menopause What are the symptoms72.15 KB 

Download Infographic Menopause What are the symptoms505.50 KB

Menopause occurs when you have not had a menstrual period for 12 months. Menopause is a natural part of life occurring at around age 51 years but can also happen for other reasons including after:

• surgery to remove ovaries (oophorectomy) and/or your womb/uterus (hysterectomy) 
• chemotherapy
• radiotherapy to your pelvis.

At menopause, you stop producing oestrogen (the main sex hormone in women) and this can lead to menopausal symptoms. Oestrogen levels can vary in the time leading up to the final menstrual period (called the perimenopause). 

Early symptoms - change in menstrual periods 

Menopausal symptoms often start before periods stop. Many women have a change in their menstrual cycle (period) before their periods stop. You should see your doctor if your periods become heavy or more frequent.

Hot flushes and night sweats

Hot flushes and night sweats can range from mild to quite severe. Some women find these symptoms disturb their sleep – they may even need to change the sheets during the night because of heavy sweating.
Almost all women experience hot flushes and sweats, but these are not always troublesome.

Problems sleeping

Some women have problems sleeping even if they don’t have hot flushes and night sweats.

Changing hormone levels can affect your body clock or make it more difficult for you to fall asleep or stay asleep. This can happen especially if you have other conditions that affect your sleep – for example, pain, snoring or if you have consumed alcohol or caffeine before bed.

Pain in your joints and tiredness

Studies have shown that the hormonal changes of menopause can cause some women to feel pain in their joints or make them feel more tired than usual.

Anxiety or mood changes

Most of us feel anxious at times, but you might find that things that you can usually cope with make you feel overwhelmed with anxiety. You might also feel upset, sad or angry in situations that
would not have bothered you before.

These increases in anxiety and mood changes can be caused by hormonal changes.

Dry vagina

Some women feel discomfort in their vagina, especially during sex. This is a common symptom caused by a decrease in moisture produced by the lining of the vagina. 

Overactive bladder or discomfort

Women can also find they have bladder changes during menopause. If you have this symptom, you might find you need to urinate more often, you can’t “hold on” or your bladder might feel full and uncomfortable.

What can you do about your symptoms?

Understanding menopause and developing a strategy to manage your symptoms can improve your health and lifestyle. 

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Many treatment options are available and include:

• Lifestyle changes (See AMS fact sheet – Non-hormonal treatment options)
• Menopausal Hormone Therapy
• Non-hormonal treatment options (See AMS fact sheet – Non-hormonal treatment options)
• Complementary therapies

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor on the AMS website. 

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated April 2017

MAIN POINTS

• Your doctor can suggest prescription medication options for your menopausal symptoms if you are unable to or do not want to use menopausal hormone therapy (MHT).
• Prescription medication options can help with hot flushes, sweats and changes in mood and sleep patterns.
• Specific antidepressants and epilepsy medications can help with menopausal symptoms in many women.
• A blood pressure drug (clonidine) can give relief for some women with milder symptoms

Non-hormonal treatment options for menopausal symptoms59.3 KB

At menopause, changes in hormone levels can cause symptoms for many women – for example, hot flushes, mood and sleep changes. If your symptoms are bothering you, your doctor can help you to understand your symptoms and your treatment options.

Non-hormonal prescription medications are one of the treatment options available for managing symptoms. You might ask your doctor about these options because: you are not able to use menopausal hormone therapy (MHT) for medical reasons, you might not want to use MHT, lifestyle changes alone might not be enough if you have more severe symptoms. Your doctor can explain the best non-hormonal treatment options for your situation. Only your doctor can prescribe medications that can help with hot flushes, sweating and changes in sleep patterns and mood.

Antidepressants

Antidepressants (usually low dose) have been used for many years and some types help about 70% of women with more severe flushes and sweats. Options in this class of drugs include:

• venlafaxine (a Serotonin-Noradrenaline Reuptake Inhibitor or SNRI)
• escitalopram and paroxetine (Selective Serotonin Reuptake Inhibitors or SSRIs).

Paroxetine might decrease the effectiveness of tamoxifen, a medication sometimes used for women living with breast cancer. If this is an issue, ask your doctor about other options.

Epilepsy treatments

Epilepsy drugs (gabapentin and pregabalin) have been used for many years to treat epilepsy and nerve pain and are safe and have few side effects. These medications can help with hot flushes and sweats in around 70% of women.

High blood pressure medication

Clonidine is a medication for high blood pressure that has been used for nearly 50 years. This medication can help some women with mild menopausal symptoms.

Emerging Treatments

Stellate Ganglion Block

This is a new potential treatment option involving a small injection of a local anaesthetic at the base of your neck.

This nerve block is not yet available in most clinics.

Antihistamines

Small studies have shown that a widely available antihistamine (cetirizine) might help some women with menopausal symptoms. At this stage, more research is needed to confirm this is a future treatment option.

What are the other treatment options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other treatment options include:

• Lifestyle changes: Improving diet, regular exercise and stopping smoking improve overall wellbeing and can make symptoms easier to tolerate. Some psychological treatments e.g. cognitive behavioural therapy (CBT) and mindfulness may also help (See AMS information sheet - Lifestyle and behavioural modifications for menopausal symptoms)
• Menopausal Hormone Therapy (HRT): if other things do not work and you are able to have hormone treatment (See AMS information sheets – Combined menopausal hormone therapy and Risks and Benefits of MHT/HRT)
• Complementary therapies: (See AMS information sheet – Complementary and herbal therapies for hot flushes) 

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated April 2017