• AMS Congress 2014
  • ALMp
  • health-prof-411p
  • info-sheets-143p
  • Member resources

CPD Points AMS Congress 2014

All CPD points have now been approved for each of the AMS Pre-Congress workshops and also the AMS Congress. Read more...

Women generally undergo menopause between the ages of 45 and 55 years. Around the time of menopause many women may experience symptoms such as hot flushes, sweats, vaginal dryness, loss of libido, irritability, sleep disturbance, and muscle/joint pains. There are a number of ways of managing these symptoms, but for those whose symptoms are troublesome and disruptive, oestrogen containing HRT may be considered.

The following advice does not apply to 'bio-identical', lozenge or compounded hormone products. There are inadequate safety or efficacy data for these products and they should be avoided. 

 pdfMenopause - oestrogen only therapy May 2012619.4 KB

Types of hormone therapy (HRT) 

  • Women who have not had a hysterectomy are advised to take combined hormone replacement therapy (HRT) which contains oestrogen plus progestogen. The progestogen protects the endometrium against hyperplasia or cancer and does not have a therapeutic role.
  • After hysterectomy HRT only needs to contain oestrogen.
  • Young women who have had their ovaries and uterus removed may consider additional testosterone therapy..
  • Women with vaginal dryness causing discomfort should consider vaginal oestrogen treatment.

How the Oestrogen-only hormones are taken

  • Oestrogens are available as tablets, skin patches and gels.
  • The products contain different kinds of oestrogen (oestradiol, conjugated equine oestrogen or oestriol) which are all thought to be effective in treating menopausal symptoms
  • There is no clear consensus about which delivery method is best.
  • Patches or gels are better for those who have high triglyceride concentrations, are at increased risk of DVT (deep vein thrombosis) – including those with hypertension, overweight or smokers, and those who may not absorb tablets adequately. (See Menopausal Treatments and the Risk of Blood Clots).
  • Vaginal oestrogen in creams, pessaries or tablets is available for women with symptomatic vaginal dryness.

The benefits of Oestrogen

  • Oestrogen reduces the severity and frequency of hot flushes by around 85%.
  • Oestrogen improves vaginal dryness.
  • By reducing menopausal symptoms, oestrogen may improve sleep and quality of life.
  • Oestrogen reduces the risk of post-menopausal bone fracture, including hip fracture. Oestrogen increases bone density.
  • Oestrogen use is not associated with weight gain

Side-effects of oestrogen-only HRT

  • Common side-effects, which are usually temporary, include breast enlargement and tenderness, and nausea. This may be dose related.

The risks of oestrogen-only HRT

  • Oestrogen should be prescribed for the relief of troublesome menopausal symptoms.
  • Women who go through menopause before 45 years are usually advised to take oestrogen until the age of average menopause at 50 years. The decision to continue oestrogen beyond 50 should be reviewed annually by the woman in consultation with her doctor. (See AMS pamphlet on Early Menopause)
  • Oestrogen increases the risk of blood clots (venous thromboembolism). The risk increases with age and other risk factors such as obesity, previous thromboembolism, smoking and immobility. In low-risk women less than 60 years the risk is low. The risk may be less with the use of oestrogen gel or skin patches.
  • Oral oestrogen increases the risk of stroke and the risk increases with age. Stroke risk is not significantly altered in women younger than 60 years with normal blood pressure. The risk may be less with lower doses and the use of oestrogen gel or skin patches.
  • Oral oestrogen is associated with an increased risk of gallbladder inflammation (cholecystitis). There is no data regarding gel or skin patches.
  • Oestrogen alone does not appear to increase the risk of breast cancer
  • Oestrogen alone commenced at the time of menopause does not increase the risk of coronary heart disease and may decrease the risk.
  • See separate graphs of Risks and Benefits of HRT from WHI Study in AMS pamphlet list

Managing the risks

  • HRT should not be prescribed unless mammographic screening is up to date
  • Regular breast checks and screening mammograms should be performed in women over 50 years.
  • A decision to use oestrogen should be reviewed annually by the woman in consultation with her doctor. Personal benefits versus risk should be discussed.
  • Oestrogen is not a first line treatment for fracture prevention. However, some women may elect to use hormone therapy to protect against osteoporosis- this needs to be done in consultation with the woman's doctor and the woman needs to understand the risks and benefits of this therapy.
  • If a woman using oestrogen develops symptoms suggesting a DVT or stroke she should stop the HRT and seek medical attention. (See Menopausal Treatments and the Risk of Blood Clots)


This fact sheet is designed to be informative and educational.
 It is not intended to provide specific medical advice or replace advice from your health practitioner.


AMS New directions in women's health 

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 Information 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 update July 2012

What's New?

  • Members update

    NAMS FTK August 2014; Vitamin D and health issues – questioned benefits; New term will banish stigma, educate providers on postmenopausal problems; Ovarian conservation at the time of hysterectom...
  • Cholesterol drug cuts heart and stroke risks by 30% in diabetic women

    The cholesterol-lowering drug fenofibrate cuts cardiovascular disease risks by 30 per cent in women with type-2 diabetes, a new University of Sydney study reveals. "The finding is good news for women...
  • Soy may help women's hearts if they start early

    A diet rich in soy may help feminine hearts, but timing matters, finds a new study published online Menopause, the journal of The North American Menopause Society. Lifelong soy consumption, similar t...
  • Supplements of calcium and vitamin D may have too much for some older women

    Calcium and vitamin D are commonly recommended for older women, but the usual supplements may send calcium excretion and blood levels too high for some women, shows a new study published online today ...
  • HRT substitution questioned

    Women with menopausal symptoms may need guidance, given the lure of bioidentical hormones according to Prof Henry Burger MD, FRACP, FCP(SA), FRCOG, FRANZCOG, FAA from the Jean Hailes Foundation for Wo...


  • A Practitioner’s Toolkit for the Management of the Menopause

    This toolkit for managing the menopause has been endorsed by the International Menopause Society, the Australasian Menopause Society and the Jean Hailes Foundation. A Practitioner’s Toolkit for the M...
  • The menopause transition - out of our comfort zone

    Presenter Natasha Mitchell, Jean Kittson and Professor Martha Hickey discuss all matters menopause in the final program in the ABC Radio National's Women's Health Series that aired on 28 June 2014, ab...
  • Lifestyle advice for healthy ageing

    Menopause is a normal part of ageing. With increasing age the risk of many common illnesses increases. Optimising health at menopause may help to improve healthy physical and emotional health into old...
  • Osteoporosis

    Osteoporosis is a condition characterised by weakened bones that fracture easily. After menopause many women are at risk of developing osteoporosis. Peak bone mass is usually reached during a woman’s...
  • Menopause Management

    AMS provides information for doctors and other health practitioners in supporting women through midlife health and the menopause. The Information Sheets have been organised into the following managem...

Popular Articles

  • NonHormonal Treatments for Menopausal Symptoms

    This pamphlet is intended for medical practitioners and nurses to help provide information to their patients. Many women request non-hormonal treatments for menopausal symptoms. This pamphlet addres...
  • Contraception For Women Approaching Menopause

    Fertility naturally declines with age, so when you are heading towards the end of your fertile years, you have a lower chance of becoming pregnant. However, you do still need to think about using cont...
  • Vaginal Atrophy - a Change with Menopause

    As women age they will experience changes to their vagina and urinary system largely due to decreasing levels of the hormone oestrogen. The changes -- which may cause dryness, irritation, itching and...
  • Diagnosing Menopause

    DON'T Check FSH, LH, oestradiol or testosterone levels in a woman with symptoms at the normal age for menopause (over 45 years) because these results are unlikely to change your management. The i...
  • AMS Guide to Equivalent HRT Doses

    This Information Sheet has been developed as a guideline only to approximately equivalent doses of the different HRT products available in 2014. The intention is to help physicians change their patien...