MAIN POINTS

• Vaginal laser is a new treatment being offered for some menopausal symptoms
• There is insufficient high quality evidence for its safety and benefits
• Vaginal oestrogen is safe and effective and can be used by most women
• Vaginal laser for menopausal symptoms is not approved by regulatory authorities in Australia and the USA  

Vaginal Laser Therapy63.05 KB

What is vaginal laser treatment and what is it used for?

Vaginal laser treatments are now being offered to women to treat symptoms commonly found after menopause. Low oestrogen after menopause can cause vaginal dryness and inflammation, pain during intercourse and urinary symptoms. The CO2 (carbon di-oxide) laser has been used for many years in other areas of medicine, especially for the treatment of some skin conditions, pre-cancerous cervical abnormalities and genital warts. After using some local anaesthetic cream, a probe is inserted into the vagina. Beams of light penetrate the tissue causing heat-related injury. This causes collagen production as it heals. A series of several treatments spaced some weeks apart is usually recommended and “top-up” treatments may be advised.

What are the risks and benefits of vaginal laser therapy?

Currently in Australia and the USA, the CO2 laser has not been approved for use in treating menopausal symptoms because there has not been enough high-quality research evidence supporting its benefit and safety. In the USA, the Food and Drug Administration (FDA) has issued a warning about the use of laser therapy for “vaginal rejuvenation”. In addition to CO2 laser, there are other types of lasers and radio frequency devices being used in a similar way and without good evidence. Some studies have shown that vaginal laser helps to thicken the fragile vaginal lining and increase lubrication, with improvement in vaginal dryness, pain, and urinary symptoms. However, there are potential complications such as scarring, infection, pain and altered sexual sensation. This is a relatively new treatment and so far, there are no good studies of long-term follow-up. In addition, there are concerns that women are being sold an expensive treatment where there is a safer and much cheaper option available.

What other treatments are available?

Vaginal oestrogen treatments are safe and effective in most women other than those with breast cancer. They remain the “gold standard” for treatment of vaginal dryness. For some women with breast cancer who are unable to use vaginal oestrogen, non-hormonal vaginal moisturizers are available although they may not be as effective.

Where can I go for help?

Your doctor can discuss your concerns and examine you. It is very important to check for other conditions that may be causing your symptoms.

Information for your doctor to read includes AMS Information Sheet:

• Genitourinary Syndrome of Menopause

Further reading includes:

1. US Food and Drug Administration 2018. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures: FDA safety communication. http://www.fda.gov/MedicalDevices/Safety/ AlertsandNotices/ucm615013.htm. Updated July 30, 2018. Accessed 29 November, 2018

2. Buttini M, Maher C. The first published randomised controlled trial of laser treatment for vaginal atrophy raises serious questions. MJA 2018;209(9):376-377.

3. Buttini M, Maher C. To the Editor. Menopause 2018;25(8):951.

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 March 2019

MAIN POINTS

• Falls and fractures can happen at any age, but the risk increases as women age.
• Falls in older people are more likely to cause more severe injuries.
• Low bone density, low muscle strength and poor balance are more likely as women age and increase the risk of falls.
• Improving your bone health can also help decrease the risk of falls and decrease the severity of any injuries or other consequences if you do fall.
• Appropriate physical activity can help decrease several fall risk factors.
• Speak with your doctor, assess your overall health and make changes to decrease your risk of a fall.

Decreasing the risk of falls and fractures before, during and after menopause67.29 KB

You can reduce your risk of having a fall. The years before, during and after menopause are great times to speak with your doctor, assess your overall health and make changes to decrease your risk of a fall.

By the numbers – falls and fractures in women after the age of 40

Between the ages of 40 and 60 years, women begin to experience a decrease in the ability to balance and a decrease in bone density. Both of these changes contribute to the likelihood of both a fall and more severe outcomes after a fall. Here are some statistics showing the increase in the risk of falls as women age:

• After the age of 50, one in two women will break a bone at some stage during the rest of her life because of a fall.
• One in five women will fall each year before she reaches the age of 60.
• One in three women will fall each year after the age of 65.
• One in two women will fall each year after the age of 80.

In older people, 30 per cent of falls result in more severe injuries such as head trauma, hip fracture, other fractures and dislocations. Of the hip fractures in older people, more than 90 per cent are caused by a fall – 25 per cent of people with hip fractures die within 12 months and 25 per cent never regain full mobility. After a fall, older people can also lose confidence and become less physically and socially active.

Factors increasing the risk of falls and fractures

A proper review of your risk of falls and bone fractures can be performed by healthcare professionals. Self-assessment tools are also available to help you to uncover any risk factors. Your risk of having a fall increases if you have:

• low bone density / osteoporosis – women 60 years or older with osteoporosis have twice the risk of falling
• decreased strength in your lower body
• decreased balance, reaction time and postural stability
• a history of previous falls
• other medical conditions including (but not limited to) – hearing and vision problems, heart disease, incontinence or dementia.

Decreasing your risk of falls and fractures

Your doctor can suggest steps you can take to decrease your risk of falls. These include:

• increasing muscle strength through physical activity
• maintaining or improving your bone density (see section below)
• improving your mobility through physical activity
• improving balance through physical activity
• having your vision and hearing checked
• making sure your footwear is appropriate
• reviewing your environment for tripping hazards
• speaking with your doctor if you have a fear of falling or feel physically or socially restricted.

Maintaining or improving your bone health decreases the risk of falls and fractures and may decrease the severity of injuries or other consequences if you do fall.

You can improve your bone health with:

• physical activity to improve bone density, muscle strength, mobility and balance – weight-bearing activities or strength training can improve your muscle strength, bone density and mobility, while activities such as Tai Chi, yoga or Pilates can improve balance
• adequate calcium intake – a minimum of 1200g per day, preferably from dietary sources
• Vitamin D – helps calcium absorption and maintains bones. Low vitamin D blood levels are common in Australia and you may need supplements if your blood levels are low
• anti-osteoporosis medications, including menopausal hormone therapy (MHT), can reduce the risk of a first fracture and especially further fractures by up to 70%.

Where can I find more information?

Lifestyle and behaviour changes for menopausal symptoms (See AMS fact sheet Lifestyle and behaviour changes for menopausal symptoms)

Osteoporosis (healthybonesaustralia.org.au)

Calcium Supplements (See AMS information sheet Calcium supplements)

Self-assessment tool: Are you at risk of osteoporotic fracture?

Self-assessment tool: Know your bones

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 March 2019

MAIN POINTS

• Weight gain during and after menopause has more to do with your lifestyle and the changes of ageing than with hormonal changes of menopause.
• The hormonal changes of menopause can cause fat to settle in your abdomen rather than your hips, thighs and buttocks.
• Menopausal Hormone Treatment (MHT) does not cause weight gain and can reduce the abdominal fat caused by menopause.
• Menopause is a great time to visit your doctor, assess your overall health and make changes to improve your lifestyle and health.
• Eating a healthy diet, engaging in physical activity, stopping smoking and drinking less alcohol will help you to maintain a healthy weight beyond menopause. 

Maintaining your weight and health during and after menopause98.50 KB

Both men and women can gain weight as they age, but for women, it can be difficult to separate the effects of ageing from the effects of menopause.
Menopause is a great time to speak with your doctor, assess your overall health and make changes to improve your lifestyle.

Lifestyle choices and ageing are the main cause of weight gain after menopause

Between the ages of 45 and 55, women gain on average half a kilo a year. Contrary to popular belief, weight gain around menopause is mainly associated with your lifestyle and ageing. Hormonal changes of menopause do result in a change in body composition with increased fat and decreased muscle (thus no net change in weight) and can cause fat to settle in your abdomen rather than your hips, thighs and buttocks. It is a myth that Menopausal Hormone Therapy (MHT) causes weight gain, although some women might experience some fluid retention. On the contrary, MHT can decrease the accumulation of abdominal fat after menopause. The good news is that making healthy lifestyle choices can help you to achieve and/or maintain a healthy weight and improve your future health. Healthy choices help at any age, but are even more important around the time of menopause. Healthy choices you can make at menopause include:

• monitoring menopausal symptoms and other body changes and getting early advice from your doctor
• ensuring adequate intake of calcium (preferably through your diet) and vitamin D
• eating a healthy diet
• maintaining a healthy weight
• engaging in physical activity
• stopping smoking
• drinking no more than two standard alcoholic drinks per day.

Benefits of maintaining a healthy weight beyond menopause

Excess abdominal fat is associated with heart(cardiovascular) disease and diabetes, so decreasing abdominal fat by maintaining a healthy weight can decrease your risk of these diseases. For both women and men, maintaining a healthy weight and engaging in physical activity can also reduce the risk of other diseases such as cancer and dementia. Obesity is a risk factor for more severe menopausal symptoms, so losing weight if you are overweight might also help to improve your symptoms. Lifestyle choices will also improve your bone health and reduce the risk of osteoporosis. Post–menopausal women should consume 1300 mg of calcium each day (equivalent to 3–4 serves of low-fat dairy), preferably spread throughout the day. For older women, adequate vitamin D requires 15 to 30 minutes of sunshine, two to three times per week, but speak with your doctor about whether you might need vitamin D supplements. Participating in weight bearing and resistance exercise is also important (see below). Low body weight (body mass index<18) is a risk factor for osteoporosis.

Healthy eating to reach and maintain a healthy weight

Whatever your weight, to reduce the risk of chronic disease you should eat a wide variety of nutritious foods. This strategy will also help you to improve your health through maintaining a healthy weight. If you are overweight or you are gaining weight, speak with your doctor about a healthy diet plan and other lifestyle changes. We now know that diet and exercise plans should be tailored for each person and should take into consideration your physical condition and personal circumstances. The debate about which dietary strategy (eg. low fat, low carbohydrate, high protein, intermittent fasting) is best to lose body fat is ongoing and requires more research. Your doctor is best placed to understand both your situation and the latest research and can discuss which approach might be best for you.

Physical activity to promote your future health

During and after menopause, adequate physical activity can reduce the risk of chronic diseases of ageing and has other potential benefits such as:

• reducing cholesterol, blood pressure and improving heart health
• improving physical abilities and reducing risk of falls– strength, coordination, balance and endurance
• increasing muscle mass and bone strength reducing the risk of osteoporosis.

Your doctor can recommend a program of physical activity suited to your current physical condition.

The Australian physical activity and sedentary behaviour guidelines for adults 18–64 years recommend physical activity for all adults at all ages, including women during and beyond menopause.

The recommendation is for people to do either:

• 150 minutes (2.5 hours) of moderate intensity physical activity weekly

or

• 75 minutes (1.25 hours) of vigorous intensity physical activity weekly.
• To obtain greater benefits and help weight loss, avoid unhealthy weight gain and to reduce the risk of cancer, the recommendation is for women to do:
• 300 minutes (5 hours) of moderate intensity physical activity weekly

or

• 150 minutes (2.5 hours) of vigorous intensity physical activity weekly.

Activities of moderate intensity take effort, but you will still be able to talk. Examples include:

• brisk walking
• recreational swimming
• dancing
• household tasks like cleaning windows or raking leaves
• pushing a stroller.

Activities of vigorous intensity need more effort, and breathing becomes harder and faster. Examples include:

• jogging
• aerobics
• fast cycling
• organised sports
• tasks involving lifting, carrying or digging.

Muscle-strengthening exercises are also recommended at least twice per week.

If you are more than 65 years old, your physical activity program must take into account your health status and previous experience of a particular activity. Speak with your doctor for advice.

Where can I find further information?

• Myths about MHT (see AMS fact sheet – 9 myths and misunderstandings about menopausal hormone therapy)
• Osteoporosis (see healthybonesaustralia.org.au)
• Healthy eating (see www.eatforhealth.gov.au)
• Physical activity (see Australian physical activity and sedentary behaviour guidelines for adults 18–64 years at http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apaadult)
• Information for your doctor to read includes AMS Information Sheets:
  Osteoporosis
  Weight management and healthy ageing 

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 February 2019

MAIN POINTS

• The Australasian Menopause Society does not recommend the use of compounded bioidentical hormone therapy in any form.
• Many pharmaceutical-grade, approved menopause hormone therapies (MHTs) prescribed by your doctor are ‘body-identical’ – i.e. they contain hormones identical to those produced in the human body.
• Compounded bioidentical hormones (BHTs) are not more ‘natural’ – even when made from plants, they must be chemically synthesised in a laboratory.
• Compounded BHTs are not tested for quality, safety and negative side effects and they have been associated with cases of endometrial cancer.
• There is no evidence that compounded BHTs are effective and safe to use.

AMS Compounded Bioidentical HT89.17 KB

Many women are attracted to the idea of using ‘natural’ forms of hormones that are identical to those produced by the body before menopause. For this reason, an industry has sprung up selling compounded bioidentical hormone therapies (BHT) with the claim that these are a better source of hormones.

Compounded BHT preparations are handmade by some pharmacists and are marketed as ‘safe’, natural and superior to conventional, pharmaceutical-grade menopause hormone therapy(MHT). Some marketing even claims the compounded BHTs have ‘anti-ageing’ effects. The marketing often describes MHT as ‘synthetic’ when, in fact, many MHTs contain the same hormones as those produced by the body.

As you will read below, these claims are either not true or are inaccurate.

The Australasian Menopause Society does not recommend the use of compounded bioidentical hormone therapy in any form including creams, lozenges and pessaries. If you are having menopausal symptoms, see your doctor to discuss your concerns and treatment options.

Compounded bioidentical hormones are not more ‘natural’ than MHT

Even if compounded BHTs are produced from plant sources, the hormones must be chemically synthesised in a laboratory, just like conventional MHT. The oestradiol found in many conventional MHTs is the same hormone produced by ovaries before menopause, so many MHTs could also be described as ‘natural’ or ‘bioidentical’. ‘Bioidentical or ‘body-identical’ hormone therapies are terms which can be applied to pharmaceutical-registered MHT products where the hormones have the same chemical structure as those produced in the human body.

Many conventional MHTs contain hormones identical to those produced in the body

When using MHT, you can be assured the safety and effectiveness of the products has been widely tested and you can avoid the uncertainty and potential dangers of compounded BHTs. In most cases, MHT is also cheaper. If you wish to use products containing pharmaceutical-grade body-identical hormones, the following approved and regulated products are available in Australia and New Zealand:

• oestradiol – as tablets, transdermal patches or gel and as a vaginal treatment
• progesterone – as capsules in Australia (‘Prometrium’) and NZ (‘Utrogestan’).

Compounded bioidentical hormones are not safer than MHT

The reputation and use of MHT went into decline after the highly publicised Women’s Health Initiative (WHI) studies in 2002and 2004 led to confusion among women and doctors. This contributed to the rise of the compounded BHT industry.

We now have a much better understanding of the risks and benefits of MHT, as more information has been collected and the WHI studies have been reassessed.

Today, there are many treatment options using regulated MHTs with known and tested quantities of hormones. These are available in many different combinations and forms such as tablets, transdermal patches, gels or vaginal treatments. Doctors can now tailor MHT for each woman’s personal health situation to give the best possible results with the lowest possible risk.

In contrast:

• compounded BHT preparations have not been tested for quality, safety or negative side effects
• there is no way to know if compounded BHTs are contaminated with other additives
• compounded BHTs are not regulated and standardised like pharmaceutical-grade MHT.

Compounded bioidentical hormones have been associated with endometrial cancer

If you still have your uterus, your doctor can prescribe conventional MHT containing progestogens to protect your uterus and reduce the risk of endometrial cancer.

Of concern, compounded BHTs have been associated with cases of endometrial cancer, after the compounded progestogen component did not protect women from endometrial cancer.

Compounded bioidentical hormones do not work better than MHT

There is no evidence that compounded BHTs are more effective than conventional MHT. It is difficult to know the levels of hormones compounded BHTs will produce in your body for a number of reasons:

• Compounded BHTs are handmade for women often based on expensive, saliva testing for hormone levels – these tests are not standardised and are not quality controlled.
• Compounded BHTs are not regulated and standardised like pharmaceutical-grade MHTs.
• It is impossible to know the exact quantities of hormones in a handmade preparation of compounded BHT and it is impossible to know what else has been added or whether it is contaminated.

Even if compounded BHT preparations result in an adequate level of hormones in your body to decrease your menopausal symptoms, you will still have the side effects of those hormone levels and, at the same time, you will have no way of knowing if the compounded BHT is safe (see above).

Compounded bioidentical hormones are sold outside Pharmacy Board Guidelines

Compounded BHTs are sold outside Pharmacy Board Guidelines, which state that medications can be compounded only for research purposes or if a commercial product is not available or not suitable.

As pharmaceutical-grade MHTs are available and can deliver ‘body-identical’ hormones, this means compounded BHTs are not required and their preparation and sale is outside the guidelines.

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:

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

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 September 2018

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