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 overall more evidence is needed.

• To assure safety, ideally complementary medicines should be prescribed by a health professional trained in their use.

• Always inform your doctor if you are using complementary medicines, and ensure your health practitioner has checked for any interactions that might affect other medications.

• Avoid buying online products – their safety cannot be guaranteed.

• Bioidentical compounded hormone therapies cannot be recommended because their safety is unknown.

• No complementary medicine is as effective as oestrogen therapy for menopausal symptoms.

Download:

AMS Complementary Therapies Fact Sheet87.77 KB 

Complementary medicine and therapies (CM&T) is a broad term used to describe a wide range of health care medicines, therapies 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&T 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&T, ask your doctor if it will affect other medications you might be taking. Some CM&T are promoted as natural and safe with little evidence the therapy works. Often there is no way to know if CM&T are safe or uncontaminated, especially if bought online. Your doctor can help you to understand the benefits and risks of a CM&T. The table provides a summary of commonly used CM&T 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)

Medicine/Therapy	Symptom	Comments	Rec'n*
Botanical/herbal/Vitamin supplements
Vitamin E	Hot flushes	Vitamin E can decrease the number of hot flushes by 1-2 per day.
St John’s Wort	Mood symptoms	Can improve mood and may help with mild depression. This therapy interacts with many prescription medicines.
Soy isoflavones or phyto-oestrogens	Menopausal symptoms	May help hot flushes. Not helpful for sleep.
Wild yam cream or progesterone cream	Endometrial (lining of the uterus) protection	No evidence that it is effective.
Red clover	Menopausal symptoms	Can slightly reduce the frequency of hot flushes. Post menopausal women may see a greater reduction.
Omega-3 supplements	Hot flushes	No evidence that effective for menopausal symptoms but can lower high triglycerides.
Black cohosh	Menopausal symptoms	There are different forms of Black Cohosh and some extracts (isopropanolic) may be beneficial. There are possible safety concerns.
Evening primrose oil	Hot flushes	No evidence that it is effective.
Ashwagandha	Menopausal symptoms	Insufficient evidence of benefit and concerns for gastrointestinal and liver side effects.
Mind-body therapies
Acupuncture	Hot flushes	May be effective at reducing frequency and severity of hot flush versus a placebo, but not compared to sham acupuncture.
Cognitive behavioural therapy	Menopausal symptoms	Can help some women with menopausal symptoms (sleep/ hot flushes/mood).
Hypnosis	Menopausal symptoms	Hypnosis might be helpful for some women.
Yoga	Menopausal symptoms	Yoga might be helpful for some women.
Homeopathy	Menopausal symptoms	No evidence that is it effective.
Other
Bioidentical compounded hormone therapy	Menopausal symptoms	Do not take it if you can’t take prescribed menopausal hormone therapy (MHT) or hormone replacement therapy (HRT) for safety reasons.

* Rec'n = Recommendation

Information obtained from The North American Menopause Society (The 2023 nonhormone therapy position statement of The North American Menopause Society).

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 15 April 2025

MAIN POINTS

• Osteoporosis is a common condition whereby individuals have weakened bones that can break (fracture) easily.
• Oestrogen plays an important role in maintaining bone strength, with peak bone mass reached at around 30 years of age. During the time of menopause, oestrogen levels drop and bone loss occurs.
• Half of women 60 years of age or older have lower than normal bone density (osteopenia), while approximately one quarter have the more severe bone loss seen in osteoporosis.
• Women who have undergone a premature menopause (menopause before age 40) are at higher risk of osteoporosis.
• Your doctor can assess your risk for osteoporosis and refer you for a bone density scan.

Menopause and bone health - decreasing the risk of osteoporosis142.03 KB

Osteoporosis is a common condition whereby individuals have weakened bones that can break (fracture) easily. Bone loss and fractures affect quality of life and can lead to other health conditions.

Oestrogen plays an important role in maintaining bone strength, with peak bone mass reached at around 30 years of age. During the time of menopause, oestrogen levels drop and bone loss occurs.

Half of women 60 years of age or older have lower than normal bone density (osteopenia), while approximately one quarter have the more severe bone loss seen in osteoporosis. Women who have undergone a premature menopause (menopause before age 40) are at higher risk of osteoporosis.

Diagnosis

Osteoporosis does not have any symptoms and unfortunately is often diagnosed after a bone has broken. Low bone density can be diagnosed with a quick and painless bone density or DEXA scan. The scan measures the ‘thickness’ or strength of your bones at the hip and spine.

Your doctor can assess your risk for osteoporosis and refer you for a bone density scan.

Risk factors for osteoporosis

During the menopausal transition and after menopause, a range of factors can increase your risk of osteoporosis.

Personal circumstances that can increase your risk include:

• a family history of osteoporosis
• a previous fracture
• smoking
• alcohol intake of more than 2 standard drinks per day
• insufficient calcium in your diet
• low levels of vitamin D
• lack of exercise.

Medical conditions that can increase your risk include:

• early menopause
• diabetes
• rheumatoid arthritis
• Coeliac disease, or other intestinal conditions that affect food absorption
• Thyroid or parathyroid conditions

Medications that can increase risk include:

• some treatments for breast cancer which block oestrogen
• steroid treatments such as prednisone or cortisone
• some treatments for epilepsy.

Lifestyle changes and managing risk of osteoporosis

Some risk factors can be controlled though lifestyle changes and this will help reduce your risk of osteoporosis. These include:

• Adequate calcium in your diet: the recommended intake is 1300mg/day for women age 50 years and over, which is equivalent to 3–4 serves of dairy per day. For those who cannot reach this intake with food, calcium supplements are an option
• Vitamin D: Vitamin D is important for absorption of calcium. Vitamin D levels increase upon exposure to sunlight. A few minutes of exposure in summer (avoiding when the UV Index is above 3), with slightly longer times needed in winter is recommended by Healthy Bones Australia. Some patients may need Vitamin D supplements
• Physical activity: weight-bearing activity can help you to maintain bone mass. Useful activities include weight-bearing aerobic exercise (walking, stair climbing, jogging, volleyball, tennis and dancing), strength/resistance exercises and balance exercises
• Stopping smoking: smokers are at higher risk of bone loss and fractures
• Avoiding excess alcohol: more than 2 standard drinks of alcohol per day is associated with an increased risk of fracture.

Medications for osteoporosis

Medications for osteoporosis aim to slow or prevent bone loss and improve bone density over time to reduce the risk of fractures.

Some treatments are commonly used for osteoporosis and others have restricted use for people with severe osteoporosis. Medications are prescribed based on the specific circumstances of each person, so it is best to speak with your doctor about your treatment options and any potential side effects of medications.

The broad classes of medications include:

Antiresorptive medications

These medications slow bone loss, improve bone density and decrease the risk of fractures. Included in this class are:

• Bisphosphonates: these medications can be given by tablet form but are also available as in intravenous infusion.
• Denosumab: an injection is given every 6 months. Importantly Denosumab must be given without delay at 6-month intervals. Failure to do so may result in spinal fractures.

Hormone based therapies

ncluded in this group is menopausal hormone therapy (MHT). MHT reduces bone loss and risk of fracture. Tibolone and Raloxifene are synthetic medications which mimic the action of oestrogen and are also used to treat osteoporosis.  MHT is most suitable for use in women under age 60 and has the added benefit of relieving the symptoms of menopause such as hot flushes.

Anabolic (bone building) medications: 

These agents are effective in building new bone.  At present PBS use is restricted to patients with severe osteoporosis who have had a fracture while on other treatment for osteoporosis.

Where can you find more information?

Your doctor can help with any concerns about the weakening of bones and osteoporosis. Your doctor can tell you about the changes in your body and offer options for maintaining strong bones and managing symptoms. Other fact sheets relevant to osteoporosis and menopause include:

• Decreasing the risk of falls and fractures before, during and after menopause
• Menopause before 40 and spontaneous premature ovarian insufficiency
• Early menopause – chemotherapy and radiation therapy
• Maintaining your weight and health during and after menopause
• Lifestyle and behaviour changes for menopausal symptoms

Other resources:

• Healthy Bones Australia
• Physical activity and exercise guidelines for all Australians

If you have any concerns or questions about options to manage your menopausal symptoms or health, 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 a particular person's circumstances and should always be discussed with that person's own healthcare provider. This Information Sheet contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner.

Content created 3 March 2025

The ESHRE Guideline on premature ovarian insufficiency contains best practice recommendations for the care of women with with both primary and secondary premature ovarian insufficiency (POI). POI is a clinical condition defined by the loss of ovarian function indicated by irregular menstrual cycles together with biochemical confirmation of ovarian insufficiency before the age of 40.

Women with POI have unique needs. They may not only suffer from symptoms associated with estrogen deficiency, but can also experience other issues, with a significant impact on their quality of life and later health outcomes. POI can have significant effects on fertility, bone health, cardiovascular health, sexual function, psychological health and neurological function.

The impact of POI on these different domains and the treatment options for each along with monitoring needs where relevant are all discussed in the guideline.

In addition to hormone therapy the guideline also covers non-hormonal and complementary treatments, lifestyle interventions and puberty induction.

There are also patient resources as show below.

Patient resources

POI GUIDELINE Patient version2.28 MB

Fact sheets on topics related to POI co-created with women with lived experience - website

AMS Patient centered resources

Support groups

In addition to the support of family, friends and a healthcare team, some women find it useful to talk to other women in the same situation. Available support groups include:

ACCESS Australia (Australia’s National Infertility Network) – www.access.org.au

The Daisy Network Premature Menopause Support Group – www.daisynetwork.org.uk

NZ Early Menopause Support group – www.earlymenopause.org.nz

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:

• Early menopause – chemotherapy and radiation therapy

• What is Menopausal Hormone Therapy (MHT) and is it safe?

• 9 myths and misunderstandings about MHT

• Non-hormonal treatment options for menopausal symptoms

• Complementary medicine options for menopausal symptoms

• Lifestyle and behaviour changes for menopausal symptoms

• Weight management and healthy ageing

• POI and Osteoporosis infographic 

The Healthtalk Australia Early Menopause online resource contains women’s stories, information, question prompt list and links to services: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-womens-experiences/

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 2025

AMS Suggested strategies to optimise sleep154.48 KB

The following strategies may or may not work for you. Perhaps choose one suggestion that you aren’t currently doing and stick with it for several weeks. 

• Wake up at the same time every day, even on weekends. When opening your eyes after waking, light reaches the part of the brain responsible for keeping your internal clock regular. This daily dose of light at the same time will signal this is the end of sleep and help maintain the same sleep pattern each day. If you can, expose yourself to morning sunlight by having your coffee outside or by taking your dog out for a walk.

• Avoid looking at screens before bedtime and when you wish to be asleep. The backlight from phones, tablets and laptops can signal to the part of your brain that controls the sleep/wake cycle that this is morning sunlight. This can wake you up further.

• Establish a bedtime routine to help your body get ready for sleep. For instance, you could take a shower, drink a warm (non-caffeinated) beverage, brush your teeth, read a book (one you can put down after a chapter), and listen to a relaxing podcast, music, or TV show that you only use for falling asleep. Playing something familiar can help if you drift off while it's playing, as you know how it ends and so it doesn’t matter if you miss it!

• Use your bedroom only for sleep and sex. The bedroom should be an enjoyable place to be, not invaded by work, laptops, TV, or anything other than a comfortable bed. This helps to associate the bedroom with being asleep.

• If you do wake up during the night, try not to be annoyed. Waking up is a normal part of sleep, and as we get older, this will become more frequent. Becoming stressed about being awake can release the stress hormone cortisol, which can make it harder to get back to sleep.

• If you are awake longer than 15 minutes during the night, get out of bed and do something boring that doesn’t require bright lights. For example, fold the washing, read a book that isn’t great, or do a puzzle that isn’t too difficult.

• If you have symptoms of sleep-disordered breathing, such as snoring, waking up gasping or someone has observed your breathing not being regular during sleep, then consider talking to your GP to arrange a sleep study.

• Restless legs syndrome can feel like itching or crawling sensations in the legs. If you have these uncomfortable sensations, you may want to consider making changes to your diet. Reducing caffeine and increasing iron, folate and magnesium intake can reduce these symptoms. Other home-based techniques include massaging your legs and taking warm baths. If these don't work, you might want to talk to your doctor about medications that can help.

• Cut back on caffeine and keep it under 300-400 mg daily (about 100-200 mg per cup of coffee). Caffeine acts as a ‘stimulant’ as it is an adenosine receptor antagonist. Adenosine promotes sleepiness and therefore, caffeine can keep you from feeling sleepy. Caffeine works quickly and stays in your system for several hours. This can make it hard to fall asleep at night. Therefore, a good rule of thumb is to avoid caffeine after 2pm. It’s not just coffee you need to watch out for, caffeine is found in other things such as tea, chocolate and soft drinks such as Coca Cola.

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 contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner. ID:2025-02-25

Revised February 2025

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. There is a registered medication specifically developed for the management of flushes and sweats Specific antidepressants and epilepsy medications can help with menopausal symptoms in many women.

Non-hormonal treatment options for menopausal symptoms130.06 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.

Fezolinetant

This is a treatment that blocks the nerve pathways in the hypothalamus that are involved in the production of hot flushes and sweats. It can reduce the frequency and severity of flushes.

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.

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.

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.

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 hypnosis may also help (See AMS fact sheet - Lifestyle and behavioural modifications for menopausal symptoms)
• Menopausal Hormone Therapy (MHT, formerly known as HRT): if other things do not work and you are able to have hormone treatment (See AMS fact sheets – What is Menopausal Hormone Therapy (MHT) and is it safe?)
• Complementary therapies: (See AMS fact sheet – Complementary medicine options 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 Member service on the AMS website.

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 contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner. ID:2025-02-27

Content updated February 2025 

MAIN POINTS

• Women going through the menopausal transition are at a higher risk of mood changes and symptoms of depression and anxiety
• Common physical, emotional and cognitive issues related to menopause can complicate and overlap with mental health symptoms
• Stress related to life circumstances can also complicate understanding whether changes in mood and mental health are related to menopause 
• Having an open discussion about your symptoms, life circumstances and mental health history can assist your doctor in offering suitable treatment options and lifestyle changes
• Therapies proven for the broader population are also suitable for mental health symptoms related to menopause – medication, psychological therapy and lifestyle changes

AMS Menopause and mental health95 KB

While not a problem for everyone transitioning through menopause, the risk of mood changes and symptoms of depression and anxiety are higher during perimenopause, even in women without a history of major depression.

While the risk is higher for women in the age-related and natural menopausal transition, women might also have a higher risk of mood changes after menopause caused by surgery such as hysterectomy or if the ovaries have been removed. Depression also occurs at a higher rate in women with a lack of oestrogen caused by primary ovarian insufficiency.

Mental health symptoms related to menopause

Mental health symptoms related to menopause can include feeling:

• irritable
• sad
• anxious 
• hopeless 
• less able to concentrate or focus 
• tired 
• unmotivated.

Some women might experience these symptoms in a mild form. Others might have more severe symptoms of depression (including thoughts of suicide) lasting for at least two weeks. This is known as a major depressive episode and is more likely in women who have a history of major depression during their pre-menopausal years.

While many women do not have mental health issues during the menopausal transition, unstable oestrogen levels can have an impact on the brain, predisposing some women to feelings of depression and anxiety.

Some of the common physical, memory and thinking symptoms related to menopause (hot flushes, night sweats, sleep and sexual disturbances, weight changes and “brain fog”) can complicate and overlap with mental health symptoms.

Another complicating factor is stress related to life circumstances. Feeling stress is common during middle age as personal and environmental changes take place. This can have a strong effect on mood in some women. Life circumstances that can impact mental health include:

• caring for children
• caring for elderly parents
• career changes
• relationship changes
• ageing
• body changes
• illness.

The menopause transition is an ideal time to take stock of all aspects of your health and consider lifestyle and other changes so that you can live the healthiest possible lifestyle.

Given the complex and overlapping nature of the physical and mental health changes during the menopause transition, speaking with your doctor is the best place to start.

Untangling physical and mental health symptoms related to menopause

For some women, mental health issues and other changes can begin to affect how they live their lives. Your doctor can take a holistic approach to your health to help you untangle the web of symptoms around physical and mental health changes. Understanding mental health during perimenopausal and postmenopausal changes can include:

• identifying your stage of perimenopause / menopause and any physical and cognitive symptoms
• discussing your history of mental health symptoms
• discussing your current mental health symptoms
• understanding any lifestyle factors that could affect your mood – for example, lack of sleep and exercise
• understanding other stressful life circumstances contributing to your symptoms – for example, caring for children and parents, career and relationship changes, body changes and illness.

Speaking with your doctor about your menopausal symptoms, life circumstances and clinical history can help them to recommend the best treatment options and lifestyle and behavioural changes for your situation.

Treatment options for mental health symptoms 

Lifestyle changes to assist with managing mental health are similar to those recommended for menopause-related physical changes. Changes that can help with mental health symptoms include:

• ensuring healthy levels of physical activity
• improving sleep
• considering changes to decrease stress associated with life circumstances
• limit alcohol intake

Psychological therapies and social supports can be beneficial to women with mental health symptoms.

Women should have an individualised assessment with their doctor in order to discuss the most appropriate treatment pathway. Options may include lifestyle changes, psychological therapies and medications such as menopausal hormone therapy (MHT) or antidepressants.

While some international guidelines do not recommend MHT as firstline therapy, many doctors have seen a positive effect on mood with the use of MHT in the first instance. There is evidence that oestrogen has antidepressant effects, particularly in perimenopausal women. We emphasise an individualised approach with treatment tailored to the individual patient.

Oestrogen is not recommended for women with a history of breast cancer.

At this stage, there is no evidence to recommend alternative or complementary therapies for treatment of perimenopausal depression.

Where can you find more information?

If your mental health or other symptoms are bothering you, your doctor can help. Your doctor can help you understand physical and mental health changes and offer options for managing your symptoms.

Fact sheets:

• Menopause what are the symptoms?
• Lifestyle and behaviour changes for menopausal symptoms
• Complementary medicine options for menopausal symptoms

Infographics:

• Menopause what are the symptoms?
• Maintaining your weight and health during and after menopause

Where can you get help for depression and mood changes?

If you have severe mental health symptoms or symptoms of depression and have thoughts of suicide, help is available.

• Lifeline – Phone 13 11 14
• beyondblue – Phone 1300 22 4636
• Australian Psychological Society – Find a psychologist service – Phone 1800 333 497
• Your doctor
• Australasian Menopause Society – Find an AMS Doctor

If you have any mental health concerns or questions, 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 a particular person's circumstances and should always be discussed with that person's own healthcare provider. This Information Sheet contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner. I

Content updated February 2023

MAIN POINTS

• Addressing menopause in the workplace can benefit both the organisation and employees with menopausal symptoms affecting their work
• Collaborating with employees and including menopausal health in policies can improve an inclusive organisational culture and avoid discrimination against employees with menopausal symptoms
• Workplaces can make changes to policies and the environment to support employees with symptoms
• Managers can promote discussions with employees who are open to discussing how their symptoms are impacting their work
• Managers can suggest workplace adjustments and occupational advice for employees to access strategies to improve their work experience
• Employees can speak with healthcare professionals about treatment options and self-help strategies for their symptoms

AMS Menopause and the workplace101.09 KB

Addressing menopause at work can benefit both employers and employees.

Employers who make workplaces responsive to gender and diversity will be better able to attract and retain skilled and talented staff. Menopause is a genderand age-equity issue and remains one of the last “unspoken” issues in workplaces. 

For many women, menopause is a natural stage of life. But menopausal symptoms may also be caused by interventions such as surgery, radiotherapy and chemotherapy or medications.

Some employees even consider a career break or retiring when their work is affected by menopausal symptoms such as hot flushes, sweats, sleep disturbance and mental health issues. In the workplace, difficulties with memory and concentration may be particularly difficult.

A 2021 study found 83% of women experiencing menopause were affected at work, but only 70% would feel comfortable speaking with their manager about it.¹

The following tips are based on global consensus recommendations for menopause in the workplace.²

How can employers and organisations improve menopause awareness?

The Australian Government has included promoting workforce participation as a priority area for older women.³ Addressing the lack of awareness of menopause is a major step employers can take to assist their organisation and workforce. Free resources for Australian workplaces and managers are available.⁴

Organisations can address the lack of menopause awareness by:

• improving understanding of menopause and prioritising health and wellbeing in the workplace
• ensuring employees with menopausal symptoms impacting their work are not stigmatised, discriminated against, bullied, or harassed
• recognising how work patterns could impact symptoms and allowing flexible working arrangements, where possible
• developing policies supportive of menopause as part of induction, training and development programs for employees
• including coverage of menopause in leave policies and assisting employees to access workplace healthcare
• providing training for managers and supervisors to understand menopause and how to have sensitive conversations about menopause at work.

How can managers and supervisors improve menopause awareness?

Managers who are comfortable having sensitive conversations about menopause are in a better position to help create a positive workplace that improves quality of life, productivity, and motivation for all employees.

Managers and supervisors can contribute to a more inclusive workplace by:

• creating a supportive culture for people going through menopause
• enabling employees to discuss their menopausal symptoms without assuming everyone who experiences menopause will want to talk about it
• considering using occupational health professionals to advise on suitable arrangements for employees
• allowing flexibility of dress codes
• reviewing workplace temperature control and ventilation, including the ability to adjust temperature (eg. fans in work areas)
• allowing work breaks to manage severe symptoms
• promoting a healthy lifestyle in the workplace (eg. healthy snacks, lunchtime walking groups.

How can employees with menopausal symptoms improve their workplace experience?

Not all employees going through menopause want to discuss their situation with people at work. But if they wish, employees who are having health concerns at work, could consider:

• speaking with their manager or supervisor about menopause-related problems impacting their work
• seeking help and advice from employee support bodies if they feel unsupported with their health at work
• consulting with their doctor to discuss treatment options and self-help strategies
• speaking to occupational health or other healthcare professionals
• learning about any equity and occupational health and safety legislation and regulations for employees experiencing menopause at work
• assist in developing workplace policies or training programs to ensure menopause is meaningfully considered
• taking part in online support menopause support groups.

Where can you find more information about menopause and the workplace?

1. Circle In, Driving the change: Menopause and the workplace, 2021. Access here: https://circlein.com/research-and-guides/menopause-at-work/  

2. Rees et al, Global consensus recommendations on menopause in the workplace: A European Menopause and Andropause Society (EMAS) position statement. Access here: https://doi.org/10.1016/j.maturitas.2021.06.006 

3. Australian Government, National Women’s Health Strategy 2020 to 2030, 2020. Access here: https://www.health.gov.au/resources/publications/national-womens-health-strategy-2020-2030 

4. Menopause Information Pack for Organizations (MIPO). Access website here: https://www.menopauseatwork.org/

5. Jean Hailes Foundation: Menopause and work fact sheet | Jean Hailes

Where can employers and employees find more information about menopause?

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.

Fact sheets:

• Menopause what are the symptoms? – https://www.menopause.org.au/health-info/fact-sheets/menopause-what-are-the-symptoms 
• Menopause before 40 and spontaneous premature ovarian insufficiency – https://www.menopause.org.au/health-info/fact-sheets/menopause-before-40-and-spontaneous-poi   
• Early menopause – chemotherapy and radiation therapy – https://www.menopause.org.au/health-info/fact-sheets/early-menopause-chemotherapy-and-radiation-therapy 

Infographics:

• Menopause what are the symptoms? – https://www.menopause.org.au/health-info/infographics/menopause-what-are-the-symptoms  
• What is Menopausal Hormone Therapy (MHT) and is it safe? – https://www.menopause.org.au/health-info/infographics/what-is-menopausal-hormone-therapy-and-is-it-safe  

If you are an employee and 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 a particular person's circumstances and should always be discussed with that person's own healthcare provider. This Information Sheet contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner. I

Content updated November 2022

AMS Glossary Fact Sheet for Women114.06 KB

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 updated February 2022

MAIN POINTS

• Chemotherapy and radiation therapy for cancer and other conditions can cause temporary or permanent loss of your menstrual periods and menopause.
• Before the age of 40, this is known as premature ovarian insufficiency (POI).
• Between the ages of 40 and 45, this is known as early menopause.
• Early menopause and POI can cause infertility and have short- and long-term health consequences such as heart disease, osteoporosis and memory problems.
• Some women who have chemotherapy remain fertile, so it is important to use contraception if you do not want to become pregnant or if your doctor advises you that it is not safe to become pregnant.
• Speak with your doctor about treatments and other options to manage any infertility and long-term health consequences.

Early menopause – chemotherapy and radiation therapy102.27 KB

Chemotherapy and radiation therapy for cancer and other conditions can cause temporary or permanent loss of your menstrual periods, which can lead to menopause and infertility.

If this occurs before the age of 40, it is known as premature ovarian insufficiency (POI) and between the ages of 40 and 45, it is known as early menopause. POI and early menopause can also happen for other reasons (see AMS fact sheet – Menopause before 40 and premature ovarian insufficiency).

Chemotherapy and radiation therapy can be toxic to the ovaries

Chemotherapy or radiation therapy can cause early menopause because these treatments are toxic to the ovaries, especially when used at high doses to treat cancer. Whole-body radiation therapy and radiation in the pelvic area are more likely to affect your ovaries. At birth, ovaries contain one million immature eggs (primordial follicles). The number of eggs naturally decreases until, at menopause, less than 1000 eggs remain. When chemotherapy or radiation therapy damages the ovaries, women can have fewer remaining immature eggs and/or the immature eggs are unable to mature. Loss of your period after chemotherapy or radiation therapy can either be temporary or permanent. If your period returns, that does not necessarily mean that your fertility returns.

Risk factors for entering early menopause

The likelihood of entering POI or early menopause after chemotherapy or radiation therapy increases:

• with increasing age
• when there are fewer eggs in the ovaries before treatment starts
• with higher doses of chemotherapy or radiation
• with radiation therapy of the whole body or pelvic area
• with some types of chemotherapy
• when doses of chemotherapy and radiation are given together.

Symptoms and health consequences of POI and early menopause

The signs, symptoms and health consequences of POI and early menopause after chemotherapy and radiation therapy include: 

• missing your period or having infrequent periods – an early symptom of POI or early menopause
• menopausal symptoms (either with or without your period) including
  • hot flushes
  • mood changes
  • problems sleeping
  • aching joints
  • dry vagina or poor lubrication during sexual arousal.
• psychological distress and increased risk of anxiety and depression because of:
  • a diagnosis of cancer or severe medical illness
  • treatment with chemotherapy/radiotherapy and the related longterm consequences
  • infertility – women often feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies.
• short and long-term health risks – infertility, osteoporosis and heart disease.

Diagnosis of POI and early menopause

POI and early menopause are difficult to diagnose and the process can take many months. This can be a very stressful time and women should speak with their healthcare team for support and management options. Criteria for a diagnosis of POI or early menopause include:

• more than four months without a period
• follicle stimulating hormone (FSH) levels in the menopausal range on two occasions at least 4–6 weeks apart.

Managing fertility issues

Chemotherapy and radiation therapy might affect your fertility. Thinking about whether you will be able to have children and preserving your fertility can be overwhelming, especially when added to the stress of a diagnosis of cancer or other serious illness. Speak with your healthcare team and get the support you need. If losing fertility is a possibility, your doctor might be able to suggest options to try to preserve your ability to have children. Monthly injections with a gonadotrophin releasing hormone analogue during chemotherapy may help to preserve ovarian function. The most effective option is to have your eggs or embryos frozen before you begin treatment. Some women who have chemotherapy remain fertile, so it is important to use contraception if you do not want to become pregnant or if your doctor advises it is not safe to become pregnant. Some types of contraception are not safe for women with certain cancers or illnesses so talk to your doctor about what is best for you. For those who have developed POI or early menopause, some women choose to live a childfree life, while others adopt or foster children.

Treatment of POI and early menopause

Women with POI/early menopause should discuss with their doctor the possibility of using hormone therapy. In women more than 50 years of age, hormone therapy is called menopausal hormone therapy (MHT). In women who are aged less than 50, the same hormone therapy can be called hormone replacement therapy (HRT) because the treatment is replacing the hormones that the ovaries would be producing if you hadn’t had chemotherapy or radiation therapy.

If you choose to use HRT, your doctor might advise you to continue this treatment until the typical age of menopause (51 years).

HRT options include:

• oestrogen tablets, patches, gels and topical vaginal treatments – if you have had a hysterectomy (see AMS fact sheet – What is MHT and is it safe?)
• oestrogen plus progesterone – if you have not had a hysterectomy
• combined oral contraceptive pill as a replacement hormone – if you have no significant risk factors (such as risk of blood clotting, past blood clots or if you are a current smoker).

Oestrogen therapy is not suited to everyone and is best avoided if you have breast or endometrial cancer. Your doctor can suggest non-hormonal options to help manage hot flushes and other symptoms. If contraception is required, hormonal options include the oral contraceptive pill or an intrauterine device plus oestrogen (usually as a patch or gel). If your doctor does not recommend hormones for your situation, discuss non-hormonal contraceptive options.

Managing health risks associated with POI and early menopause

Adopting healthy lifestyle changes (see AMS fact sheets – Lifestyle and behaviour changes for menopausal symptoms and Weight management and healthy ageing) can reduce the risk of some of the health impacts associated with POI and early menopause. These health impacts include:

• osteoporosis or bone loss
• cardiovascular/heart disease
• learning and memory disturbances
• emotional issues.

It is widely known that regular physical activity, a healthy diet and healthy sleep patterns can improve these problems, no matter what the cause. In addition, regular check-ups (including blood tests and bone scans) with your doctor can help you to manage your health.

Osteoporosis

Osteoporosis in women with POI and early menopause can be caused by:

• low levels of oestrogen
• low levels of calcium in the diet
• smoking
• low levels of physical and weight-bearing activity
• some types of chemotherapy and medications.

In addition to lifestyle changes (quitting smoking, engaging in regular weight-bearing activities, and ensuring adequate dietary intake of calcium and vitamin D) women should have regular bone density scans every one or two years. Use of HRT can also help to maintain bone density.

Cardiovascular or heart disease

POI and early menopause can result in an earlier increase in the risk of heart disease in women.

Taking HRT early and continuing treatment until the age of a natural menopause (50–55 years) can reduce the risk of heart disease. A healthy lifestyle and regular check-ups for high blood pressure, diabetes and fats in the blood will help you manage your heart health.

Learning and memory problems

There is evidence that chemotherapy can cause memory problems, but there is limited evidence that low levels of oestrogen affect memory.

Taking HRT early and continuing treatment until the age of a natural menopause (51 years) might reduce the risk of learning and memory problems.

Emotional issues

In addition to a diagnosis of cancer (or severe medical illness) requiring chemotherapy/radiation therapy, women also have to cope with possible infertility and other long-term health impacts.

It is only natural to feel distressed and some women might have anxiety and depression. Women often feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies. Psychological counselling can ease this distress. Support from the woman’s partner, family and friends is also important.

Support groups

In addition to the support of family, friends and a healthcare team, some women find it useful to talk to other women in the same situation. Available support groups include:

ACCESS Australia (Australia’s National Infertility Network) – www.access.org.au

Cancer Australia – www.cancer.org.au

The Daisy Network Premature Menopause Support Group – www.daisynetwork.org.uk

New Zealand Early Menopause support group - www.earlymenopause.org.nz

Where can you find more information?

If your symptoms are bothering you or you feel you need more support, your doctor can help. Your doctor can tell you about the changes in your body and offer options to manage your symptoms. Other fact sheets about treatment options include:

• Menopause before 40 and premature ovarian insufficiency
• What is Menopausal Hormone Therapy (MHT) and is it safe?
• 9 myths and misunderstandings about Menopausal Hormone Therapy (MHT)
• Non-hormonal treatment options for menopausal symptoms
• Complementary medicine options for menopausal symptoms
• Lifestyle and behaviour changes for menopausal symptoms
• Weight management and healthy ageing
• POI/ Early menopause and osteoporosis https://www.monash.edu/__data/assets/pdf_file/0010/1515187/Early-Menopause_POI-and-Osteoporosis.pdf

The Healthtalk Australia Early Menopause online resource contains women’s stories, information, question prompt list and links to services: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/

If you have 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 October 2020

MAIN POINTS

• Urinary incontinence is common in women
• Women can have stress or urge incontinence or a mixture of both
• Learning how to contract pelvic floor muscles correctly can help treat stress incontinence. Some women may need surgery
• Bladder training and vaginal oestrogen can assist with urge incontinence

AMS Urinary Incontinence in Women87.09 KB

What is incontinence?

Urinary incontinence is the involuntary loss of urine.

It is a common problem for women, getting worse with advancing age. 1 in 2 women over the age of 70 has some form of urinary incontinence. Not everyone who has had a baby has incontinence, and women who have not had children may still suffer from incontinence.

Urinary incontinence can be also associated with vaginal prolapse, chronic lower back pain, or bowel issues, including faecal incontinence. Children may also suffer from incontinence but this often has a different cause. What are the different types of incontinence? There are two main types of urinary incontinence:

• Stress incontinence
• Urge incontinence

Stress Urinary Incontinence (SUI) is more common, affecting 1 in every 5 women. Women who have not had a baby have a 1 in 10 chance of developing SUI, while for those who have had a baby, the chance rises to approximately 1 in 3.

Urge Urinary Incontinence (UUI) is less common in younger women, affecting approximately 1 in 30 women, but becomes more common with advancing age.

The difference between managing these two types of incontinence are discussed below.

In some instances, both types of incontinence can occur in one person, though the cause for each type is different. This is known as mixed incontinence. Mixed incontinence affects approximately 1 in 10 women.

What is considered normal bladder function?

• Passing urine 4-6 times per day
• Passing urine no more than once per night
• Passing 1-2 cups of urine (250-500mls) each time
• Passing urine in a steady stream until the bladder is empty
• Being able to delay passing urine until convenient, and
• Having no leakage of urine between visits to the toilet

In a woman with normal bladder function, the muscles of the pelvic floor contract when she is doing any physical activities. These activities may include sneezing, coughing, sports or any other physical effort which can cause the pressure in the abdomen to rise.

When the pressure in the abdomen rises, the muscles of the pelvic floor contract, compressing the urethra (the tube which connects the bladder to the outside) and triggering contraction of the sphincter (the muscle that wraps around the urethra to keep it closed). This prevents any leakage of urine.

What causes stress urinary incontinence?

Stress incontinence is the involuntary loss of urine often related to physical exertion. This is caused by either:

• loss of the support of the urethra by the muscles and ligaments of the pelvic floor, or
• loss of the strength of the sphincter

When the pressure in the abdomen rises, insufficient contraction of the pelvic floor means the compression of the urethra will also be insufficient. This in turn leads to insufficient contraction of the sphincter, resulting in the loss of urine and “stress incontinence”.

What causes urge urinary incontinence?

Urge urinary incontinence is the involuntary loss of urine associated with urgency (having to rush to the toilet), or being unable to delay passing urine until a convenient time.

The uncontrollable need to pass urine occurs due to overactivity of the muscle of the bladder wall. It is associated with increased urinary frequency, urgency and needing to wake up multiple times during the night in order to pass urine. Typically, the feeling of urgency can be associated with daily activities, such as when you put the key in the front door, or when water is running. This is also known as overactive bladder syndrome. Some people with overactive bladder syndrome can feel urgency, but not actually leak any urine.

Mixed urinary incontinence is the involuntary loss of urine associated with both urgency and any physical exertion, or when sneezing or coughing.

Management of Stress Incontinence

Strengthening the pelvic floor muscles and learning how to contract them correctly is an important step in managing SUI. About one in two women are unable to contract their pelvic floor correctly. Nurse Continence Advisors or physiotherapists specialised in pelvic floor management can assist you with a personalised training program of pelvic floor muscle contractions. They will also teach you "the knack”. “The knack” is contracting your pelvic floor before coughing, sneezing, or doing anything that raises the pressure in your abdomen. The training can also help you learn how to isolate the muscles of your pelvic floor around the anal area, to help control any anal incontinence and the passage of wind.

Other approaches to treating stress incontinence

Using stool bulking agents or softeners will help avoid constipation and having to strain when opening your bowels. When emptying the bowels and bladder, it may also help to use a low stool to elevate the knees slightly higher than hips, relaxing the pelvic floor and the abdomen. Additionally, avoiding heavy lifting can help avoid raised intra-abdominal pressure leading to SUI.

Some women may be able to use a continence pessary, which is inserted into the vagina and supports the bladder neck, helping to reduce leakage.

Another non-surgical option is duloxetine, an antidepressant medication known as a serotonin and noradrenaline reuptake inhibitor (SNRI). It may help some women but its use is not approved for this purpose in Australia or New Zealand.

Your doctor may recommend surgery if other treatments have not helped. You may be referred to a specialist urogynaecologist to discuss the benefits and risks of surgery for SUI. The types of surgery available for SUI include urethral bulking agents, midurethral slings, colposuspension, or an autologous fascial sling.

None of the types of surgery currently available have a 100% cure rate, however for 80-90% of women, their surgery will provide significant improvement at 12 months post-surgery.

For incontinence caused by neurological disorders, such as multiple sclerosis or spinal cord injury, management should be tailored to the individual woman's needs.

It’s very important to have an accurate diagnosis of SUI before considering surgical treatment because it can make overactive bladder symptoms worse. The diagnosis of SUI can be established with a special test called urodynamic studies. This test is essential before surgery is undertaken.

Management of Urge Incontinence

This usually starts with simple measures, such as using vaginal oestrogen and seeing a physiotherapist to help with pelvic floor rehabilitation. Learning how to retrain your bladder to hold larger amounts of urine can help reduce the urge to pass urine.

Retraining the bladder includes learning how to contract pelvic floor muscles repeatedly and practising how to hold the contraction for a specific period of time. Wiggling your toes can also help reduce urge incontinence as this sends a signal to the bladder to relax.

If you are overweight, even 5% weight loss can improve urinary urgency significantly. Removing bladder irritants can also help reduce the urge symptoms. Common bladder irritants include alcohol, caffeine (especially tea & coffee) and fizzy drinks. If you are postmenopausal, vaginal oestrogen may be prescribed to use as a vaginal cream or tablet. Oestrogen can plump up the lining of the vagina, which thins out once you go through menopause, and may provide some improvement in incontinence. However, the effect wears off once you stop using the treatment. The amount of oestrogen that gets absorbed into the body is very small and considered safe. Women who have had breast cancer should consult with their doctor to discuss whether or not they can use vaginal oestrogen.

Adding in anticholinergic medications can help in addition to bladder training and weight loss. These medications aim to decrease the contractions of the detrusor (bladder wall muscle). Another available medication is called mirabegron. Some of these medications can be quite expensive as not all of them are available on the Pharmaceutical Benefits Scheme (PBS).

If a trial of two or more medications has not helped, you may need to see a specialist who will talk to you about other treatment options, including injections of Botulinum toxin (Botox) into the bladder wall. Percutaneous tibial nerve stimulation (PTNS), or sacral nerve stimulator implants can also help by interfering the urge signals from the bladder through the process known as neurological modulation.

Where to seek further help/ information:

Your GP can start management, and if necessary, refer you onto a Gynaecology or Urogynaecology clinic.

Helpful online resources include: 

• Australian Physiotherapy Association website: http://physiotherapy.asn.au  then click “Find a Physio” and choose a Women's Health & Continence physio in your area
• www.UGSA.com.au  then click “Patient Information”
• www.yourpelvicfloor.org 

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 May 2020