Menopause & Perimenopause Support Online

What are perimenopause and menopause?

Perimenopause is the transition phase leading up to menopause, during which hormone levels fluctuate and menstrual cycles change. Menopause is confirmed once a person has not had a period for 12 consecutive months and typically occurs in Australia between ages 45 and 55.

Common symptoms include hot flushes, night sweats, sleep disturbance, mood changes, joint aches, brain fog, vaginal dryness, and changes in libido. Some people experience few symptoms; others find the impact on daily life significant.

How a telehealth GP can help

A NewDoc GP can take a thorough history, discuss your symptoms and concerns, and explain the available management options. This includes menopausal hormone therapy (MHT, formerly called HRT), non-hormonal medication options, and lifestyle approaches. Your GP can issue eScripts, order pathology tests, and refer to specialists such as gynaecologists or endocrinologists if needed.

Because menopause affects bone and cardiovascular health, your GP may also review cholesterol, blood pressure, and bone density risk, and discuss whether additional investigations such as a bone density scan (DEXA) are appropriate for you. Our blood test referrals service can arrange pathology forms electronically.

Menopausal hormone therapy (MHT) and non-hormonal options

Australian Menopause Society and Therapeutic Guidelines (eTG) recommend MHT as the most effective treatment for vasomotor symptoms (hot flushes, night sweats). Transdermal estrogen (patches and gels) is preferred over oral for most women because of lower venous thromboembolism risk. Body-identical micronised progesterone is recommended alongside transdermal estrogen where the uterus is intact.

Transdermal estrogen — preferred first-line

• Estradiol patches (Estradot 25–100 mcg/24h, Climara) — twice-weekly (Estradot) or weekly (Climara); skin patches deliver estradiol through the skin
• Estradiol gel (Estrogel, Sandrena) — daily application to inner arm or thigh; flexible dosing

Progesterone for endometrial protection

• Micronised progesterone 100–200 mg nocte (Prometrium) — body-identical; preferred for women with intact uterus on transdermal estrogen; favourable cardiovascular and breast risk profile vs synthetic progestogens
• Mirena IUD — alternative for endometrial protection; provides 5 years of contraception and progestogen cover

Combination MHT (estrogen + progestogen in one product)

• Estradiol + dydrogesterone (Femoston, Femoston-Conti)
• Estradiol + norethisterone (Kliogest, Kliovance)
• Tibolone (Livial) — synthetic steroid with mild estrogenic, progestogenic, and androgenic activity; alternative for postmenopausal women

Vaginal estrogen — for genitourinary symptoms

• Estriol cream or pessary (Ovestin) — applied vaginally; safe long-term for vaginal dryness, urinary symptoms, recurrent UTI in postmenopausal women
• Estradiol vaginal tablet (Vagifem) — twice-weekly insert
• Prasterone (DHEA) vaginal pessary (Intrarosa) — alternative non-estrogen option

Non-hormonal options

• Venlafaxine 37.5–75 mg daily or paroxetine 10–20 mg daily — SSRIs/SNRIs reduce hot flushes by about 50% and help mood symptoms
• Clonidine — for hot flushes where SSRIs/SNRIs are not suitable
• Gabapentin 100–300 mg nocte — useful for night sweats and sleep disturbance
• Cognitive behavioural therapy (CBT) — evidence-based for hot flushes, sleep, and mood; can be accessed via a Mental Health Treatment Plan

Treatment is individualised based on symptoms, time since last menstrual period, personal and family history (breast cancer, VTE, cardiovascular disease), and your preferences. Most women have follow-up at 3 months after starting MHT, then 6–12 monthly review.

Risk factors and related considerations

Menopause is a natural life stage, but several factors can influence when it occurs and how symptoms present. Premature ovarian insufficiency may result in menopause before age 40, and surgical removal of the ovaries or certain cancer treatments may induce menopause earlier than expected. Smoking is also associated with an earlier natural menopause.

Personal and family history influence treatment decisions. A history of breast or hormone-sensitive cancer, blood clots, stroke, or cardiovascular disease may affect whether MHT is suitable. If you are still at risk of pregnancy, discussing contraception alongside symptom management is often helpful. Your GP will weigh the considerations with you.

Monitoring and follow-up

Menopause care generally involves regular review, especially in the first few months after starting or changing MHT. Follow-up appointments give your GP a chance to review symptom response, adjust dose or formulation if appropriate, and check for any new concerns. Routine checks of blood pressure, weight, breast awareness, and cervical screening remain important during and after the menopause transition.

Bone and cardiovascular health become more important with age, so periodic review of cholesterol, glucose, bone density risk, and lifestyle factors is often part of ongoing care. Repeat scripts and pathology requests can be managed through telehealth follow-ups, and your GP will advise when in-person review or specialist input is appropriate.

Tips for managing menopause symptoms

Dressing in layers, keeping a cool sleeping environment, and identifying personal hot-flush triggers such as spicy foods, alcohol, caffeine, or stress may help reduce how disruptive symptoms feel day to day. Regular physical activity, including some weight-bearing exercise, supports bone and heart health alongside mood and sleep.

Good sleep hygiene, relaxation practices, and reducing evening alcohol can help with night sweats and disrupted sleep. If low mood, anxiety, or persistent sleep disturbance is affecting daily life, discuss these with your GP so that appropriate support can be considered.

Vaginal dryness and urinary symptoms are common and can be addressed with specific treatments. These symptoms often persist beyond the menopause transition, so raising them during follow-ups ensures they are not overlooked. Peer support groups and trusted information sources may also help people feel more prepared and less alone.