Menopause Treatment in 2026: Your Options Explained

Menopause is a natural stage of life — but that does not mean the symptoms have to be endured in silence. In 2026, there are more evidence-based treatment options available than ever before, and your GP plays a central role in helping you find the right approach for your body, your health history, and your life.

Here is what you need to know about current menopause management.

What is menopause?

Menopause is defined as 12 consecutive months without a menstrual period, typically occurring between the ages of 45 and 55 in Australian women. The average age is 51.

Perimenopause — the transition phase leading up to menopause — can begin several years earlier and is often when symptoms are most disruptive. Hormone levels fluctuate significantly during this time, which drives the wide range of symptoms women experience.

Common symptoms include:

• Hot flushes and night sweats
• Sleep disturbances
• Mood changes, anxiety, and low mood
• Brain fog and difficulty concentrating
• Vaginal dryness and discomfort during sex
• Reduced libido
• Joint aches and muscle pain
• Changes in skin and hair

Symptoms vary enormously between women — some experience minimal disruption, while others find their quality of life significantly affected.

Menopausal Hormone Therapy (MHT)

Menopausal Hormone Therapy — previously called Hormone Replacement Therapy (HRT) — remains the most effective treatment for moderate to severe menopausal symptoms. Australian and international guidelines have been updated in recent years to reflect a more nuanced understanding of its benefits and risks.

How MHT works

MHT replaces the oestrogen (and progesterone, for women with a uterus) that the body is no longer producing in sufficient quantities. This directly addresses the hormonal cause of most menopausal symptoms.

Types of MHT available in Australia

• Combined MHT (oestrogen + progesterone) — for women who have not had a hysterectomy
• Oestrogen-only MHT — for women who have had a hysterectomy
• Tibolone — a synthetic steroid with oestrogenic, progestogenic, and mild androgenic activity

MHT is available in several forms:

• Patches — applied to the skin, changed every 1–3 days
• Gels and sprays — applied daily to the skin
• Tablets — taken orally once daily
• Vaginal preparations — creams, pessaries, or rings for localised symptoms

Transdermal preparations (patches, gels, sprays) are generally preferred as they carry a lower risk of blood clots compared to oral tablets.

Who is MHT suitable for?

For most healthy women under 60, or within 10 years of menopause onset, the benefits of MHT outweigh the risks. Your GP will review your personal and family medical history to assess suitability, including any history of:

• Breast or hormone-sensitive cancers
• Blood clots (deep vein thrombosis or pulmonary embolism)
• Cardiovascular disease
• Liver disease

MHT is not a one-size-fits-all treatment. The type, dose, and delivery method are tailored to each individual.

Non-hormonal prescription treatments

For women who cannot or prefer not to use MHT, several non-hormonal options have good evidence behind them:

• SSRIs and SNRIs (such as venlafaxine or escitalopram) — originally developed as antidepressants, these can significantly reduce hot flushes and improve mood
• Gabapentin — an anticonvulsant that can help with hot flushes and sleep disturbance
• Clonidine — a blood pressure medication that may reduce hot flush frequency
• Fezolinetant — a newer neurokinin receptor antagonist specifically approved for vasomotor symptoms (hot flushes and night sweats), now available in Australia

Your GP can discuss which of these may be appropriate based on your symptom profile and medical history.

Vaginal oestrogen

Vaginal dryness, discomfort, and urinary symptoms (collectively known as Genitourinary Syndrome of Menopause, or GSM) often respond well to low-dose localised vaginal oestrogen. This is available as:

• Creams
• Pessaries
• A slow-release vaginal ring

Because the oestrogen is absorbed locally rather than systemically, vaginal oestrogen is considered safe for most women, including many who cannot use systemic MHT. It can be used long-term and does not require progesterone to protect the uterus.

Lifestyle strategies

Lifestyle measures are an important complement to any medical treatment — and for women with mild symptoms, they may be sufficient on their own.

Evidence-based lifestyle strategies include:

• Regular exercise — particularly aerobic exercise and resistance training, which can reduce hot flush frequency, improve sleep, support bone density, and improve mood
• Maintaining a healthy weight — excess body fat is associated with more severe hot flushes
• Reducing alcohol and caffeine — both can trigger or worsen hot flushes
• Quitting smoking — smoking is associated with earlier menopause and more severe symptoms
• Stress management and mindfulness — cognitive behavioural therapy (CBT) has good evidence for reducing the distress associated with hot flushes and sleep problems
• Good sleep hygiene — keeping the bedroom cool, consistent sleep and wake times, and limiting screen use before bed

Complementary therapies

Some women find relief with complementary approaches. The evidence varies:

• Phytoestrogens (found in soy, flaxseed, and red clover supplements) — some evidence for mild reduction in hot flush frequency
• Black cohosh — modest evidence for hot flush relief; discuss with your GP before use as it can interact with some medications
• Acupuncture — some evidence for symptom relief, though study quality is variable

It is important to discuss any supplements or complementary therapies with your GP, as some can interact with medications or are not appropriate for all women.

Bone health and cardiovascular health

Oestrogen plays a protective role in bone density and cardiovascular health. After menopause, women's risk of osteoporosis and heart disease increases. Your GP may recommend:

• A bone density scan (DEXA scan) to assess your baseline
• Adequate calcium and vitamin D intake
• Weight-bearing exercise
• Cardiovascular risk assessment

MHT, when started early in the menopause transition, may also have protective effects on bone and cardiovascular health — another reason why timing matters.

When to see your GP

You do not need to wait until symptoms become severe. A GP appointment is worthwhile if:

• Symptoms are affecting your sleep, work, relationships, or quality of life
• You are unsure whether what you are experiencing is perimenopause
• You want to understand your treatment options before deciding
• You have been on MHT and want to review whether it is still right for you
• You have concerns about bone health, cardiovascular risk, or long-term wellbeing

At The Oaks General Practice, our GPs take a whole-person approach to menopause care. We take the time to understand your symptoms, your health history, and your preferences — and work with you to find a management plan that fits your life.

Book an appointment online through HotDoc, or call us on (02) 4257 1234.