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Beyond Hot Flushes

It is a welcome change that the menopause is no longer a taboo subject. Afterall, although in different ways, it will affect every woman. We should also bear in mind that menopause spans 1/3 – 1/2 of a woman’s entire life. Menopause is not simply that time when periods stop. Instead menopause transition, or perimenopause, can begin 2-10 years before final menstrual period. Furthermore, about 10% of women can experience early menopause before the age of 45, and about 1% of women can experience premature menopause (or POI) before age 40. This can be either as a spontaneous event or as a side effect of a medical or surgical treatment (pelvic surgery, chemotherapy, radiotherapy etc.). Women with premature or early menopause should always have an assessment with a doctor whether they have any bothersome symptoms or not.
The many hormonal changes that occur as a woman approaches and experiences menopause transition can impact her quality of life and long term health. These symptoms often start during perimenopause and, to name just a few, include: change to period pattern, hot flushes, night sweats, change in body shape, weight gain, joint aches, sleep disturbance, brain fog, mood fluctuations, anxiety, depression, reduced libido, headaches, skin and vaginal dryness, urinary frequency and changes in pre-existing health conditions.
We also know that due to hormonal changes, from the time of menopause transition, women are at increased risk of heart disease, bone thinning (osteopenia or osteoporosis), cognitive decline, reduced muscle mass and strength (sarcopenia).
Lifestyle factors such as healthy diet, exercise and good sleep need to be addressed. This will help with the symptoms, promote healthspan and wellbeing, reduce chance of developing chronic health issues.
Menopause transition can be managed with the help of a knowledgeable medical professional. In consultation and after careful evaluation, Menopausal Hormonal Therapy (MHT), also known as Hormone Replacement Therapy or HRT, may be considered an appropriate treatment. MHT should be tailored to the specific needs of each individual woman.
For some women non-MHT prescribed treatment may be more appropriate. Where required other therapies such as psychological therapy, acupuncture, physiotherapy may also be beneficial.
IMS Congress and More…

Can you tell us about the menopause conference you attended recently in Melbourne and its significance?
It has been 4 years since the previous International Menopause Society (IMS) World Congress. The IMS World Congress normally takes place every 2 years but the 2022 Congress did not take place due to Covid. That made this year’s World Congress, held in Melbourne on 19 – 22 October 2024, highly anticipated. Over 2,500 experts in women’s health and researchers from all over the world attended in person. It was quite special to be there and I am very grateful to my colleagues for the tremendous work they shared.
What are some of the key messages you took away from the conference?
One of the key message is that lifestyle factors are absolutely fundamental to our health in general, and during midlife in particular. Menopausal Hormone Therapy (MHT) is not a magic solution, but it can be very helpful when appropriate (see link to IMS publication below).
Of lifestyle factors, sleep is fundamental. Sleep difficulties during menopause transition can affect many women. We know that this can happen for a number of reasons including anxiety, hormonal changes, disordered breathing (e.g. sleep apnoea), restless legs, getting up to go to the toilet and, of course, night sweats. If a woman is having difficulty with sleep or waking up unrefreshed, she should seek medical advice.
Loss of lean muscle can accelerate during menopause. This is due to a number of factors including reduced physical activity, hormonal changes and low protein in the diet. Muscle mass is important to us because of its many positive health effects – stronger bones, better heart health, better metabolism, and brain health to name a few. Strength training and a healthy diet including adequate protein intake is a good start. Before commencing any significant exercise regime or making any other significant lifestyle change it is advisable to consult a health care professional.
Why were you inspired to specialise in menopause treatment?
From the start of my medical career, I was motivated to maintain wellbeing through informed prevention rather than see the management of chronic conditions as the main or only path. Supporting women in a holistic way through peri-menopause and menopause has given me the opportunity to fulfil the need so many women have for sound and up-to date medical advice that enables them to then take the necessary healthy lifestyle action for their further lifelong health.
How has the treatment/understanding of menopause changed over the past few years?
Thankfully we now have a much more in-depth understanding of how menopause can affect women in different ways. Progress in MHT treatments, namely body-identical hormones and better formulations mean that MHT is now considered safer and better utilised by the body than prior pharmaceutical treatments. We also have new non-hormonal options for hot flushes and night sweats, which came about due to advances in clinical research of how hot flushes are generated in the brain.
Are there specific tests or screenings women should have during menopause?
I advise all women to commence breast screening from at age 40 as well as to continue their cervical screening (pap smears). It is also important to get your 45-49 health check done. Other tests will depend on individual health factors as these are specific to each patient.
What resources or support groups do you recommend for women experiencing menopause?
The Australasian Menopause Society’s Factsheets:
https://www.menopause.org.au/health-info/fact-sheets
For this year’s International Menopause Day (18 October), the IMS published a concise guide to MHT the ‘5Ws’ – Who, What, Why, When and Where.
https://www.imsociety.org/wp-content/uploads/2024/10/2024-WMD-Leaflet_English.pdf?v=8bcc25c96aa5
For more information on sleep:
https://www.sleephealthfoundation.org.au/
Anything else you would like to add?
Mid-life transition is a phase in a woman’s life, it is not a taboo or somethings to be used to dismiss or even worse, against her. Many women want to feel their best, confident and strong – they need to be supported in this. Good quality of life, prevention of illness and healthspan form my approach to helping women with their health.
Beyond Hot Flushes

Menopause Hormone Therapy
Dispelling the Myths
Menopause hormone therapy (MHT), also referred to as HRT, can be an effective treatment for symptoms of perimenopause or menopause.
Some myths surrounding MHT may result in women being hesitant to consider MHT as a treatment for significant menopausal symptoms or being incorrectly denied MHT. It would be helpful to dispel some of the common myths:
Myth 1
MHT causes breast cancer.
The latest research shows that oestrogen-only MHT (may be suitable if a woman had hysterectomy) does not increase risk of breast cancer above woman’s own risk. Combined MHT of oestrogen and progesterone (the most common type of MHT) is associated with a slight increase in the incidence of breast cancer above own risk. Clinical trials show that if 1000 women aged 50-59 took MHT for 5 years, there would be 4 additional cases of breast cancer. To put this risk into perspective, if 1000 women in the same age group have 2 alcohol drinks regularly for 5 years, that alone would also result in 4 additional breast cancer diagnoses. Furthermore, in the same age group having a BMI greater than 30 increases breast cancer risk by an additional 24 cases per 1000 women, which is 6 times greater than the risk associated with MHT alone. Whereas, regular exercise reduces the risk by as much as 7 fewer cases. In short, MHT is associated with a relatively small increase in incidence of breast cancer. There are certain lifestyle factors that, if corrected, can reduce a woman’s overall risk of breast cancer.
Myth 2
Women with family history of breast cancer cannot have MHT.
This is not true in many cases. Risk of breast cancer based on family history can be classified as: low, moderate or high. An example of low risk family history would be having a great-aunt who had breast cancer after 60. This is representative of typical population risk – 1 in 7-8 women in the Western world will be diagnosed with breast cancer in their lifetime, therefore many families are reasonably likely to have one relative with a history of breast cancer. Women at a moderate or high risk of breast cancer are encouraged to discuss their options and weigh up risks and benefits with a menopause specialist.
Myth 3
Women with history of blood clots cannot have MHT.
Some types of MHT do increase the risk of blood clots (such as deep vein thrombosis or pulmonary embolism), whereas other types of MHT do not. If there is family or personal history of blood clots or a known condition that predisposes to blood clots, it is important to consider the correct type of MHT. In addition, other measures can be taken to reduce the risk of blood clots.
Myth 4
If you are on MHT you do not need contraception.
Going through perimenopause does not mean a woman cannot conceive. Recently the highest relative increase of unplanned pregnancies was observed in the over 40s age group. Therefore women are under the age of 50 and periods stopped less than two years; or for women over the age of 50 and periods stopped less than one year, then contraception options need to be discussed alongside MHT.
For a woman, the decision whether to take MHT, the dose of MHT and the duration of its use should be made on an individualised basis after discussing the benefits and risks with a doctor.