MHT and menopause: balancing evidence and individual needs

A new national program helps primary healthcare professionals confidently and consistently deliver effective evidence-based advice, symptom management, chronic disease prevention and healthy ageing strategies to support women through the menopause transition.  In 2002, the Women's Health Initiative dramatically reshaped menopause care, casting a shadow that left many women* navigating a significant life event without adequate support. Two decades on, reappraisal of the data offers a more nuanced understanding that affirms a beneficial role for menopausal hormone therapy (MHT) as standard of care for many women.  

Not one-size-fits-all  

Menopause marks the end of menstruation and the start of post-reproductive life. For about 70% of Australian women, this will be a natural event that typically occurs between the ages of 45 and 55 years (average age is 51).(1) Limited evidence suggests that women from First Nations and some non-European backgrounds may experience menopause earlier.

While the transition to menopause is a universal biological milestone, it is also a deeply personal and unique experience for the individual. Understanding may also be contextualised by cultural background and social influences, highlighting the importance of tailored person-centred care delivered on a background of consistent evidence-based information.  

During perimenopause, ovarian function begins to wind down and becomes erratic, resulting in fluctuating estrogen and progesterone levels. While these fluctuations are associated with well-known symptoms such as hot flushes, night sweats, sleep disturbances and cognitive changes, women also describe the onset of many other symptoms less commonly aligned with ‘menopause’.  

Lack of recognition that these symptoms may be associated with declining ovarian function can delay treatment and leave women distressed and with poor quality of life and overall wellbeing. Approximately 75% of women experience symptoms during perimenopause and after menopause. These symptoms are moderate to severe for around 25% and affect their quality of life.(2) 

Moreover, beyond the symptoms, and even in the absence of them, menopause can also be associated with an increased risk of significant health complications such as osteoporosis and cardiovascular disease.

Navigating the gaps and barriers

 A 2023 survey reports that one in three Australian women over 45 did not consult a GP for menopause symptoms, and only about half of women under 44 experiencing symptoms would seek medical care, with many choosing to self-manage.(1)  

Research also shows that many women have limited awareness of menopause, or experience stigma, fear or denial, and cultural practices that discourage help-seeking. Negative or dismissive encounters with health professionals, inconsistent advice, and limited follow-up further deter engagement. Financial pressures, time constraints, and regional access issues compound this as well. For culturally and linguistically diverse (CALD) and First Nations women, barriers to care may be amplified by low health literacy, limited culturally appropriate resources, and a dismissal of traditional remedies by Western practitioners. 

Misinformation is another significant challenge. The legacy of the Women's Health Initiative study continues to drive overestimation of MHT risks among both consumers and clinicians. Meanwhile on social media, information and advice from reputable sources is delivered alongside content from peer influencers, leaving consumers confused and ‘lost in transition’, with clinicians spending considerable time and effort attempting to address misinformation. 

Nationally supporting quality use of medicines 

This latest Australian Government-funded program from the Quality Use of Medicines Alliance has been developed in conjunction with key partner Jean Hailes for Women’s Health, lived experience consumers, clinical experts from general and specialist practice, and the Australasian Menopause Society. This collaborative approach is focused on improving access to effective, equitable menopause care and supporting health professionals to make safe, informed clinical decisions with greater confidence.  

Through this program, health professionals can access expert interpretation of the latest evidence and guidelines in this common yet complex area of practice, through a range of opportunities such as educational visits, webinars, online learning and more. 

Pivotal to these clinical conversations are practice-based tools, including a 2-page clinical guide designed to improve clarity around hormone and non-hormone therapies for symptom management and a decision aid to support shared decision-making around treatment options. Consumer resources developed specifically for this program complement these tools, and include information on testosterone therapy use and guidance on the application of transdermal and vaginal MHT medicines. 

*The Quality Use of Medicines Alliance acknowledges that menopause and menopausal symptoms can be experienced by people undergoing gender affirming hormone therapy and people who do not identify as women. The use of the term ‘women’ in this article is not intended to isolate, exclude, or diminish any individual’s experience, nor to discriminate against any group. 

References 

1. The impact of symptoms attributed to menopause by Australian women. Jean Hailes 2023 National Women’s Health Survey. Accessed 27 March 2026, https://www.jeanhailes.org.au/wp-content/uploads/2026/01/Menopause-and-Australian-Women-FINAL_V2_TGD.pdf 

2. Therapeutic Guidelines. Overview of menopause | Therapeutic Guidelines [Internet]. [cited 2025 Oct 23]. Available from: https://app-tg-org-au.ap1.proxy.openathens.net