Menopause and Perimenopause FAQs

The time when hormone levels start to fluctuate, and you may experience menopause symptoms, which could include anxiety, low mood, hot flushes, brain fog and vaginal dryness, among others.  Periods can change and become heavier, lighter, closer together or further apart.

Menopause is the final menstrual period and is said to have occurred when there have been no menstrual periods for one year.  The average age of menopause in Australian women is 51 years, and the normal range is 45-55 years.  Menopausal symptoms can continue to occur for several years after the menopause. 

The time in your life after menopause (final menstrual period).  

It usually starts in a woman’s 40’s.  However, it can occur 4-10 years before the final menstrual period, and so menopausal symptoms can begin in a woman’s mid to late 30’s.

Perimenopausal symptoms include hot flushes and night sweats, brain fog, mood changes, changes to menstrual flow, irregular periods, insomnia, joint pain, urinary frequency and vaginal dryness.  See the AMS factsheet:  Menopause what are the symptoms:

Menopause what are the symptoms? | Fact Sheet | Australasian Menopause Society Hub

Vasomotor symptoms are common (hot flushes and night sweats), changes in menstrual flow and regularity (cycle varying by 7 days or more), insomnia and mood changes. 

Women going through the menopausal transition are at higher risk of mood changes and symptoms of depression and anxiety.   See AMS fact  sheet: Menopause and Mental Health Menopause and Mental Health | Fact Sheet | Australasian Menopause Society Hub

Yes, this is a symptom of perimenopause and can manifest with forgetfulness, which can lead some women to question if they are developing early dementia.

This may have many causes that are related to stress and lifestyle, but can also be a direct result of hormonal change and the early fall in progesterone in the perimenopause.   Good sleep habits and regular exercise, especially outside to set circadian rhythms, can be helpful.  Melatonin and magnesium supplements are also worth consideration.  See Women’s Health Concern Factsheet Understanding and managing sleep problems during menopause:  17-NEW-WHC-FACTSHEET-menopause-and-sleep-disturbance-OCT2025-B.pdf

This is a result of the mental health changes in relation to the perimenopausal hormonal changes, and women who have had PMS or PMDD in the past may struggle particularly with mental health changes at this time.

Joint pain is a symptom of the perimenopause and can be improved with menopausal hormone therapy and exercise.  

 Caffeine, stress and being overweight can make hot flushes worse.  

Metabolic changes during perimenopause lead to weight gain of approximately 0.5 kg per year, and this is often central weight gain.  

This may have many causes but may be related to insomnia, mood changes or micro-nutrient deficiencies for example iron deficiency due to heavy menstrual bleeding.

Yes – periods can become closer together or further apart.

No – this is abnormal.  Bleeding between periods, after sex or after 12 months with no periods (post menopausal bleeding) is abnormal and you should see your GP to get checked out.  

This is due to the hormonal changes of perimenopause, and oestrogen excess relative to progesterone can lead to heavier periods.  

As hormone levels fluctuate wildly during the perimenopause, blood tests in women over the age of 45 years with menopausal symptoms are not recommended.  They are recommended in women under the age of 45 years with absent periods to diagnose early menopause. 

In the perimenopause, hormone tests fluctuate wildly, and therefore tests may come back normal even though hormone levels are overall falling.  

Generally, no unless your doctor suspects early menopause.  It is a clinical diagnosis most of the time.

Yes, you can still get pregnant as the ovaries are still active.

If you are under 50 years, 2 years after your last menstrual period, and if you are over 50 years, 1 year after your last menstrual period. 

Yes, until 2 years after your last menstrual period.  The oral contraceptive pill can be used up to the age of 50 years in healthy women with no contraindications, and there are also excellent, safe progestogen-only methods, including the Mirena IUCD, which can also be used as the progestogen-only component of menopause hormone therapy. 

Hormonal and non-hormonal options are available for menopause symptoms.  Hormone replacement therapy or MHT is the most effective treatment for menopause symptoms.  

Hormones are prescribed to help with oestrogen deficiency.  This is most prescribed for women around the time of menopause to relieve menopausal symptoms and to prevent osteoporosis

Yes.  See the AMS Factsheet What is Menopause Hormone Therapy and is it Safe?  What is Menopausal Hormone Therapy (MHT) and is it Safe? | Fact Sheet | Australasian Menopause Society Hub

Women with undiagnosed vaginal bleeding, a history of breast cancer, active blood clots, acute heart attack or stroke, porphyria and severe liver disease.

These include gabapentin, oxybutynin and a newer treatment Veoza (fezolinetant).

Reducing alcohol, sugar, caffeine, stress and optimising weight can all have a positive impact on symptoms.

Yes – maintaining blood sugar control, managing caffeine intake and eating food rich in phyto-oestrogens and fibre can be helpful.  See WHC factsheet Nutrition in menopause:  28-WHC-FACTSHEET-Nutrition-in-Menopause-JULY2023-A.pdf

Exercise can help with weight management and stress management, which then reduces hot flushes.  29-WHC-FACTSHEET-Exercise-in-menopause-JUNE2023-A.pdf

They can be for some women, but there is a lack of research evidence to confirm the benefit.  There can be contraindications for some supplements with prescribed medicines, so check with your doctor before taking. 03-NEW-WHC-FACTSHEET-Complementary-And-Alternative-Therapies-NOV2025-B.pdf

Falling oestrogen levels can lead to vaginal dryness, and this can then lead to painful sexual intercourse. 

Vaginal oestrogen is an effective treatment for menopausal vaginal dryness that is safe even for breast cancer survivors.  Other treatments include vaginal moisturisers.  Our doctors can provide vulval skin care information.

Falling female hormone levels can affect libido, and this can be treated with menopausal hormone therapy.  Topical testosterone is licensed for hypoactive sexual desire disorder (persistent low libido) and may be added to treatment.  Low libido can be complex and multifactorial, and our doctors will take a careful psychosocial and sexual history to understand the issues and formulate an appropriate management plan beyond hormone replacement. 

Yes.  Bone loss accelerates in the perimenopause and can be up to 20% post menopause.  This increases the risk of fractures and there is a 1:5 risk of mortality following hip fractures which are also highly likely to be followed by loss of independence.  Menopause and Bone Health – Decreasing the risk of Osteoporosis | Fact Sheet | Australasian Menopause Society Hub

Yes.  Risk of cardiovascular disease rises post menopause with changes in lipid profile, central weight gain and an increased risk of diabetes/insulin resistance.  Making positive lifestyle choices such as choosing a Mediterranean diet, exercise to boost cardiovascular health eg brisk walking, smoking cessation and low alcohol consumption all help to prevent strokes, heart attacks and vascular disease. Maintaining Your Weight and Health During and After Menopause | Fact Sheet | Australasian Menopause Society Hub

Consider asking your doctor for a DEXA to measure your bone density.  There is good evidence that menopausal hormone therapy prevents osteoporosis, so this may then be a consideration if your bones are starting to get thinner (osteopenia).  Having adequate dietary calcium, sufficient vitamin D and engaging in weight-bearing resistance exercise at least twice per week.  Sometimes this may mean consulting with an exercise physiologist for an appropriate exercise programme to avoid injuring yourself whilst lifting sufficient weight to boost bone density.  hba-fact-sheet-menopause.pdf

No.  The risk of breast cancer in those women with a family history of breast cancer is the same in menopause hormone therapy users vs non users.

Yes.  BRCA gene carrier status is not a contra-indication to menopause hormone therapy. 

There is a relatively new medication called fezolinetant, which is being used for hot flushes in women with a history of breast cancer.  There are other medications, including SSRI’s/SNRI’s, gabapentin and oxybutynin.  Cognitive behavioural therapy, hypnotherapy, and stellate ganglion block are also options. 

This is a controversial area and in general breast cancer is a contra-indication to hormone therapy according to international guidelines.  This recommendation was based on a single study HABITS done two decades ago that showed a significant risk of breast cancer recurrence.  There have, however, been 24 other studies that have not demonstrated risk, and there has been some criticism of the HABITS study design and conclusions.  At Elara, our doctors will carefully explain the evidence base and safety of MHT in breast cancer survivors and in some situations menopause hormone therapy can be prescribed.  

Bluming AZ. Hormone Replacement Therapy After Breast Cancer: It Is Time. Cancer J. 2022 May-Jun 01;28(3):183-190. doi: 10.1097/PPO.0000000000000595. PMID: 35594465.

If you are developing troublesome symptoms, then it is good to seek medical advice.  Some symptoms may appear to be menopausal but are in fact due to another condition, e.g., underactive/overactive thyroid. 

It can be helpful to go through a menopause checklist beforehand and bring this to the appointment.  What’s bothering you?

Yes.  It is now well recognised that perimenopausal symptoms can occur in conjunction with changes in menstruation/cyclicity and sometimes even with normal periods.