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Menopause medication is not one thing. It's a category that spans prescription hormone therapy, low-dose antidepressants, localised vaginal treatments, and newer non-hormonal drugs, each targeting different symptoms through different mechanisms. Knowing what's in the category is the first step toward asking for what you actually need, rather than accepting the first option offered or ruling out treatment entirely.
Hormone therapy: still the most effective option for most symptoms
Menopausal hormone therapy (MHT, also called HRT) remains the most effective treatment for hot flushes, night sweats, sleep disruption, and mood shifts driven by falling oestrogen. It works by replacing the hormones the ovaries reduce during the transition.
MHT comes in several forms. Patches, gels, and sprays deliver oestrogen through the skin and carry a lower clot risk than oral tablets. Oral oestrogen tablets are taken daily and suit women who prefer a simple routine. Women who still have a uterus also need progestogen, added either as a combined pill, a separate pill, or through a levonorgestrel intrauterine device (the Mirena IUD).
Body-identical hormones, which include 17-beta oestradiol and micronised progesterone (brand name Prometrium in Australia), are derived from plant sources and are chemically identical to what the body produces. Many clinicians now prefer these over older synthetic progestogens because the evidence on cardiovascular and breast-cancer risk looks more favourable, though the research is still building. If you want to understand the full picture of HRT for menopause, the evidence base and the questions worth bringing to your appointment are covered in detail.
MHT is not suitable for everyone. Women with a history of hormone-sensitive cancers, unexplained vaginal bleeding, or certain clotting disorders typically need alternatives. A clinician who specialises in menopause is better placed than a general GP to work through individual risk.
Local vaginal treatments: the underprescribed category
Genitourinary syndrome of menopause (GSM) covers vaginal dryness, discomfort during sex, urinary urgency, and recurrent urinary tract infections. It affects more than half of postmenopausal women but is consistently undertreated because many women don't raise it and many clinicians don't ask.
Local vaginal oestrogen is the first-line treatment. It comes as a cream, a vaginal tablet (Vagifem is the most widely used in Australia), or a ring inserted by a clinician. Because the oestrogen acts locally and very little reaches the bloodstream, most women who can't use systemic MHT can still use vaginal oestrogen safely, including many breast cancer survivors. It's taken long-term because GSM doesn't resolve on its own after menopause.
Ospemifene is a selective oestrogen receptor modulator (SERM) taken orally that acts on vaginal tissue without stimulating breast or uterine tissue. It's approved for dyspareunia from GSM. It isn't widely prescribed in Australia yet but is available and worth knowing about if vaginal formulations aren't tolerable.
Non-hormonal prescription options
Several prescription medications reduce hot flushes without using hormones. These matter for women who can't or won't use oestrogen.
SSRIs and SNRIs: Low doses of certain antidepressants, particularly venlafaxine, paroxetine, and escitalopram, reduce hot flush frequency and severity. They don't treat the full symptom range of menopause the way MHT does, and they come with their own side-effect profiles, but they're a real option for women with hormone-sensitive cancers or strong personal preference against hormones.
Gabapentin: An anticonvulsant used off-label for hot flushes, particularly night sweats that disrupt sleep. It can cause sedation, which makes it more useful at night than during the day. Evidence is moderate.
Fezolinetant: This is the most significant development in menopause medication in years. Fezolinetant (brand name Veozah) is a neurokinin B receptor antagonist, the first drug developed specifically to target the hypothalamic pathway responsible for hot flushes. It was approved by the FDA in the United States in 2023 and has since gained regulatory approval in the UK and EU. Australian TGA approval is a separate process, so access locally requires checking with your prescriber. It's non-hormonal and works within days for most women. It doesn't treat other symptoms of menopause beyond vasomotor ones, but for women whose main complaint is hot flushes and who can't take hormones, it's a genuinely new tool.
Clonidine: A blood pressure medication sometimes used for hot flushes. It's less effective than MHT or the newer options and carries its own side effects, so it's typically a last resort rather than a first choice.
Medications for bone health
Oestrogen protects bone density. When oestrogen falls after menopause, bone loss accelerates, and the risk of osteoporosis rises significantly over the following decade. MHT slows this process and is sometimes prescribed partly for that reason in women who are also symptomatic.
For women who aren't on MHT, bisphosphonates (alendronate, risedronate, zoledronic acid) are the most prescribed medications for preventing and treating postmenopausal osteoporosis. They reduce fracture risk substantially and are taken weekly, monthly, or yearly depending on the formulation. Denosumab is an injectable alternative given every six months.
Bone health is one area where a GP can run a DEXA scan, assess your fracture risk using the FRAX tool, and decide whether medication is warranted, without needing a specialist referral.
What to ask at your appointment
Menopause medication decisions depend on which symptoms are causing the most disruption, your health history, and your personal priorities. The most useful appointments are ones where you've named your symptoms specifically rather than broadly. A structured tool like the AMS symptom score sheet gives you and your clinician a shared starting point before you walk in the door.
Ask specifically: which medication addresses my most disruptive symptom? What form does it come in? What are the risks given my health history? How long before I notice a difference? What happens if I stop?
If your GP isn't confident discussing the options above, a menopause specialist or a gynaecologist with a menopause interest is worth seeking. The range of menopause medication has expanded considerably, and not every prescriber has kept pace with it.
Supplements vs. medication: a real distinction
Supplements are not the same as medication. Phytoestrogens, black cohosh, and magnesium are widely sold for menopause symptoms. Some have limited supporting evidence for specific symptoms; none have the evidence base that prescription medications carry. They sit outside the regulatory framework that governs pharmaceutical safety and efficacy.
That doesn't mean supplements have no place. But choosing a supplement over medication because it feels safer is a risk calculation worth making consciously rather than by default. If you're looking at the supplement options, the article on menopause treatments that actually work compares the evidence across both categories clearly.
Prescription menopause medication, used appropriately, improves quality of life in measurable ways. The conversation with your clinician is worth having more than once.