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Menopause treatment in Australia has expanded significantly over the past decade, but most women still leave their first GP appointment with a vague recommendation and a pamphlet. The options are broader than that. TGA-approved hormone therapy (also called menopausal hormone therapy, or MHT) sits at one end of the spectrum. Targeted non-hormonal medications, evidence-backed supplements, lifestyle protocols, and telehealth services now fill in the rest. Knowing what's available makes it easier to ask the right questions and push for the right treatment.
Menopausal hormone therapy: still the most effective option
MHT is the most clinically effective treatment for the core symptoms of menopause: hot flushes, night sweats, sleep disruption, vaginal dryness, and mood instability. The evidence base is strong. For most women under 60 or within 10 years of their last period, the benefits outweigh the risks when MHT is prescribed by a clinician familiar with current guidelines.
In Australia, MHT is available on the Pharmaceutical Benefits Scheme (PBS), which makes it significantly more affordable than many women expect. Forms include oestrogen patches, gels, sprays, oral tablets, and vaginal preparations. Women who have a uterus also need progestogen to protect the uterine lining. Micronised progesterone (brand name Prometrium in Australia) is preferred by many specialists because it carries a lower risk profile than synthetic progestogens.
If you want a thorough breakdown of how the different forms compare, the article on menopause patches: what they are and how to choose covers transdermal delivery in detail, including which women are likely to get the most out of a patch versus a gel or spray.
Non-hormonal prescription medications
Not every woman can or wants to use MHT. Contraindications include certain hormone-receptor-positive breast cancers, active clotting disorders, and uncontrolled high blood pressure, among others. In those cases, several prescription alternatives exist in Australia.
- Fezolinetant (Veoza): A neurokinin B receptor antagonist approved by the TGA in 2024, specifically targeting the brain pathway that triggers hot flushes. It's non-hormonal and shows meaningful reduction in flush frequency and severity in clinical trials.
- SSRIs and SNRIs: Certain antidepressants, particularly paroxetine, venlafaxine, and desvenlafaxine, reduce hot flush frequency by around 50 to 60 percent in clinical trials. They're not licensed for this indication in Australia but are used off-label and are a reasonable option for women with concurrent mood symptoms.
- Gabapentin: An anticonvulsant that reduces hot flushes, particularly useful for night sweats that disrupt sleep. Less commonly prescribed than SSRIs but effective for some women.
- Clonidine: An older antihypertensive sometimes used for vasomotor symptoms, though it's less effective than the options above.
These medications require a prescription and should be discussed with a GP or menopause specialist, not self-prescribed.
Vaginal and urogenital treatments
Genitourinary syndrome of menopause (GSM) is one of the most undertreated conditions in midlife women. Symptoms include vaginal dryness, irritation, burning, painful sex, and recurrent urinary tract infections. Unlike hot flushes, GSM doesn't improve on its own. It tends to worsen over time without treatment.
Local oestrogen therapy (vaginal pessaries, cream, or the Estring ring) delivers a very low dose of oestrogen directly to the vaginal tissue. The systemic absorption is minimal, making local oestrogen appropriate for most women, including many who can't use systemic MHT. Ospemifene (a selective oestrogen receptor modulator taken as an oral tablet) is another option available in Australia for women who prefer not to use a topical application.
Non-hormonal lubricants and long-acting moisturisers (such as those containing hyaluronic acid or polycarbophil) are useful adjuncts but don't reverse the tissue changes the way local oestrogen does. They manage comfort without addressing the underlying cause.
Evidence-based supplements and complementary approaches
Australia has no shortage of menopause supplements on pharmacy shelves, and the quality of evidence behind them varies sharply. A few have reasonable clinical support.
Phytoestrogens: Isoflavones derived from soy or red clover (the active compounds in products like Promensil) have modest evidence for reducing hot flush frequency. Effects are smaller than MHT and highly variable depending on how well an individual metabolises isoflavones. Some women get clear benefit; others notice nothing. Black cohosh extracts (the basis of Remifemin) have mixed trial data but remain one of the most-used herbal options in Australia.
Magnesium supports sleep quality and helps manage the anxiety component of menopause for some women. The evidence is not as robust as for MHT but it's plausible and the risk profile is low.
Cognitive Behavioural Therapy (CBT): CBT adapted for menopause has solid trial evidence, particularly for hot flush perception, sleep disruption, and mood. It doesn't reduce the number of flushes but changes how women experience and respond to them. The CBT for menopause: 7 things it actually helps with article covers what the evidence actually supports across different symptom categories.
Acupuncture has some trial support for vasomotor symptoms, though results are inconsistent. It's a reasonable addition but shouldn't replace evidence-based treatment.
Lifestyle approaches with real evidence
Lifestyle changes are often dismissed as the "just eat better and exercise more" platitude. That framing undersells what specific lifestyle inputs actually do at a hormonal level during menopause.
Resistance training preserves muscle mass and bone density, both of which decline faster after oestrogen withdrawal. It also improves insulin sensitivity, which matters because menopause shifts fat distribution toward the abdomen and raises cardiovascular risk. Aim for at least 2 sessions per week that include compound movements at a challenging load.
Diet composition affects symptom burden in measurable ways. High-glycaemic foods can worsen hot flush frequency in some women. A protein intake of around 1.2 to 1.6 grams per kilogram of body weight per day supports muscle retention better than the standard 0.8 grams recommended for the general population. The menopause medication: what's available and how to choose article also touches on how lifestyle inputs interact with medication decisions.
Sleep hygiene matters more than it sounds. Night sweats and core temperature instability disrupt sleep architecture at a neurological level. Keeping the bedroom cool (around 18 degrees Celsius), avoiding alcohol within 3 hours of bed, and maintaining a consistent sleep schedule all reduce symptom burden independently of any medication.
Telehealth and specialist access in Australia
Access to a menopause-informed clinician remains uneven across Australia, particularly outside major cities. Telehealth has changed this. Services like Remi now provide Australian women with access to practitioners specifically trained in menopause management, including MHT prescribing, without requiring a referral or a long wait for a specialist appointment.
The Australian Menopause Society maintains a directory of accredited menopause practitioners across Australia. It's the most reliable starting point for finding a clinician with specific training, whether you're in Sydney or in a regional area where options are sparse. The Jean Hailes for Women's Health website is another first-stop resource, offering evidence-based information and a symptom checklist that makes the first appointment more productive.
Getting the right treatment starts with finding a clinician who takes symptoms seriously, knows the current evidence, and treats menopause as a medical event rather than an inevitable inconvenience. That clinician exists. It sometimes takes more than one attempt to find them.