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Menopause treatments sit on a wide spectrum, from prescription hormone therapy to structured lifestyle changes, and no single option works for every woman. What you choose depends on which symptoms are worst, how long they've persisted, and what your medical history rules in or out. The good news: the evidence base has expanded considerably, and women now have more informed choices than they did a decade ago.
Hormone therapy: still the most effective option for most symptoms
Menopausal hormone therapy (MHT, sometimes still called HRT) remains the most effective treatment for vasomotor symptoms like hot flushes and night sweats. It also addresses vaginal dryness, sleep disruption, and mood changes caused by falling oestrogen. For women without contraindications, current clinical guidance from bodies including the Australasian Menopause Society supports MHT as safe for most healthy women under 60 or within 10 years of menopause onset.
MHT comes in several forms: oral tablets, patches, gels, sprays, and vaginal preparations. Transdermal options (patches and gels) carry a lower clot risk than oral tablets because they bypass the liver. Women who still have a uterus need a progestogen alongside oestrogen to protect the uterine lining. Women who've had a hysterectomy can take oestrogen alone. The type and dose should be individualised, which means a one-size prescription is worth questioning.
Non-hormonal prescription treatments
Not every woman can take or wants MHT. Contraindications include a personal history of hormone receptor-positive breast cancer, certain clotting disorders, and active liver disease. For these women, several non-hormonal prescription options have real evidence:
- SSRIs and SNRIs (such as venlafaxine or paroxetine) reduce hot flush frequency by around 50–60% in clinical trials. They're not as effective as MHT, but they're a solid second line.
- Gabapentin reduces night sweats and can improve sleep. It's often used when mood symptoms are also present.
- Fezolinetant, a neurokinin B receptor antagonist approved in several markets from 2023 onward, specifically targets the brain pathway that triggers hot flushes. It's the first non-hormonal drug designed precisely for this mechanism.
- Ospemifene is a selective oestrogen receptor modulator taken orally for genitourinary symptoms, useful for women who can't use vaginal oestrogen.
Vaginal treatments: often overlooked, often essential
Genitourinary syndrome of menopause (GSM) affects the vaginal tissue, bladder, and urethra. Symptoms include dryness, pain during sex, urinary urgency, and recurrent infections. Unlike hot flushes, GSM doesn't resolve on its own. It typically gets worse without treatment.
Low-dose vaginal oestrogen (cream, ring, or pessary) treats GSM directly with minimal systemic absorption. It's considered safe even for most breast cancer survivors, though women on aromatase inhibitors should check with their oncologist first. Over-the-counter vaginal moisturisers and lubricants help with comfort but don't reverse the tissue changes the way oestrogen does. Both can be used together.
Lifestyle-based treatments with real evidence
Exercise is not a soft add-on. Resistance training, in particular, addresses several menopause-specific concerns at once: it preserves muscle mass lost to declining oestrogen, supports bone density, reduces hot flush severity in some women, and improves mood. If you want a fuller breakdown of evidence-based natural treatments alongside lifestyle changes, the article on natural menopause treatments that actually have evidence behind them is worth reading alongside this one.
Sleep hygiene matters too. Thermal regulation is disrupted during perimenopause, so keeping the bedroom cool, reducing alcohol (a known hot flush trigger), and consistent sleep timing all reduce symptom load. The evidence for cognitive behavioural therapy (CBT) targeting hot flush distress is also strong. CBT doesn't reduce the number of flushes but significantly reduces how much they interfere with daily life.
Supplements: what the research actually shows
Phytoestrogens (plant compounds that weakly mimic oestrogen) are found in soy, red clover, and flaxseed. Evidence for their effect on hot flushes is inconsistent. Some women see modest benefit; others see none. Black cohosh has a long retail history but limited rigorous clinical support. Magnesium helps with sleep quality in women who are deficient. Vitamin D matters for bone health but doesn't treat menopause symptoms directly.
The supplement category is heavily marketed and lightly regulated. That doesn't mean everything in it is useless, but it does mean reading the label isn't enough. Look for products with published trial data, not just "clinically inspired" branding.
Bone and cardiovascular protection
Oestrogen plays a protective role in bone density and cardiovascular health. After menopause, bone loss accelerates. If MHT isn't appropriate, bisphosphonates (such as alendronate or risedronate) are the standard treatment for osteoporosis prevention or management. Weight-bearing exercise and adequate calcium and vitamin D intake support bone health regardless of which other treatment path a woman takes.
Cardiovascular risk rises after menopause. MHT started early (within 10 years of menopause) may carry cardiovascular benefits rather than risks, but MHT started late in older women with existing vascular disease does not share this profile. The timing matters.
How to approach your doctor
A productive menopause consultation covers symptom type, severity, and duration; personal and family medical history; and an honest conversation about the options that are and aren't appropriate for you. If a GP dismisses symptoms without offering any treatment pathway, a second opinion is reasonable. The Australian Menopause Society maintains a directory of accredited menopause practitioners, which is useful if you're not getting traction with your current provider.
Menopause treatment is not a single decision. It's a set of decisions, reviewed as symptoms shift and as new evidence comes in. Starting somewhere is better than waiting for the perfect option.