Perimenopause, Menopause & MHT: Everything You Need to Know

What is Menopause?

Menopause is officially defined as one year after a woman’s last menstrual period. However, many women experience symptoms long before this, especially those using certain types of contraception, have had a hysterectomy, or a Mirena coil.

Menopause occurs due to a decline in the hormones oestrogen, progesterone, and testosterone, which play key roles in brain function, bone health, metabolism, and cardiovascular health (1).

When Does Menopause Happen?

The average age of menopause in Australia is 51 years, but it can happen earlier due to genetics, medical conditions, or treatments like chemotherapy or ovarian removal (2).

If menopause occurs before age 45, it is considered early menopause. If it happens before age 40, it is called Premature Ovarian Insufficiency (POI) and affects about 1 in 30 women (3).

What is Perimenopause?

Perimenopause is the transition phase before menopause when hormone levels fluctuate, causing symptoms that can last months to over a decade. Symptoms often begin in a woman’s early 40s, though some may experience them earlier.

Common Symptoms of Perimenopause & Menopause

Symptoms vary between women and can change over time. 80% of women experience symptoms (4), and 25% report them as severe (5). These include:

🔹 Brain fog & memory issues

🔹 Anxiety, irritability & mood swings

🔹 Poor sleep & fatigue

🔹 Hot flushes & night sweats

🔹 Low libido & vaginal dryness

🔹 Joint pain & muscle aches

🔹 Heart palpitations

🔹 Changes in menstrual cycles

Menopause symptoms result from hormonal fluctuations before becoming permanently low. This can increase the risk of:

🚨 Osteoporosis (bone loss & fractures) (6)

🚨 Heart disease & high cholesterol (7)

🚨 Type 2 diabetes (8)

🚨 Dementia & cognitive decline (9)

🚨 Autoimmune conditions (10)

How is Menopause Diagnosed?

For most women over 45, menopause is diagnosed based on symptoms without blood tests. For women under 45, hormone tests may be recommended but are often unreliable due to daily fluctuations.

Keeping track of your symptoms can help determine patterns and assess treatment needs.

What is MHT (Menopausal Hormone Therapy)?

MHT (formerly HRT – Hormone Replacement Therapy) is the most effective treatment for perimenopause and menopause symptoms (12). It includes:

✔ Oestradiol (Oestrogen) – Improves energy, mood, memory, bone, and heart health.✔ Progesterone – Protects the womb lining, supports sleep, and reduces anxiety.✔ Testosterone – Helps with libido, energy, mood, and cognitive function.

MHT is tailored individually to balance hormone levels for symptom relief and long-term health benefits.

Who Can Take MHT?

Most women can safely take body-identical MHT, which uses hormones identical to those naturally produced in the body. MHT is not one-size-fits-all—doses and formulations are adjusted based on absorption and symptom control (13).

Important Facts About MHT:

✅ Can be started in perimenopause—no need to wait for severe symptoms.

✅ There is no time limit—many women stay on MHT for life.

✅ Reduces long-term health risks such as osteoporosis and heart disease.

✅ Safe for most women, including those with migraines (14), high cholesterol (15), and high blood pressure (16).

Types of MHT & How to Take It

💠 Oestrogen (E2) Forms:✔ Transdermal (patch, gel, spray) – Absorbed through the skin, safest for heart & blood clot risk (17).✔ Oral tablets – Effective but slightly increased clot risk.

💠 Progesterone Forms:✔ Micronised progesterone (Utrogestan, Cyclogest) – Body-identical, supports sleep & mood.✔ Mirena Coil (IUS) – Provides localised progesterone for womb protection.

💠 Testosterone Forms:✔ Testosterone gel (Testogel) & cream (AndroFeme) – Supports libido, energy & cognitive function.

How Long Does MHT Take to Work?

Most women feel improvement within a few weeks. Symptoms like hot flushes and night sweats may resolve faster, while mood, sleep, and cognitive function can take longer. Adjustments may be needed for optimal symptom control.

Benefits vs Risks of MHT

🌿 Benefits:

✔ Reduces menopause symptoms (12)

✔ Lowers risk of osteoporosis & fractures (18)✔

Protects against heart disease & cholesterol issues (19)

✔ Supports brain function & reduces dementia risk (20)

⚠️ Risks:

Clots & stroke: Minimal risk with transdermal MHT (17).
Breast cancer: The risk is very low and lower than lifestyle factors like obesity and alcohol (23, 24).
Bleeding: Some women may experience temporary spotting when starting MHT.

What’s Next?

📌 Take the AMS Menopause Quiz – Find out if MHT is right for you! https://www.wamenopauseclinic.com.au/menopausequiz

📌 Consult with Our Experts – Book a consultation to discuss your symptoms and treatment options.

📌 Read More on Our Blog – Learn about MHT, lifestyle strategies, and long-term health.

📞 Book your consultation today!

References

NICE Menopause Guidelines – www.nice.org.uk/guidance/ng23
Li M, Zhu Y, Wei J, et al. Climacteric. 2022;26(2):95-102. DOI
Woods NF, Mitchell ES. Am J Med. 2005;118(12B):14-24. DOI
Cheng CH, Chen LR, Chen KH. Int J Mol Sci. 2022;23(3):1376. DOI
Iorga A, Cunningham CM, Moazeni S, et al. Biol Sex Differ. 2017;8:33. DOI
De Paoli M, Monica L, et al. Am J Pathol. 2021;191(9):1490-1498. DOI
Jett S, Malviya N, et al. Front Aging Neurosci. 2022;14:831807. DOI
Issa Z, Seely EW, et al. Menopause. 2015;22(4):456-68. DOI
Rampling K. BJGP Life. 2023. Link
Scarabin PY. Front Horm Res. 2014;43:21-32. DOI
Rossouw JE, Anderson GL, et al. JAMA. 2002;288(3):321-33. DOI