Question 1

How do I know if I'm in perimenopause?

Accepted Answer

Mostly from your symptoms and your periods, not from a test. Perimenopause usually starts in your mid-40s, though for some women it's earlier. Your periods change: closer together, further apart, heavier, lighter. And other things turn up alongside them. Hot flushes and night sweats, poor sleep, anxiety or low mood, brain fog, aching joints, less interest in sex. You don't need all of them, and you don't need hot flushes to be in perimenopause. Menopause itself is your last period, and we only know it has happened once you've gone 12 months without one. In New Zealand the average age is about 51.

Question 2

Do I need a blood test to know if I'm in menopause?

Accepted Answer

If you're over 45, usually not. Hormone levels swing from day to day in perimenopause, so a normal result one week tells you very little about the next. The Australasian Menopause Society advises against measuring FSH, oestradiol, AMH or testosterone to diagnose menopause in women over 45, because the result doesn't change the treatment. Blood tests do matter if you're under 40 and your periods have stopped, to check for early menopause. Between 40 and 45 it depends on your situation. They're also useful to look for other causes of your symptoms, such as an underactive thyroid or low iron.

Question 3

Is MHT the same as HRT?

Accepted Answer

Yes. MHT (menopausal hormone therapy) and HRT (hormone replacement therapy) are two names for the same treatment. MHT is the term the Australasian Menopause Society uses. Both mean oestrogen, plus a progestogen to protect the lining of your uterus if you still have one.

Question 4

Does HRT cause breast cancer?

Accepted Answer

Combined HRT (oestrogen plus a progestogen) is linked to a small increase in breast cancer risk, which grows the longer you take it. Oestrogen on its own carries less. Vaginal oestrogen carries no increase that studies have been able to find. The largest analysis, published in 2019, brought together studies of more than 100,000 women with breast cancer. It estimated that out of 100 women of average weight who never take HRT, about 6 get breast cancer between the ages of 50 and 69. If they take five years of oestrogen with a daily progestogen from age 50, that becomes about 8. With oestrogen only, the increase is much smaller: about one extra breast cancer for every 200 women taking it. What these numbers don't tell you. They come from observational studies, and most of the women were on older synthetic progestogens. Micronised progesterone (Utrogestan), which I usually prescribe, made no difference to the breast cancer risk in the 2019 analysis compared with the older progestogens. They're averages: your own risk depends on your family history, your breast density, your weight and how much alcohol you drink. And they leave out what HRT does for you. It's the most effective treatment for flushes and night sweats, and it protects your bones. For most healthy women with symptoms who are under 60, or within 10 years of their last period, the benefits outweigh the risks.

Question 5

What is body-identical HRT, and is it the same as "bioidentical"?

Accepted Answer

Body-identical HRT uses hormones with the same chemical structure as the ones your ovaries make: oestradiol as a patch or gel, and micronised progesterone as Utrogestan capsules. They're made in a laboratory from plant sources, they're regulated medicines that have been tested for what's in them, and in New Zealand they're funded by Pharmac, so you pay the pharmacy charge rather than the full price. "Bioidentical" is often used for something else: custom-compounded creams or lozenges, sometimes dosed from saliva tests. These aren't tested for quality or safety, and some haven't protected the lining of the uterus. The Australasian Menopause Society doesn't recommend them, and I don't prescribe them.

Question 6

How long can I stay on HRT?

Accepted Answer

There's no set date when you have to stop. The old advice to come off after five years isn't what menopause societies recommend now. Instead we review it together every year: are your symptoms still there, have your own risks changed, and what do you want? Some women stop after a few years. Others stay on much longer, for symptoms that persist or to protect their bones. If you stop, some women find their symptoms come back, so we plan it with you.

Question 7

Why do my joints ache? Is it menopause?

Accepted Answer

It might be. Aching joints and muscles are one of the commonest symptoms of perimenopause and after menopause. A 2026 review of 37 studies and more than 93,000 women found more than half had them. Oestrogen helps look after muscle, tendon and cartilage, so as it falls, morning stiffness and sore hands, hips, shoulders and neck are common. In 2024 this was given a name: the musculoskeletal syndrome of menopause. But menopause isn't the only cause, so new joint pain is worth getting checked. Arthritis, an underactive thyroid and low vitamin D can look similar. Strength training helps. For some women HRT eases the aches; in the large American WHI trial, joint pain was a little less common in women on oestrogen than on placebo.

Question 8

What can I take for hot flushes if I can't or don't want to take hormones?

Accepted Answer

There are options that work. Cognitive behavioural therapy (CBT) and clinical hypnosis both have good evidence. Of the tablets, low-dose venlafaxine, gabapentin and oxybutynin all reduce flushes, and each has its own side effects. Newer tablets that act on the brain's temperature centre, fezolinetant (Veoza) and elinzanetant (Lynkuet), aren't approved in New Zealand. If you're on tamoxifen, paroxetine and fluoxetine need to be avoided, because they block the enzyme in the liver that switches tamoxifen on. A cooler bedroom, layers and less alcohol can make nights easier, though there's little evidence they reduce the flushes themselves. Herbal remedies haven't held up in trials.

Question 9

Do menopause supplements work, and can I take them with HRT?

Accepted Answer

For hot flushes, no supplement has been shown to work as well as oestrogen, and most haven't done better than a placebo. A Cochrane review of 16 trials found black cohosh no better than placebo for flushes. Vitamins and minerals are different. If you're low in vitamin D, B12 or iron, they're worth taking, and they're fine alongside HRT. With herbal products the trouble is that you often can't tell what's in them or how much, and some interact with prescription medicines. St John's wort interacts with many, including the contraceptive pill. Bring the bottles to your appointment and we'll go through them.

Question 10

What helps vaginal dryness and pain with sex?

Accepted Answer

Vaginal dryness is one of the most common symptoms after menopause, and unlike flushes it tends to get worse over time rather than settle. Vaginal moisturisers used regularly, not only lubricant on the day, help many women. Vaginal oestrogen, a cream or pessary, is a much smaller dose than HRT and works where the problem is. It can also help with bladder symptoms and lower the chance of repeated urine infections. In New Zealand it's a prescription medicine (Ovestin). It suits most women, including many who can't take HRT, and the 2019 analysis found no increase in breast cancer with it. You can use it on its own or with HRT.

Question 11

Can women take testosterone?

Accepted Answer

Yes, for one specific problem: low sexual desire after menopause that's distressing you, once other causes have been looked at and HRT alone hasn't helped. In New Zealand the product made for women is AndroFeme cream. It's approved but not funded, so you pay the full price. We check your blood level before you start, then 6 to 8 weeks after starting and again 6 to 8 weeks after that, and then twice a year. If it hasn't helped by six months, we stop. The evidence doesn't support testosterone for energy, mood, muscle or bones on their own.

Question 12

Is my brain fog menopause, or something worse?

Accepted Answer

For most women in perimenopause, the forgetfulness and trouble concentrating are part of the transition, not the start of dementia. A large American study, SWAN, followed more than 2,300 women. During perimenopause their learning and memory scores stopped improving the way they had before, and after menopause they picked up again. Poor sleep, night sweats, anxiety and low mood all make it worse, and treating those often helps. It's still worth seeing your doctor if it's getting steadily worse, if other people are noticing, or if it's affecting your work or your safety. HRT isn't recommended as a way to prevent dementia.

Question 13

Can my GP prescribe HRT, or do I need a specialist?

Accepted Answer

Your GP can prescribe HRT, and for many women that's all that's needed. A menopause specialist can help when things are more complicated: symptoms that haven't settled on treatment, early menopause, a history of breast cancer, blood clots or migraine with aura, a strong family history, or when you've been told HRT isn't for you and want to understand why. Second opinions are normal and appropriate. You don't need a GP referral to see me, though some health insurers ask for one.

Question 14

Can I take HRT after breast cancer, or if breast cancer runs in my family?

Accepted Answer

It depends on your own situation, and it's one of the main things I see women about. A family history doesn't automatically rule HRT out. After breast cancer there are non-hormonal treatments that work, vaginal oestrogen is used all the time, by me and by most medical and radiation oncologists, and for some women, particularly after DCIS, hormone therapy can still be discussed.

Your menopause questions, answered