Why these symptoms often occur together

Many women are surprised to experience new or worsening anxiety, low mood, irritability, or cognitive changes during perimenopause — particularly if they have never had mental health concerns before.

Sleep, mood, anxiety, and cognition are closely linked through shared brain pathways and neurochemical systems. Changes in one area can influence the others, creating a bidirectional cycle:

• Poor sleep can worsen mood, anxiety, and concentration
• Anxiety and low mood can disrupt sleep initiation and maintenance
• Cognitive symptoms may be amplified by fatigue, stress, and fragmented sleep

Understanding this overlap helps explain why symptoms may feel broad, unpredictable, or disproportionate to a single cause.

Hormonal influences on the brain (high-level overview)

Oestrogen and progesterone influence several neurotransmitter systems involved in emotional regulation, stress response, and cognitive processing, including serotonin, GABA, and dopamine.

During the menopause transition, fluctuating or declining hormone levels may increase sensitivity within these systems. This does not mean hormones are the sole cause of mood or cognitive symptoms, but rather that the brain may become more vulnerable to stressors that were previously well tolerated.

Importantly, this vulnerability varies widely between individuals.

The sleep–mood–stress connection

Sleep disturbance is both a symptom and a driver of emotional and cognitive change.

Fragmented or insufficient sleep can:

• Lower stress tolerance
• Increase emotional reactivity
• Reduce concentration and memory efficiency
• Exacerbate anxiety and low mood

At the same time, heightened stress, worry, or mood changes can make it harder to fall asleep or stay asleep, reinforcing the cycle.

This overlap explains why addressing sleep patterns is often a key component of broader symptom assessment in perimenopause and menopause.

Understanding “brain fog”

“Brain fog” is a commonly reported term used to describe experiences such as:

• Reduced concentration or focus
• Slower word retrieval
• Forgetfulness
• Feeling mentally less sharp or efficient

In midlife women, these symptoms are often functional rather than degenerative. They may reflect the combined effects of sleep disruption, stress, hormonal sensitivity, and cognitive load, rather than underlying neurological disease.

While frustrating, these changes are typically subtle, fluctuate over time, and are not associated with progressive cognitive decline.

Anxiety and mood changes in midlife

Some women experience:

• New-onset anxiety
• Increased worry or rumination
• Panic symptoms
• Low mood or loss of enjoyment
• Heightened emotional sensitivity

These changes may occur even in women with no prior mental health history. For others, existing anxiety or mood disorders may worsen during the menopause transition.

Distinguishing between menopausal vulnerability, situational stressors, sleep-related effects, and primary mental health conditions is an important part of clinical assessment.

Other contributing factors to consider

As with sleep disturbance, mood and cognitive symptoms should not automatically be attributed to menopause alone. Other contributors may include:

• Chronic stress or burnout
• Caring responsibilities or life transitions
• Thyroid dysfunction
• Iron deficiency
• Medication effects
• Alcohol sensitivity
• Underlying mental health conditions

A systems-based approach helps ensure important contributors are not overlooked.

When to consider a clinical review

A longer or more comprehensive review may be appropriate if mood, anxiety, or cognitive symptoms:

• Are persistent or worsening over time
• Interfere with work, relationships, or daily functioning
• Are associated with significant sleep disruption
• Include panic symptoms or marked distress
• Are accompanied by physical symptoms such as palpitations, tremor, or unexplained weight change
• Raise concerns about safety or wellbeing

Assessment may involve exploring symptom patterns, sleep quality, medical history, psychosocial factors, and, where appropriate, further investigation.

Key takeaway

Sleep disturbance, mood changes, anxiety, and cognitive symptoms commonly overlap during perimenopause and menopause. These experiences are best understood as interconnected systems influenced by hormonal sensitivity, sleep quality, stress, and individual context.

A structured, individualised approach, rather than focusing on a single symptom in isolation, is supported by current clinical guidance.

In Part 3, we will explore how clinicians think about evidence-based management pathways, including hormonal and non-hormonal options, sleep-focused strategies, and broader supportive approaches.

If you would like to seek further information about these symptoms or learn more about assessment options, you can contact Menopause & Me:

📧 hello@menopauseandme.com.au

🌐 menopauseandme.com.au/booking

You’re not alone on this journey: knowledge is power!

Warm Regards,

Jenna Bell

Nurse Practitioner & Menopause Educator

P.S. Missed our recent editions?

They’re all saved on the website for you anytime in the blog section

Sources

Australasian Menopause Society | International Menopause Society | North American Menopause Society | NICE Guidelines NG23

Important  Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse  Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements –  particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past.  Individual needs and responses vary.

Why sleep can change during perimenopause and menopause?

Vasomotor symptoms and sleep disruption

Hot flushes and night sweats can fragment sleep, trigger waking episodes, and reduce overall sleep quality. For some women, effectively addressing vasomotor symptoms may improve subjective sleep quality.

However, not all sleep disturbance during menopause is driven by vasomotor symptoms alone.

Hormonal influence on sleep regulation

Oestrogen and progesterone interact with brain pathways involved in thermoregulation, mood, and sleep–wake regulation. During the menopause transition, fluctuating or declining hormone levels may increase vulnerability to sleep disruption, even in the absence of other health changes.

Importantly, hormonal change is rarely the sole cause of sleep disturbance.

Other contributors common in midlife

Sleep changes during this stage may also be influenced by:

• Sleep apnoea or snoring
• Iron deficiency or restless legs symptoms
• Thyroid dysfunction
• Anxiety or low mood
• Increased sensitivity to alcohol
• Caring responsibilities, work demands, or chronic stress

For this reason, sleep disruption should not automatically be attributed to menopause alone, and other contributing factors may need to be considered and addressed.

How sleep disturbance may present

Women may notice:

• Difficulty falling asleep
• Frequent night-time waking
• Early morning waking with difficulty returning to sleep
• Non-restorative sleep
• Daytime fatigue, reduced concentration, or irritability

While these experiences are common, they are not insignificant and warrant assessment if they persist or interfere with daily functioning.

An evidence-based approach to assessment

Step 1: Identify your sleep pattern

Tracking sleep for 1–2 weeks can be helpful. This may include:

• Bedtime and wake time
• Night sweats (if present)
• Alcohol or caffeine intake
• Exercise timing
• Mood or stress levels
• Duration and frequency of night waking

Identifying patterns can help differentiate between insomnia, vasomotor-related sleep disruption, circadian rhythm changes, or other sleep disorders.

Step 2: Consider insomnia-focused approaches when appropriate

For women experiencing persistent insomnia, cognitive behavioural therapy for insomnia (CBT-I) is recognised as a first-line, evidence-based management option.

CBT-I is a structured, non-medication therapy that focuses on how sleep habits, behaviours, and thought patterns influence sleep quality. It commonly includes strategies such as:

• Improving sleep consistency and sleep drive
• Reducing behaviours that unintentionally disrupt sleep
• Addressing unhelpful beliefs or anxiety related to sleep

International guidance, including NICE Guideline NG23 (updated 7 November 2024), supports menopause-specific CBT approaches for sleep difficulties associated with vasomotor symptoms, as well as broader cognitive and behavioural strategies for menopause-related sleep disturbance.
Recent research continues to support the role of CBT-I in this population.

Step 3: Address contributing symptoms

Where vasomotor symptoms are a major contributor to sleep disruption, symptom-directed approaches may be considered following individual clinical assessment.

For women who are unable or prefer not to use hormone-based therapies, non-hormonal options — supported by evidence such as the NAMS Nonhormone Therapy Position Statement — may also be discussed where appropriate.

Practical strategies that may support sleep

The following approaches may be helpful, depending on the underlying pattern and are aligned with lifestyle guidance from menopause societies such as the Australasian Menopause Society, which emphasise restorative sleep as part of midlife health:

If night sweats are present

• Maintaining a cool bedroom environment
• Using breathable bedding and layered sleepwear
• Limiting alcohol and heavy meals close to bedtime

If difficulty settling or racing thoughts occur

• Establishing a consistent wind-down routine
• Limiting stimulating activities before bed
• Structured insomnia-focused strategies (such as CBT-I principles)

If early morning waking is a concern

• Keeping wake times consistent
• Exposure to morning daylight
• Avoiding long or late naps

When to consider a clinical review

A longer appointment may be appropriate if sleep disturbance:

• Persists most nights for more than four weeks
• Is associated with loud snoring, gasping, or marked daytime sleepiness
• Occurs alongside persistent low mood or anxiety
• Is accompanied by symptoms such as restless legs, palpitations, or unexplained weight change
• Is associated with bleeding changes or other new health concerns

Assessment may involve reviewing symptoms, medical history, medications, and, where appropriate, further investigation.

Key takeaway

Sleep and fatigue changes during perimenopause and menopause are common and often multifactorial. A structured, individualised approach — identifying contributing factors and tailoring assessment and management accordingly — is strongly supported by current clinical guidance.

If you would like to seek further information about sleep changes during menopause, or learn more about available assessment options, you can contact Menopause & Me:

📧 hello@menopauseandme.com.au

🌐 menopauseandme.com.au/booking

You’re not alone on this journey: knowledge is power!

Warm Regards,

Jenna Bell

Nurse Practitioner & Menopause Educator

P.S. Missed our recent editions?

They’re all saved on the website for you anytime in the blog section

Sources

Australasian Menopause Society | International Menopause Society | North American Menopause Society | NICE Guidelines NG23

Important  Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse  Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements –  particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past.  Individual needs and responses vary.

Why Skin Changes Occur in Menopause

Oestrogen plays an important role in maintaining skin structure and function. As levels decline during perimenopause and menopause, several changes can occur:

• Reduced collagen production and accelerated collagen breakdown
• Decreased skin thickness and elasticity
• Reduced natural oils and hydration
• Impaired skin barrier function

Research suggests that up to 30 percent of skin collagen may be lost within the first five years after menopause, with ongoing gradual decline thereafter.

Common skin changes reported include:

• Dryness, itching, or increased sensitivity
• Fine lines and deeper wrinkles
• Loss of firmness or sagging
• Changes in pigmentation or uneven tone
• Adult-onset or persistent acne related to hormonal fluctuation

Why Hair Changes Occur in Menopause

Hair growth is influenced by hormonal balance. As oestrogen and progesterone levels fall:

• The active (growth) phase of the hair cycle shortens
• Hair follicles may become smaller over time
• Relative androgen activity may increase

As a result, many women notice:

• Diffuse thinning or widening of the part (female-pattern hair thinning)
• Dry, brittle hair texture
• Slower regrowth
• Increased facial hair in some areas

Evidence-Based Ways to Support Skin and Hair Health

Lifestyle and topical care remain first-line strategies:

• Use gentle cleansers and moisturisers containing ceramides or hyaluronic acid
• Apply broad-spectrum sunscreen daily
• Introduce retinoids or peptides gradually if appropriate
• Ensure adequate dietary protein, essential fats, and antioxidants
• Prioritise sleep and stress management

Hormone therapy:
For women who are suitable candidates, menopause hormone therapy has been shown to improve skin hydration, elasticity, and collagen content. Evidence for direct benefits on scalp hair is more limited and outcomes vary between individuals.

A Simple 3-Step Approach

1. Observe and track changes
   Photos or brief journaling can help identify patterns over time.
2. Seek a clinical review
   Other contributors such as iron deficiency, thyroid conditions, nutritional gaps, or dermatological conditions should be considered.
3. Ask targeted questions
   “Which skincare, hair treatments, or medical options are appropriate for me?”

If you’d like support or a personalised plan, you can reach me at:

📧 hello@menopauseandme.com.au
🌐 menopauseandme.com.au

Warmly,
Jenna
Nurse Practitioner & Menopause Educator

Sources

Australasian Menopause Society | North American Menopause Society | International Menopause Society | European Menopause and Andropause Society | Brincat M et al. Skin ageing and menopause. Climacteric | Thornton MJ. Oestrogen and hair follicle biology. Journal of Endocrinology | Affinito P et al. Effects of hormone therapy on skin collagen. Maturitas

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.

Progesterone recap

Progesterone receptors are found in many tissues (including the uterus and brain). In menopause hormone therapy (MHT), progesterone (or another progestogen) is primarily used to protect the lining of the uterus (endometrium) when oestrogen is prescribed and you still have a uterus.

Some women also report improvements in sleep or mood with certain progestogens, but responses vary and this isn’t the main reason progesterone is prescribed in MHT.

Body-identical option:

• Micronised progesterone (e.g., Utrogestan) is the body-identical progesterone option used in MHT.

Common TGA-approved progesterone options in Australia

• Micronised progesterone capsules (e.g., Utrogestan): used orally for MHT and also used vaginally in some contexts (follow prescriber advice and product information).
• Other progestogens may be used for endometrial protection depending on the regimen and individual factors (your clinician will guide this).

Key safety point: If you have a uterus and are using systemic oestrogen for MHT, a progestogen is usually required to reduce the risk of endometrial hyperplasia/cancer.

Testosterone recap

Women produce testosterone across the lifespan, and it plays a role in sexual function among other physiological processes. However, when it comes to menopause care, international consensus is clear:

The only evidence-based indication for systemic testosterone therapy in women is:
✅ Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women, after a biopsychosocial assessment and after other contributing factors are addressed.

There is insufficient evidence to recommend testosterone for problems such as fatigue, “brain fog”, mood, or disease prevention.

TGA-approved option in Australia

• AndroFeme 1 (testosterone cream) is TGA-registered for HSDD in postmenopausal women.

PBS note (important correction):

• As of December 2025, AndroFeme 1 is not PBS-listed, following a PBAC decision not to recommend listing.

Monitoring matters: If testosterone is prescribed, guidelines recommend using the lowest effective dose, aiming for physiological female ranges, and monitoring for side effects (e.g., acne, hair changes) and blood levels.

DHEA recap (prasterone)

DHEA is an adrenal precursor hormone that declines with age. In menopause care, the most established role is local vaginal DHEA (prasterone) for symptoms of genitourinary syndrome of menopause (GSM) such as dryness and painful sex.

TGA-approved option in Australia

• Intrarosa (prasterone) vaginal pessaries are TGA-approved for moderate–severe vulvar and vaginal atrophy in postmenopausal women. Therapeutic Goods Administration (TGA)+1

Important safety note (correction):

• Australian prescribing information and Australian Prescriber reporting indicate contraindications, including a history of breast cancer or thromboembolism. This is a situation where personalised specialist advice is essential. Australian Prescriber+1

Oral DHEA supplements:

• Evidence for broad menopause symptom relief is limited and inconsistent, and they’re not routinely recommended in major menopause guidance. menopause.org.au+1

What symptom changes are realistic?

Guidelines support the following, when therapy is clinically indicated:

• Progesterone (as part of MHT if you have a uterus): endometrial protection; some women notice sleep benefits, but this varies.
• Testosterone (for diagnosed HSDD): can improve sexual desire and related distress in postmenopausal women; effects are typically moderate.
• Vaginal DHEA (prasterone): can improve vaginal tissue symptoms and painful sex related to GSM.

Individual responses vary, and treatment choice depends on your overall health and preferences.

Your helpful 3-step plan

1. Reflect on symptoms
   • Uterus + systemic oestrogen? You’ll usually need a progestogen for uterine protection. menopause.org.au+1
   • Distressing low desire? Ask whether assessment for HSDD is appropriate. International Menopause Society+1
   • Vaginal dryness/pain? Ask about local GSM treatments (vaginal oestrogen, prasterone, other options). Dutch Menopause Society+1
2. Book with a menopause-trained health professional
3. Ask: “Are progesterone, testosterone or vaginal DHEA options for my needs—and what monitoring would be required?”

Non-hormonal supports that still matter

• Resistance training 2–3 times/week supports strength, function, and bone health across midlife. Monash University+1
• Sleep and stress supports (routine, light exposure, limiting alcohol, addressing sleep disorders) can improve wellbeing alongside medical care. Monash University+1
• Protein-rich meals and adequate overall nutrition support muscle and energy. Monash University+1

If you’ve missed the first two newsletters in this series, you can find them — along with all previous newsletters — at menopauseandme.com.au/blog.

If you’d like support or a personalised plan, you can reach me at:
📧 hello@menopauseandme.com.au
🌐 menopauseandme.com.au/booking

Warmly,
Jenna
Nurse Practitioner & Menopause Educator

Sources

Australasian Menopause Society (AMS) – Treatment options & MHT dosing resources
The Menopause Society (NAMS) – 2022 Hormone Therapy Position Statement
International Menopause Society (IMS) – Global Consensus on Testosterone Therapy for Women (2019)
Jean Hailes for Women’s Health – Menopausal hormone therapy & testosterone guidance
Monash University – Practitioner’s Toolkit for Managing Menopause (updated 2025)
TGA (Australia) – Intrarosa (prasterone) + ARTG listing
NPS MedicineWise – AndroFeme 1 (indication and consumer information)
Australian Prescriber – Prasterone overview and contraindications

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.

Oestrogen Recap

Oestrogen receptors are found body-wide (quick visual reminder):

Adapted from tissue distribution data in Paterni et al. (2014) Steroids and Australasian Menopause Society guidelines (2025). Illustration by Menopause & Me.

Brain • Heart and blood vessels • Bones and muscles • Skin and collagen • Bladder and vagina • Many more

• Oestradiol (E2): The strongest and most active before menopause. Produced mainly by the ovaries. This is the key oestrogen in menopause hormone therapy.
• Oestrone (E1): Weaker than oestradiol. Becomes the main oestrogen after menopause (produced in fat tissue).
• Oestriol (E3): The weakest. Mainly produced during pregnancy by the placenta.
• Oestetrol (E4): Produced only during pregnancy by the fetal liver.

In menopause therapy, we primarily replace oestradiol because it most closely matches what your body made in higher amounts pre-menopause.

Safe, TGA-approved oestrogen options in Australia (2025)

Transdermal routes (patches/gels) generally have the lowest risk profile.

Many are PBS-subsidised.

Common symptom relief (from guidelines)

Many women notice:

• Clinical trials show substantial reductions (often in the range of 75-90%) in hot flushes for many women
• Improvement in vaginal dryness, painful sex and bladder symptoms
• Better sleep, mood and joint comfort
• Reduced brain fog

Individual responses vary.

Long-term considerations (when started early: under 60 or within 10 years of menopause)

Guidelines note potential benefits including:

• Reduced bone loss and fractures
• Neutral to potentially beneficial cardiovascular effects have been observed when started early, particularly with transdermal formulations

At standard doses, risks are considered low in guideline summaries, but decisions are always individualised.

Your helpful 3-step plan

1. Continue tracking symptoms
2. Book a longer appointment with your clinician
3. Ask: “Is oestradiol a safe option for my history and symptoms?”

Non-hormonal helpers that make a real difference

Many women start here for mild to moderate symptoms:

• Keep core body temperature lower (layered bedding, cool room, fans, cold drinks)
• Identify and reduce personal triggers (caffeine, alcohol, spicy foods)
• Practice paced breathing or relaxation during a flush
• Regular physical activity (e.g., walking, yoga or strength training 2–3 times/week)
• Maintain a healthy weight (evidence shows weight gain can worsen flushes)
• Cognitive behavioural therapy (CBT) or clinical hypnosis (some evidence for reducing flush bother and improving sleep/mood)

Next up: Part 3 (Progesterone, Testosterone and DHEA).

If you’d like support or a personalised plan, you can reach me at:

📧 hello@menopauseandme.com.au

🌐 menopauseandme.com.au/booking

You’re not alone on this journey: knowledge is power!

Warmly, Jenna

Nurse Practitioner

Sources

Australasian Menopause Society | North American Menopause Society Position Statement | Jean Hailes for Women’s Health | Monash University Practitioner Toolkit

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.

What are sex hormones, really?

They’re powerful chemical messengers made from cholesterol that coordinate functions across your entire body. Women and men have the same three main sex hormones — just in different amounts and patterns throughout life:

• Oestradiol (the most potent oestrogen – your pre-menopause superstar)
• Progesterone (the calming balancer)
• Testosterone (supports energy, libido, muscle and bone strength)

These hormones don’t just affect reproduction — their receptors are found throughout your body:

Brain (mood, memory, sleep) • Heart & blood vessels • Bones & muscles • Skin & hair •Eyes & saliva glands • Bladder & vagina • Gut • Mitochondria (cell energy factories)

Common symptoms linked to these changes

Symptoms vary hugely woman to woman, but here are some of the most reported:

Physical

• Hot flushes & night sweats
• Joint or muscle aches
• Fatigue & low energy
• Thinning hair or dry skin
• Weight changes (especially around middle)

Genitourinary (vaginal, sexual & bladder)

• Vaginal dryness & painful sex
• Urinary urgency, frequency or recurrent UTIs

Emotional & cognitive

• Low mood, anxiety or irritability
• Brain fog & memory lapses
• Sleep disturbance
• Reduced libido

Remember: A wide range of symptoms may be influenced by perimenopause or menopause… but it’s essential to rule out other causes first with your clinician.

Your helpful 3-step starting point

1. Track your symptoms for 2–4 weeks (frequency, severity, triggers)
2. Book a longer appointment with your Nurse Practitioner
3. Take your tracker and ask: “Could changing hormones be contributing?”

Non-hormonal helpers that make a real difference

• Paced breathing or mindfulness during hot flushes
• Regular movement (walking, yoga, strength training 2× week)
• Cool bedroom, cotton sheets & layered bedding
• Reducing personal triggers (caffeine, alcohol, spicy foods)
• Prioritising protein & calcium-rich foods

Next up – Part 2: Estrogen Essentials (safe options, symptom relief & long-term

protection).

You’re not alone on this journey — knowledge is power!

If you’d like support or a personalised plan, you can reach me at:

📧 hello@menopauseandme.com.au

🌐menopauseandme.com.au/booking

Warmly,

Jenna

Nurse Practitioner & Menopause Educator

Sources

Australasian Menopause Society | North American Menopause Society Position Statement | Jean Hailes for Women’s Health | Monash University Practitioner Toolkit

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.

What does “bioidentical” actually mean?

Bioidentical hormones have the same molecular structure as the hormones your ovaries produced before menopause. These include:

• Oestradiol (the main form of oestrogen)
• Micronised progesterone
• Physiologic-dose testosterone (for specific indications)

In Australia, bioidentical hormones are available in two forms:

✔ TGA-approved bioidentical products

These are standardised, regulated medicines (patches, gels, capsules, tablets).

✔ Compounded bioidentical hormones*

These may be considered when:

• a person cannot tolerate TGA-approved products
• they require an excipient-free option
• a specific dose or formulation is needed that is not commercially available

Because compounded products are not TGA-approved and may vary in strength and purity, they are not first-line in Australian and international guidelines.

However, they can be appropriate in selected cases following an individualised discussion of risks, benefits and alternatives.

This means compounded options remain available — just not the default starting point.

*Always discuss risks like inconsistent dosing/purity with your practitioner

Bioidentical, Synthetic and Compounded Hormones – Understanding the Differences

Both synthetic and bioidentical hormones have been used safely for decades and are supported by substantial international research. The best choice depends on symptoms, health history, preferences and individual tolerability.

Below is a simple, AHPRA-compliant comparison of key characteristics, not expected outcomes.

📊 Key Characteristics of Hormone Therapy Options

(AMS, NAMS, NICE, Monash Toolkit — 2024–2025)
Individual suitability varies; outcomes are not guaranteed.

Treatment Options in Australia

Depending on your symptoms and where you are in the menopause transition, options may include:

• Oestradiol (gel, patch or tablet)
• Micronised progesterone
• Combined oestrogen–progestin tablets
• Low-dose vaginal oestrogen for dryness and discomfort
• Testosterone for low sexual desire when clinically indicated

Suitability varies from person to person. Age, medical history, personal risk factors and prior responses to treatment all help guide decision-making.

A simple way to explore your options

Here’s a supportive way to begin:

1. Track your symptoms for 2–4 weeks.
2. Book a longer consultation to allow time for discussion.
3. Bring this newsletter and ask:
   “Which option aligns best with my health history and goals?”

Hormone therapy often requires minor adjustments over time to find the right fit.

Non-hormonal choices

Some women prefer non-hormonal options or cannot use hormones. Evidence-based alternatives include:

• Non-hormonal medications for hot flushes
• Cognitive behavioural strategies for flushes and sleep
• Regular vaginal moisturisers and lubricants
• Strength training, movement and sleep optimisation
• Tracking and reducing personal triggers such as alcohol or caffeine

You’re supported

Perimenopause and menopause are significant life phases. With personalised care, many women find approaches that help improve comfort, confidence and daily wellbeing.

If you’d like support or a personalised plan, you can reach me at:

📧 hello@menopauseandme.com.au
🌐 menopauseandme.com.au

Warmly,
Jenna
Nurse Practitioner & Menopause Educator

Sources (2024–2025)

Australasian Menopause Society (AMS)
NICE NG23
North American Menopause Society (NAMS)
Monash University Practitioner Toolkit
Jean Hailes for Women’s Health
Therapeutic Goods Administration (TGA)

Medical Disclaimer

This newsletter contains general information only and does not replace personalised medical advice. Hormone therapy is not suitable for everyone. All treatment decisions should be made in consultation with a qualified health professional.

The Hidden Risk: Osteoporosis in Midlife and Beyond

Menopause marks a pivotal shift for bone health, thanks to plummeting oestrogen levels that once protected your skeleton. In perimenopause, fluctuations start the subtle erosion; by menopause (average age 51 in Australia), bone loss accelerates, and post-menopause, it becomes a steady concern—potentially spanning decades.

Osteoporosis, or “brittle bones,” affects an estimated 23% of Aussie women over 50, making fractures from simple falls a real threat (think hip, spine, or wrist). Around 42% of Australian women over 50 face a lifetime risk of an osteoporosis-related fracture—most from a simple fall from standing height. Post-menopause, oestrogen’s absence means bones break down faster than they rebuild, with women losing up to 2% density annually in the first few years.

Risks spike if you smoke, drink heavily, or have a family history, but even without those, the hormonal drop puts us all in the spotlight. The good news? Early action—like the strategies below—can slash fracture risk by up to 50%, per Healthy Bones Australia.

Why Weight Training is Your Menopause Superpower ?

Enter resistance training (think weights, bands, or bodyweight moves): it’s not just for gym buffs—it’s essential medicine for our bones and beyond. During perimenopause, it counters early muscle loss (sarcopenia); in menopause, it halts the 1–2% annual decline; and post-menopause, it rebuilds what time (and hormones) have taken.

Key Effects and Benefits:

• Bone Boost: Loading bones stimulates density gains—studies show postmenopausal women can increase hip and spine strength by 1–3% yearly, directly fighting osteoporosis.

• Muscle Maintenance: Oestrogen dips erode lean mass (up to 3–5% per decade post-40), slowing metabolism and raising fall risk. Weight training preserves or builds it, enhancing balance and daily ease.

• Metabolic Magic: It regulates blood sugar, curbs midlife weight gain, and eases insulin resistance—vital as visceral fat rises.

• Whole-Body Wins: Better sleep, mood lifts (via endorphins), reduced hot flush severity, and heart health perks. Aussie experts from the Australasian Menopause Society highlight it as a top non-drug therapy for symptom relief.

Start light:

2–3 sessions weekly, 8–12 reps of compound moves like squats or rows. No gym? Home dumbbells or resistance bands work wonders.

Your 3-Move “Strong in 10 Minutes” Home Routine (2–3× per week)

• Goblet Squat (hold a heavy bag of groceries or a dumbbell) – 10–12 reps
• Push-ups on knees or against a wall – 8–12 reps
• Single-arm row (use a tin of beans or dumbbell) – 10–12 reps each side

Rest 60–90 sec between moves. Progress by adding a rep or two each week.

Fueling the Fire: The Role of Protein Intake – Protein isn’t optional—it’s the building block for muscles and bones, and menopause amps up our needs as absorption dips and repair slows.

In perimenopause, it helps stabilise weight amid hormonal chaos; during menopause, it supports training gains; post-menopause, it prevents frailty.

While collagen peptides are popular, current evidence shows they are not superior to regular dietary protein (chicken, eggs, lentils, etc.) for bone density. Save your money unless you love the taste!

Australian guidelines set the base RDI at 0.75–0.84g/kg body weight/day for women, but for midlife maintenance and activity, experts recommend 1.0–1.2g/kg—that’s about 70–84g daily for a 70kg woman. Active? Aim 1.4–1.6g/kg to maximise muscle synthesis. Prioritising protein (e.g., 25–30g per meal) can even ward off perimenopausal weight creep by curbing hunger and boosting satiety.

Easy Sources:

• Lean meats, fish, eggs (20–30g per serve).
• Plant power: Lentils, chickpeas, tofu (15–25g).
• Dairy: Greek yoghurt, cheese (10–20g).
• Snacks: Nuts, seeds, or protein shakes for quick hits.

Spread it out—post-workout is prime for recovery.

Essential Nutrients: Vitamins, Minerals, and Where to Source Them: Weight training and protein shine brighter with the right cofactors. Focus on these bone heroes, per Jean Hailes and Healthy Bones Australia—test levels with your health practitioner first, as over-supplementing isn’t wise.

• Calcium (1000–1300mg/day): The bone scaffold. Post-menopausal women need the higher end to offset loss. Sources: Whole foods like dairy (milk, yoghurt: 300mg/glass), leafy greens (kale, broccoli: 100–200mg/serve), fortified plant milks, or almonds.

• Vitamin D (600–2000 IU/day): Unlocks calcium absorption and aids muscle function. Deficiency hits up to 36% of Aussie women in winter. Sources: Sunlight (10–15 mins midday, arms/legs exposed, sans sunscreen—safely, per Cancer Council). Foods: Fatty fish (salmon: 400 IU/serve), eggs, fortified cereals.

• Magnesium (310–320mg/day): Partners with calcium for bone matrix and eases cramps/mood swings. Sources: Whole foods like spinach, nuts/seeds (pumpkin: 150mg/handful), wholegrains, dark chocolate.

More than 4 coffees or 2 standard drinks daily can increase calcium loss – easy swap: try decaf or sparkling water with lemon. Pair with Vitamin K2 (from fermented foods like natto) for directing calcium to bones, not arteries. Hydrate and limit salt to retain minerals.

Your Strong Start: Tips and Aussie Resources – Ready to lift? Begin with a check-in with your health practitioner for bone density guidance and tailor to your stage. Join free programs via Osteoporosis Australia or Jean Hailes webinars. Track progress in our community—small wins build big strength.

Menopause isn’t a slowdown—it’s your cue to get fierce.

With weight training, protein smarts, and nutrient savvy, you’re fortifying not just bones, but a vibrant life ahead.

Cheers to your power,

The Menopause & Me Team

menopauseandme.com.au

P.S. Missed our recent editions? → Embrace the Change (perimenopause, menopause & post-menopause)??

They’re all saved on the website for you anytime in the blog section

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.

The Stages: Mapping Your Menopausal Journey

Menopause isn’t a sudden switch—it’s a gradual shift across three key phases, each influenced by your body’s reproductive winding down.

• Perimenopause (The Lead-Up): This transitional phase typically starts in your 40s (sometimes earlier) and lasts 4–6 years on average, though it can stretch to 10. It’s defined by the first signs of irregular cycles—periods might be shorter, longer, heavier, or skipped altogether—as your ovaries begin to produce fewer eggs. In Australia, this stage often brings the first waves of symptoms, signaling the end of your fertile years.
• Menopause (The Turning Point): Officially, this is 12 consecutive months without a period, marking the end of ovulation and menstrual cycles. At around 51 years old for most Aussie women (ranging from 45–55), it’s a normal part of ageing, not a disease.
• Post-Menopause (The Long Haul): Everything after that final period, which could span a third of your life—up to age 80 or beyond. Hormone levels stabilise at a low baseline, and while some symptoms fade, others may linger, alongside increased health risks like osteoporosis or heart disease.

These stages vary by genetics, lifestyle, and health history. If you’ve had surgeries like a hysterectomy or treatments like chemotherapy, menopause can arrive earlier (induced menopause). (click on the arrow to the left to open the full article)

Why It Happens: The Hormone Story

At its core, this is about hormones doing their job—then slowing down. From your mid-30s, your ovaries house fewer eggs, leading to less frequent ovulation. Oestrogen, the star player for reproductive health, fluctuates wildly in perimenopause (sometimes spiking before plummeting), then drops by up to 90% by menopause. Progesterone dips too, as egg release becomes erratic, and testosterone gradually halves over decades. These shifts don’t just affect periods—they influence everything from mood to bone density. It’s biology’s way of redirecting energy from reproduction to maintenance, but the transition can feel like a bumpy ride.

Common Symptoms: What to Expect

No two journeys are identical, but many Australian women share these hallmarks, starting in perimenopause and peaking around menopause.

Physical Symptoms (affecting up to 80% of us):

• Hot flushes and night sweats: Sudden heat waves, often with sweating and chills—think chest-to-face flaring that disrupts sleep.
• Irregular periods: Unpredictable flow and timing.
• Vaginal dryness and discomfort: Thinning tissues leading to itchiness, painful sex, or urinary issues like incontinence.
• Joint aches, fatigue, and sleep disturbances: Tiredness hits hard, with 25% of women over 50 reporting poor sleep.
• Weight gain, bloating, headaches, and breast tenderness.

Emotional and Cognitive Symptoms:

• Mood swings, anxiety, irritability, or low mood: Higher depression risk, especially if you’ve had PMS before.
• Brain fog, forgetfulness, and trouble concentrating: That “mental cloudiness” many describe.

In post-menopause, flushes often ease, but dryness and bladder woes may persist. About 64% of midlife Aussie women (45–64) report bothersome symptoms in the last five years.

The Real Impact: On Work, Relationships, and Wellbeing

These changes aren’t just physical—they can shake your world. A 2023 national survey found 37% of affected women struggled with daily activities, like chores or self-care, while 31% faced work or study hurdles—17% even took extended breaks. Emotionally, 55% noted hits to mental health, with 58% of midlife women feeling the strain. Relationships suffer too: 19% reported tensions with partners, and 13% with friends or family. It’s no wonder—disrupted sleep fuels fatigue, and symptoms overlap with midlife stressors like caring for kids or ageing parents. Yet, only 61% seek professional support, often due to embarrassment (8.6%) or thinking “nothing can be done” (24%). The good news? Awareness is growing, and so are solutions.

Thriving Through It: Pathways to Relief and Renewal

Here’s where hope shines: menopause is manageable, and with the right tools, you can reclaim your vitality. Australian guidelines from the Australasian Menopause Society (AMS) and Jean Hailes emphasise personalised care—starting with lifestyle tweaks and escalating as needed. Let’s break it down.

Non-Pharmacological Therapies: Empowering Everyday Wins

These evidence-based strategies build resilience without meds, often improving overall health.

• Lifestyle Foundations: Regular exercise (aim for 30 minutes daily—walking, weights for bone health) cuts hot flushes and boosts mood. A balanced diet rich in calcium (dairy, greens, tofu) and phytoestrogens (soy) supports bones and symptoms. Ditch smoking, limit alcohol/caffeine, and layer clothes for flush management. Weight loss, if relevant, can ease multiple issues.
• Mind-Body Practices: Cognitive behavioural therapy (CBT) reduces flush bother and improves sleep/mood. Hypnosis shows promise for severity reduction. Mindfulness or paced breathing helps with anxiety—try apps tailored for menopause.
• Complementary Options: Black cohosh may rival low-dose hormones for flushes (with mood perks), per some trials. Soy isoflavones offer mild relief, but evidence is mixed—discuss with me first, especially if cancer history. Acupuncture has inconsistent but positive anecdotal support.

These aren’t cures but amplifiers: many women see 50%+ symptom relief from placebo alone, so belief matters!

Pharmacotherapy: Targeted Relief When You Need It

For moderate to severe symptoms, targeted therapies can truly transform your quality of life—backed by recommendations from the Australasian Menopause Society (AMS).

• Menopausal Hormone Therapy (MHT): Often considered the most effective option for managing hot flushes, night sweats, vaginal dryness, and supporting bone health. Whether using oestrogen-only (suitable for those who’ve had a hysterectomy) or combined with progestogen, it can provide significant relief and may even help reduce the risk of heart disease when initiated within 10 years of menopause. For most women under 60, the benefits far outweigh the risks, and we’ll tailor a discussion to your unique health profile. Topical forms are available to focus relief locally while minimising broader effects.
• Non-Hormonal Alternatives: When MHT isn’t the right fit, other prescription options like certain antidepressants or nerve-modulating medications can help ease flushes, mood changes, and sleep issues effectively.

We always start with the lowest effective approach, monitor progress closely with personalised support, and adjust as needed—many women experience meaningful improvements, paving the way for a more vibrant chapter ahead.

Your Thriving Chapter Awaits

Perimenopause, menopause, and post-menopause are chapters, not the whole story—hormonal shifts that herald wisdom and freedom. Yes, symptoms can disrupt (37% of us feel it daily), but with tools like MHT or CBT, thriving is the norm. In Australia, resources like Jean Hailes and AMS are your allies—if you wish to discuss your journey, book an appointment at menopauseandme.com.au/booking.

What’s one step you’ll take? Share in the comments or reply—we’re building this community together!

Warmly,
Menopause & Me

P.S. Next up: Building Strong Foundations! Head back next week for more information.

Insights from Jean Hailes, Australasian Menopause Society, and healthdirect—evidence-based for Aussie women.

Important Disclaimer: The information in this blog/newsletter is general in nature and intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Nurse Practitioner, doctor, or another qualified health practitioner with any questions you may have regarding a medical condition or before commencing any new treatment, exercise program, changing your diet, or taking supplements – particularly if you have existing health conditions, are on medication, or have had fractures or falls in the past. Individual needs and responses vary.