Menopause

We understand that menopause affects women, trans men, and gender-diverse individuals assigned female at birth. Hazel is committed to offering inclusive support and care to everyone experiencing menopause.

Menopause is the natural life milestone that marks the end of a woman’s reproductive years. It's that time when periods are (finally) a thing of the past. While some women breathe a sigh of relief, this phase can bring its own troublesome symptoms, such as hot flashes, insomnia, mood swings, and even brain fog and memory lapse.

Menopause symptoms can vary in intensity and duration, hanging around for months or even years. Around 80% of Australian women will experience menopausal symptoms throughout their lifetime¹, with some women experiencing symptoms for 5 – 10 years.

At Hazel, we understand that menopause isn’t a one-size-fits-all experience, that’s why women need personalised treatment plans to manage their unique symptoms. Whether you’re exploring hormone replacement therapy (HRT), looking into natural remedies, or considering lifestyle changes, it’s important to know your options and the science behind them.

Every treatment comes with its own perks and pitfalls, so getting the lowdown on how they work is the first step toward making a decision that’s right for you. Ready to demystify menopause? Let’s get started.

What is menopause?

While we’ve all heard of menopause, it’s surprisingly common for women to avoid talking about it or digging into the details until those telltale symptoms start to rear their heads.

67% of women aged 40–65 say their mothers or other influential women in their lives never openly talked about menopause.²

Even the definition of menopause can be a bit confusing. While it’s often thought of as the time when a woman’s period stops, menopause is only officially diagnosed after 12 consecutive months without menstruation.³

For most women, menopause happens between ages 45 and 55, with the average age of 51 in Australia.⁴ While menopause is a universal milestone for women and people assigned female at birth, menopause is anything but predictable — symptoms and timelines can vary widely due to a range of factors, including genetics, lifestyle, and hormones.

Genetics play a big role in when and how you’ll experience menopause. If your mum had an early or late menopause, chances are you might too. Overall health also matters, with smoking, stress or mental health often speeding things up, while a balanced lifestyle can sometimes soften symptoms. Bottom line: no two journeys are the same. ‍

What causes menopause?

Just like our periods begin with a surge in hormones, they eventually cease due to a complex hormonal shift too.

During puberty, the ovaries ramp up production of oestrogen (also known as “estrogen”), a critical hormone responsible for the development of secondary sexual characteristics, such as breast tissue and wider hips, and the initiation of the menstrual cycle.

This surge also lays the groundwork for regular ovulation. However, on the other side of the reproductive timeline, things begin to change. Women and people assigned female at birth are born with a finite number of follicles (potential eggs), and as this supply diminishes over time, the ovaries gradually reduce their production of oestrogen and progesterone.

These hormones are not just essential for regulating the menstrual cycle—they play vital roles in maintaining bone density, modulating metabolism, and influencing mood and cognition. As their levels decline, the body undergoes a series of physiological changes. While some, like mild mood shifts, may pass unnoticed, others—hot flashes, brain fog, and significant mood swings—are hallmark symptoms of the menopausal transition.

Perimenopause, menopause, and post-menopause

While we wish that menopause was a switch that could be flicked overnight, the journey from menstruating to menopause is a long and rocky one for most women.

Menopause is often misunderstood as a one-time event, but in reality, it’s a drawn-out process that can last for years. Here’s a quick breakdown of the three main phases:

• Perimenopause:
  Perimenopause typically begins in a woman's 40s but can start as early as the mid-30s. During this stage, hormone levels—particularly oestrogen—begin to fluctuate, leading to symptoms like irregular periods, hot flashes, mood swings, and sleep disturbances.
  
  The length of perimenopause can vary from woman to woman, lasting anywhere from a few months to several years. This phase is marked by hormonal changes that can make your body feel like it’s on a rollercoaster.
  
  
• Menopause:
  Menopause officially occurs when a woman has gone 12 months without a period. It is the point where the ovaries stop producing eggs and hormone production declines significantly, particularly oestrogen and progesterone.
  
  Due to the dramatic shift in hormones, you’re more likely to experience hot flashes, sleepless nights, and other symptoms, like vaginal dryness.
  
  
• Post-menopause:
  Post-menopause is the phase that follows menopause and continues for the rest of a woman’s life. Once you’ve passed the 12-month mark without a period, you are considered post-menopausal.
  
  At this point, the worst of the hot flashes and mood swings may subside, but some symptoms, like vaginal dryness or changes in libido, may persist. The hormone levels in the body remain low, leading to a higher risk for osteoporosis and heart disease.
  
  Post-menopause is an important time to pay close attention to long-term health—after all, your body’s “new normal” is here to stay.

Why does menopause cause so many symptoms? ‍

If menopause means the end of your period, then why does it come with a veritable host of other uncomfortable symptoms too? The answer: Because oestrogen and progesterone do a lot more in the body besides regulating your menstrual cycle.

When your ovaries start to decrease the production of oestrogen and progesterone, your whole body — not just your uterus — feels the effect. Here’s a quick look at how oestrogen and progesterone help the body function:

In addition to regulating the menstrual cycle, oestrogen helps to:

• Maintain bone density, protecting you from osteoporosis
• Support cardiovascular health, keeping blood vessels flexible
• Keep skin and tissues elastic (preventing dry, saggy skin)
• Influence brain function, mood, and cognition (aka, your mental clarity and emotional stability)
• Maintain vaginal health (keeping tissues lubricated and preventing dryness)

And in addition to preparing the uterus for pregnancy/triggering periods, progesterone helps to:

• Balance oestrogen (prevents oestrogen dominance, which can cause bloating, irritability, and heavy periods)
• Regulate mood (maintaining emotional balance by acting on GABA and serotonin systems)
• Support sleep (boosts melatonin production, helping you relax and fall asleep easier)
• Reduce inflammation 
• Support thyroid function (low progesterone can lead to slower metabolism and energy dips)

Menopause doesn’t just mess with your periods. It messes with everything these hormones were working to keep in check. But don’t worry, you’re not alone—Hazel is here to help you find your way through.

Do the ovaries completely stop producing oestrogen and progesterone during menopause?

While the ovaries don't completely stop producing oestrogen and progesterone, their production does drop to negligible levels in post-menopause.

After menopause, the adrenal glands (located on top of your kidneys) and fat cells step up to produce small amounts of oestrogen. Some studies also suggest that small amounts of progesterone may still be produced by the adrenal glands, but it’s minimal compared to what the ovaries once provided. Regardless, the body isn’t able to produce the kinds of levels needed to keep our bodies comfortable, cool, and lubricated. 

Symptoms of menopause

Menopause isn’t just a milestone—it’s a full-on physiological and psychological overhaul. The symptoms can range from mildly annoying to downright disruptive, and everyone’s experience is unique. Let’s break down some of the most common symptoms:

• Hot flashes/night sweats
  More than 80% of women experience hot flashes during menopause.⁵ These sudden, intense waves of heat—often paired with sweating and skin flushing—can strike any time, day or night.
  
  The root cause? Changes in the hypothalamus, the part of the brain responsible for regulating body temperature. When oestrogen levels drop, the hypothalamus becomes overly sensitive, overreacting to even slight changes in body temperature.
  

• Mood swings (anxiety and depression)
  Hormonal fluctuations during menopause are closely linked to mood swings. Oestrogen and progesterone have significant effects on neurotransmitters in the brain, including serotonin and dopamine, which regulate mood.
  
  The Penn Ovarian Aging Study found that women with no history of depression were four times more likely to experience it during menopause than before.⁶ As if that weren’t enough, other symptoms—like disrupted sleep— can lead to further emotional and psychological distress.

• Hair loss
  Around 50% of women will experience hair loss in postmenopause.⁷ Hair loss during menopause is once again linked to hormone levels, with declining oestrogen levels affecting hair growth cycles.
  

• Hair growth
  Facial hirsutism—otherwise known as unwanted facial hair—affects about half of all postmenopausal women.⁸ (PCOS ladies, we know you’ve been dealing with this one for a long time already)
  
  As if losing the hair on your head wasn’t enough, the hormonal imbalance caused by declining oestrogen and relatively higher levels of androgens (aka "male" hormones) can cause coarse, dark hairs to appear on your chin, upper lip, or even jawline.
  

• Sleep problems
  Menopause and sleep disturbances tend to go hand in hand, with 40–60% of women experiencing sleep issues during menopause, the most common complaint being waking during the night.⁹
  
  Research from the Study of Women's Health Across the Nation (SWAN) showed that difficulty staying asleep increases during menopause, with higher levels of follicle- stimulating hormone (FSH) linked to more nighttime awakenings, while lower estrogen levels were tied to trouble falling and staying asleep.¹⁰
  

• Vaginal dryness
  Around 64% of menopausal women report vaginal dryness (also known as vaginal atrophy), and, spoiler alert, it gets worse as you move deeper into postmenopause.
  
  This irritating symptom is yet again due to a drop in oestrogen, which leaves the vaginal lining thinner, drier, and less lubricated. The result? Discomfort, irritation, and pain during sex—because menopause just loves making things difficult.
  

• Memory and concentration issues (aka “brain fog”) 
  ‍Walk into a room and immediately forget why? Yep, menopause might be the culprit. Research shows that 44% to 62% of women deal with some level of cognitive decline (also known as “brain fog”) during menopause.¹¹
  
  Cognitive changes like during menopause are caused by dropping estrogen levels, which impact brain function, especially memory and focus. Fortunately, once the body adjusts to new hormone levels after menopause, cognitive function typically improves. 

The symptoms listed above are just the tip of the iceberg—menopause can affect your body and mind in many ways, including joint pain and stiffness due to declining oestrogen, which can also increase the risk of osteoarthritis.¹² Urinary changes, like increased frequency or urgency, skin changes, and low libido are also reported.

If you think these symptoms might be related to menopause, book in a chat with one of our supportive Hazel doctors to help you get to the bottom of it.

Menopause diagnosis

Diagnosing menopause typically involves connecting the dots between symptoms, age, medical history, and, when necessary, conducting blood tests. 

Menopause symptoms can sometimes overlap with other conditions, like thyroid issues or sleep disorders. That’s why checking in with a doctor, like one of our Hazel specialists, can be an important step to rule out other issues.

Changes in your menstrual cycle are often the earliest signs that menopause is on the horizon. Periods may become irregular, lighter, or heavier before eventually stopping altogether. As these changes unfold, other symptoms like hot flashes, night sweats, and mood swings often appear.

If you see a doctor to confirm menopause, they may also investigate other factors, including your overall health and family trends (like whether your mother experienced early menopause).

While symptoms and medical history are usually enough for diagnosis, some women may undergo blood tests to measure hormone levels. The most common tests are:

• Follicle-Stimulating Hormone (FSH): FSH levels rise as the ovaries start to produce less oestrogen, making it a key marker in diagnosing menopause. High levels of FSH, typically above 30 mIU/mL, are often an indicator that menopause is nearing or has already occurred. 
• Estradiol: This is a form of oestrogen that is measured to check for a drop in levels. Low estradiol levels, often below 30 pg/mL, can indicate that menopause is occurring. 

While tests like these can be helpful, levels of FSH and estradiol can fluctuate, and because the transition to menopause can take years, blood tests don’t always give a clear answer.

Different treatments for menopause

Of the women navigating menopause and feeling the impact on their quality of life, 78% aren’t taking anything to manage their symptoms.¹³

Let’s be real—the gender pain gap hasn’t exactly been on our side when it comes to menopause. Women and gender-diverse people are often told their pain is “normal”  or have their symptoms downplayed by healthcare professionals, leaving them to struggle in silence.

Menopause might be a part of life, but struggling with menopause symptoms doesn’t have to be. It’s time to reach out for help, because you deserve to feel your best. With so many treatment options out there, it’s about finding what works for you. Here are some common menopause treatments we can discuss with during a Hazel appointment:

Hormone Replacement Therapy (HRT)

As you can imagine, with low hormone levels causing so much chaos, one effective way to manage menopause symptoms is by replacing the lost oestrogen (and sometimes progesterone, too).

There are two main types of HRT:

• Oestrogen-only therapy: Often used for women who have had a hysterectomy.
• Combined therapy: This includes both oestrogen and progesterone for those who still have their uterus.

In combined therapy, progestogen is used to keep the uterine lining in check. Without it, oestrogen alone could cause the lining of the uterus to build up too much, leading to complications like abnormal bleeding or even an increased risk of cancer.¹⁴

HRT is highly effective for many women, especially in reducing hot flashes and night sweats. It can also help prevent osteoporosis by maintaining bone density. Keep your uterus—and your peace of mind—in check with the right combination.

Does HRT cause breast cancer?

A major reanalysis of global breast cancer data found that current and recent users of HRT had a slight increase in relative risk (2.3%) for each year of use. However, the actual absolute risk bump is small—just 2 extra cases of breast cancer per 1,000 women after 5 years of use for those aged 50-70. And, for those who’ve stopped using HRT for at least 5 years? No significant risk increase.¹⁵

Let's be honest—when the media went into overdrive about "HRT causes cancer," it made a lot of women second-guess getting help. And without a nuanced discussion, it only added stress, making women shy away from a treatment that could help with things like hot flashes and bone health.

While HRT is not without risks and isn't suitable for everyone, it remains a valid treatment option for some women managing menopausal symptoms.

Bioidentical Hormone Therapy (BHT)

Bioidentical Hormone Therapy (BHT) uses hormones that are structurally identical to what your body naturally produces. They’re often plant-derived and marketed as the "natural" alternative to traditional HRT.

But, here’s the catch: BHT is still being researched, and while it sounds great in theory, we don’t have enough long-term safety data yet to be absolutely sure about its benefits and risks.¹⁶

Non-hormonal treatments for menopause

For women who can’t—or simply don’t want to—use HRT, there are still a few non-hormonal treatments to keep things in check. These include:

• Antidepressants (SSRIs/SNRIs): Some antidepressants have been shown to reduce hot flashes and improve mood, offering relief from both emotional and physical symptoms.¹⁷
• Gabapentin: Originally used for nerve pain, gabapentin can also help reduce hot flashes.¹⁸
• Clonidine: Originally prescribed for high blood pressure, this medication can also help reduce night sweats.¹⁹

While these treatments may not deliver the same results as hormone therapy for menopause, they’re worth exploring if you’re after a different route. Just manage your expectations—some women get great relief, others … not so much.

Natural and herbal treatments

For those who want to take a more natural route (or just can’t deal with another prescription), there are herbal remedies that some women swear by to ease menopause symptoms. Some common ones include:

• Black Cohosh: Often used to treat hot flashes and mood swings, though research results are mixed.
• Red Clover: Contains phytoestrogens and may help reduce hot flashes.
• Evening Primrose Oil: Known for treating mood swings and breast tenderness.

While natural remedies may offer symptom relief, their effectiveness can vary, and they are less regulated than pharmaceuticals, meaning their quality can differ between brands.²⁰

Are over-the-counter (OTC) oestrogen vitamins effective?

These types of vitamin products, sometimes labelled "oestrogen" or “female hormones” claim to support hormonal balance with ingredients like phytoestrogens or herbal extracts. However, they don’t contain actual oestrogen, and evidence for their effectiveness is limited. Plus, OTC products aren’t regulated like prescription HRT, so quality and potency can vary.²¹

The bottom line: They might help but they’re generally unproven and are certainly no match for medical-grade treatments.

Lifestyle, diet, and behavioral modifications

Lifestyle changes can be a game-changer when it comes to managing menopause symptoms. Here are some simple changes you can make to support your health during menopause:

• Sleep hygiene: Creating a cool, dark, and quiet environment while sticking to a consistent bedtime routine can help regulate your body’s circadian rhythm. Research even shows that mindfulness and relaxation techniques can ease menopausal insomnia.²²
• Cut back on alcohol and caffeine: While your morning latte and evening wine might be a beloved ritual, they’re also notorious for triggering hot flashes and messing with your sleep. A little moderation goes a long way.
• Maintain a healthy weight: Fat tissue can produce estrogen post-menopause, which might sound good—but excess weight is linked to more frequent and intense hot flashes.²³
• Stay active: Get moving—physical activity is one of the best ways to keep menopause symptoms in check. It doesn’t just tame those hot flashes²⁴, but also lifts your mood and strengthens your body. 
• Quit smoking: For those who smoke, menopause is another excellent excuse to kick the habit. Smoking is a known culprit for making hot flashes worse. Nicotine overstimulates the hypothalamus, triggering symptoms like increased heart rate and blood pressure that mimic hot flashes.²⁵
• Eating a balanced diet: Eating a diet rich in fruits, vegetables, whole grains, and lean protein can support hormone balance and reduce inflammation. Foods like flaxseeds, soy, and beans are especially good at providing phytoestrogens that can help ease symptoms. And don’t forget calcium and vitamin D to protect your bones.

While these changes might not soothe every menopause symptom, they’re a solid foundation for managing menopause with a little more comfort—and a lot less sweat.‍

When to see a doctor for menopause symptoms

Menopause might be natural, but it doesn’t mean you have to suffer through it. If your hot flashes, night sweats, or mood swings are making life uncomfortable, it’s probably time to get some expert advice.

At Hazel, we get it—menopause isn’t just about dealing with the heat. It’s about you feeling like yourself again. Whether it’s lifestyle or nutrition advice with our naturopath, therapy with our psychologist, or exploring treatment options with our doctors, we’re here to help you move through this transition with confidence and care. Don’t just grin and bear it. Get the support you deserve.

Menopause in a nutshell

Menopause is the natural end to your reproductive cycle. It can bring on a mix of uncomfortable symptoms like hot flashes, night sweats, mood swings, and trouble sleeping. But the key to handling their challenging process is to understand your options and find the support you need — and deserve.

From hormone treatments to natural alternatives, Hazel’s here to offer personalised treatment plans and support. Ready to take charge of menopause? We’re here to help you feel cool, calm and confident about this exciting next chapter in your life. 

Menopause FAQs

What is the best treatment for perimenopause?
The best treatment can differ from person to person. Menopause symptoms can be unique to each woman, that’s why personalised care plans (like what we offer at Hazel) are so important. Common options include Hormone Replacement Therapy (HRT), which helps balance oestrogen and progesterone levels, natural remedies, and lifestyle adjustments. HRT is particularly effective for hot flashes, mood swings, and night sweats, thanks to its ability to regulate hormones that dip during this phase.

Is there treatment for perimenopause?
Absolutely. Perimenopause symptoms can be treated, and deserve treatment if they’re affecting your life and wellbeing. Treatments like hormone therapy (oestrogen or progesterone) can help balance your fluctuating hormones. Non-hormonal options like SSRIs can help with mood swings, and herbal remedies like black cohosh may reduce hot flashes—just be sure to chat with your doctor before starting a treatment plan.

Does menopause require treatment?
While menopause doesn’t require treatment (it’s not a medical condition or a “disease” — it’s a natural stage of life), many women choose to manage symptoms like hot flashes, night sweats, and vaginal dryness. Hormone Replacement Therapy (HRT) can restore oestrogen levels, which drop significantly during menopause. If you’re not into hormones, there are plenty of non-hormonal alternatives that you can explore. 

What is Hormone Replacement Therapy (HRT)?
HRT is a treatment designed to replace the hormones that decline during menopause—primarily oestrogen and progesterone. It’s a highly effective treatment for symptoms like hot flashes, night sweats, and mood swings. By restoring hormone balance, HRT can also help reduce the risk of osteoporosis and heart disease, both of which become more significant after menopause.

What are the natural treatments for menopause?
Natural treatments often focus on balancing hormones without pharmaceutical interventions. Soy-based products, rich in phytoestrogens, mimic the effects of estrogen in the body and can help ease symptoms. Herbal remedies like black cohosh and red clover are also popular for their potential to reduce hot flashes. But remember, not all natural treatments are created equal—talk to your doctor or naturopath to ensure you’re choosing something safe and effective.