Decision aid

Menopause & HRT — weighing your options

By Dr HB Lo, FACRRM 4 min read

General information to help you prepare for your GP — not a diagnosis, not personal medical advice. It doesn't replace a consultation, and using it doesn't create a doctor–patient relationship.

Whether to take menopausal hormone therapy (HRT, also called MHT) is one of the most personal decisions in midlife health — and one of the most clouded by old headlines. For most healthy women under 60, or within 10 years of their last period, who have bothersome symptoms, the benefits of HRT generally outweigh the risks. But "most women" isn't you: the right answer depends on your symptoms, your history, and what you most want to change.

The honest picture is more reassuring than the scare stories: the risks are real but often smaller and more specific than many women have been led to believe.

This guide explains how the decision is weighed, so you can take clear questions to your GP.

The symptoms are real. The fear is mostly outdated. Both can be true.

If you’ve spent a few years being told your hot flushes, broken sleep, brain fog and mood swings are “just your age,” you’ve probably also absorbed a quiet message that HRT is dangerous — something to be endured around rather than treated. A lot of that fear traces back to one set of headlines from two decades ago that were applied far too broadly. The science has moved a long way since. So has the advice.

This isn’t a pitch for HRT or against it. It’s a map of how the decision is actually made now, so you can walk into your appointment asking the questions that fit your situation.

Where Australian guidance actually sits today

The current position from the Australasian Menopause Society and reflected in Therapeutic Guidelines is this: for most healthy women who are under 60, or within about 10 years of their last period, and who have bothersome menopausal symptoms, the benefits of HRT generally outweigh the risks. HRT remains the most effective treatment for hot flushes and night sweats, as Jean Hailes and HealthDirect both summarise for patients.

That’s a meaningfully more permissive picture than the one many women carry. It doesn’t mean HRT is right for everyone — it means the starting assumption is no longer “avoid unless desperate.”

The 2002 headline, in proportion

The study behind the fear — the Women’s Health Initiative — studied women whose average age was 63, many years past menopause, and its alarming top-line was then generalised to all women, including symptomatic 51-year-olds. That’s the wrong comparison. Re-analysis and the years of evidence since have reframed the risk as real but small and specific, concentrated mainly in longer-term combined (oestrogen-plus-progestogen) use, and weighed differently depending on your age and how you take it, per the Australasian Menopause Society and Australian Prescriber.

The practical upshot: a blanket “HRT causes cancer” is not how clinicians frame it now. A specific, individualised “here’s the size of the risk for someone with your history” is. Sorting your worries into that honest shape is what the HRT decision aid below is for.

The benefits worth naming

For the right person, HRT does several things that matter:

  • Hot flushes and night sweats — the symptom it treats most effectively, per eTG.
  • Sleep and quality of life — often improved indirectly when the flushes and sweats settle.
  • Vaginal and urinary symptoms — sometimes treated with local vaginal oestrogen alone, a low-risk option even for some women who can’t take systemic HRT, as the Australian Medicines Handbook notes.
  • Bone protection — HRT reduces fracture risk, relevant for some women’s overall picture.

None of this means HRT is the only route. Non-hormonal medicines, cognitive behavioural therapy and lifestyle measures all have a place, and some symptoms point more clearly toward one path than another.

What shifts the answer

The decision genuinely changes with your circumstances — which is why there’s no universal yes or no:

  • How close you are to menopause — earlier (under 60, within 10 years) tilts the benefit-risk balance more favourably, per the Australasian Menopause Society.
  • Your personal and family history — breast cancer, blood clots, stroke and some other conditions change the calculation and may point to non-hormonal options.
  • Whether you’re still having periods — perimenopause is treated differently from post-menopause, and contraception may still matter, as HealthDirect explains.
  • What bothers you most — local symptoms, whole-body symptoms, sleep, mood: these point toward different treatments.

The questions worth taking in

  • Given my age, symptoms and history, do the benefits of HRT generally outweigh the risks for me?
  • For me specifically, how big is the breast-cancer or clot risk — in real numbers, not in headlines?
  • Which of my symptoms would HRT help most, and which might be better treated another way?
  • If I start, what’s the plan for reviewing it over time?

Take these in as questions. The aim is a decision made with your GP, fitted to you.

What this is, and is not

This is general information to help you prepare for your GP — not a diagnosis, and not personal medical advice. It doesn’t tell you to start, stop or change HRT or any other treatment; that’s decided with your own doctor, who can weigh your history. For trustworthy Australian background, see the Australasian Menopause Society, Jean Hailes and HealthDirect.

Related on this site: the menopause and perimenopause explainer covers the transition itself, the forensic look at the 2002 WHI HRT evidence unpacks the study behind the fear, and the periods and endometriosis decision aid is relevant if heavy or painful periods are part of the lead-up.

If you want an unhurried, thorough work-up of your own menopause picture, you can work with Dr Lo.

Author: Dr Hoe Bing Lo — AHPRA MED0001212640 · FACRRM. Fun Doctors Pty Ltd · ABN 83 404 436 330.

Tools to take to your GP

Each runs in your browser — nothing you enter is stored or sent anywhere. They help you prepare the questions and print a one-page summary to bring to your appointment. They don't diagnose or recommend a specific treatment.

Frequently asked questions

  • Didn't a big study show HRT causes breast cancer?

    The 2002 Women's Health Initiative made headlines that, in hindsight, were over-generalised. The women studied were older (average age 63) and the results were applied to all women, including those in their early 50s with symptoms — a very different group. The current Australian position, from the Australasian Menopause Society, is that for healthy women under 60 or within 10 years of menopause, the benefits of HRT generally outweigh the risks. Any increase in breast cancer risk with combined HRT is real but small and relates mainly to longer-term use. This is a conversation to have with your GP using your own risk picture.

  • Is HRT the only option for menopause symptoms?

    No. HRT is the most effective treatment for hot flushes and night sweats, but it isn't the only path. Non-hormonal medicines, cognitive behavioural therapy, vaginal oestrogen for local symptoms, and lifestyle measures all have a place, and some women choose them by preference or because HRT isn't suitable for them. The decision aid below helps you sort which of your concerns point toward HRT and which might be better served another way.

  • I'm still getting periods — is it too early for HRT?

    Perimenopause — the years of changing, often erratic symptoms before periods stop — is exactly when many women have the most disruptive symptoms, and treatment can be appropriate then. The approach differs from post-menopause, and contraception may still matter. The point is that 'still having periods' doesn't rule out help; it changes the conversation, and it's worth raising with your GP rather than waiting it out.

  • How long can I stay on HRT?

    There's no fixed cut-off or maximum duration that applies to everyone. The older idea of 'lowest dose for shortest time' has softened — current Australian guidance supports individualising duration based on your symptoms, benefits and risks, reviewed periodically. Some women use it for a few years; others longer. It's a decision to revisit with your GP over time, not a one-off.

  • What about 'bioidentical' or compounded hormones I've seen advertised?

    Custom-compounded 'bioidentical' hormones are marketed heavily but are not recommended by the Australasian Menopause Society, because their doses aren't standardised or regulated the way registered HRT products are. Many registered, body-identical HRT options are available on prescription. If you've seen compounded products promoted, that's worth specifically raising with your GP.

Source quality

Sources grouped by evidence tier. Australian primary tier first; international where Australia is silent or lagging. How tiers work.

If you want a thorough, unhurried work-up of your own — not a generic answer — you can work with Dr Lo.

Author: Dr Hoe Bing Lo · AHPRA MED0001212640 (verify)

General health information drawn from current Australian guidelines and primary trial data. Not personal medical advice. Always consult your own GP for diagnosis, treatment, or referral specific to you. See full disclaimer.

Last reviewed: 14 June 2026