RANZCOG has published Australia and New Zealand's first evidence-based clinical guidelines for managing menopause symptoms, covering vasomotor and genito-urinary symptoms in women aged 40 and above. The guidelines clarify the use of menopausal hormone therapy, address options for women with a breast cancer history, and aim to standardise care across different regions and healthcare providers.
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Vasomotor episodes of warmth and perspiration are among the bodily changes that can accompany hormonal shifts. Sweating through the night can fragment sleep and leave sheets noticeably damp by the time morning arrives. Reduced lubrication in vaginal tissue, intercourse that causes discomfort or distress, and a need to urinate more often than usual are also recognised concerns.
Reaching the end of fertility, women enter a phase known as menopause, which brings with it a variety of physical and emotional changes that can affect day-to-day wellbeing. Guidance on managing symptom severity draws from a wide body of research, though not all of it points in the same direction.
RANZCOG — the Royal Australian and New Zealand College of Obstetricians and Gynaecologists — has released a new set of clinical guidelines aimed at streamlining practice. Drafted to address uncertainty around prescribing menopausal hormone therapy (MHT) versus alternative treatments, the guidelines also lay out the choices available to patients with a prior breast cancer diagnosis.
Catriona Melville, who leads the RANZCOG guideline development group, described the goal as cutting through contradictory information to give clinicians a grounded, evidence-based starting point for substantive conversations with patients. Dr Melville noted that a practitioner who lacks a working understanding of where the evidence sits, what risks attach to available options, and what the guidelines actually advise is poorly positioned to shape that conversation around the individual patient.
Drafted to reflect research-backed recommendations, the updated guidance addresses how to manage menopausal symptoms — a stage that sets in once a full year has passed without menstruation. The guidance is directed at women aged 40 and older and addresses two clusters of menopausal complaints: vasomotor disturbances — hot flushes and night sweats among them — alongside genito-urinary changes, including vaginal dryness and a heightened urge to urinate.
Bone density, joint pain, libido, depression, and anxiety fall outside the scope of what those guidelines address. Variations in both the nature and intensity of symptoms mean the experience differs from woman to woman, according to Magdalena Simonis, a GP and women's health researcher at the University of Melbourne.
Though Dr Simonis had no hand in drafting the guidelines, she noted that they underscored the value of clinicians addressing the full range of a patient's health rather than focusing narrowly on a presenting complaint. She added that the period around menopause offered a particularly useful opening to review lipid levels, bone density, and broader lifestyle factors.
The document outlines a spectrum of treatment pathways for the various stages and symptoms of menopause — ranging from menopausal hormone therapy (MHT) through to acupuncture and hypnosis — while grading the supporting evidence on a four-point scale from very low to high. It also points to the value of reviewing personal and family histories of other cancers alongside participation in breast and cervical screening programmes and discussions about ongoing chronic conditions.
Under those guidelines, anyone on MHT is directed to sit down with their doctor once a year to go over how the treatment is working for them. Current evidence does not establish that shedding weight, exercising more, or pursuing hypnotherapy reliably addresses vasomotor symptoms such as hot flushes and disturbed sleep at night.
According to Dr Melville, whose practice spans gynaecology and a sub-specialisation in sexual and reproductive health, the updated guidelines are expected to give both clinicians and patients a clearer picture of the choices available to them. Vaginal oestrogen is among the options that clinicians may discuss with patients who have a breast cancer history and are dealing with menopausal symptoms.
Dr Melville noted that, while the organisation had put out earlier position statements on menopause management, the newly released document represented its first set of guidelines grounded in formal evidence review. Adopting consistent clinical guidelines across Australia, she said, would give every woman access to the same evidence-based advice, regardless of which practitioner she consults or where in the country she lives.
Sarah White, chief executive of Jean Hailes for Women's Health and independent of the guideline development process, noted that practitioners were keen to offer patients well-grounded support yet faced a considerable volume of inaccurate information circulating online. She added that having the updated guidelines available would allow health professionals to walk patients through the evidence and offer reassurance about the quality of advice they were receiving.
The guidelines also direct clinicians to enquire about distressing symptoms with women nearing menopause, with particular attention to those who face obstacles in accessing care — including First Nations, Māori, and Pacific Islander women.
Separate guidelines covering perimenopause and menopause have received government funding in Australia, with their release expected in the coming year. RANZCOG holds a contributing role in developing those protocols, which are designed to be revised on an ongoing basis as fresh evidence becomes available.
The increased attention being paid to the health of women going through menopause drew a positive response from Dr Simonis. Anyone noticing persistent or unusual symptoms was advised to arrange a visit with their GP, while those nearing mid-life were directed to consider a routine health check.