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Hot off the press
Australia’s new menopause guideline says that for most women with hot flushes or night sweats, the benefits of hormone therapy outweigh the risks [1].
And there’s a second headline women need to hear. Body-identical progesterone appears safer than most of the lab-designed copies that used to get handed out by default [4].
That’s the news. Here’s what it means in plain English.
MHT (menopausal hormone therapy) is the new name in Australia for HRT (hormone replacement therapy). Both mean topping up oestrogen and progesterone, the hormones that drop at menopause [5].
Who wrote the guideline? The Royal Australian and New Zealand College of Obstetricians and Gynaecologists — short name RANZCOG. It was published in October 2026 [1, 2], one day after a new US guideline. That US guideline is from the American College of Obstetricians and Gynecologists (ACOG), and we’ve already covered it here.
Both agree that MHT is on the table for most women with symptoms and that the benefits outweigh the risks.
The guideline covers hot flushes, night sweats and vaginal symptoms. Mood, joint pain and brain fog sit outside this guideline for now — other national guidelines are on the way for those [2].
If hot flushes, night sweats or vaginal symptoms are bothering you, and there’s no medical reason you shouldn’t use it, you should be offered MHT [1]. Then you and your practitioner talk through the benefits, the risks, and what you actually want. It can be a patch or gel through the skin, or a tablet. Start low. Increase if you need to. There’s no set time limit: you can stay on MHT while symptoms need it, with a yearly check-in about staying on or stopping. Stop if you want, but know the flushes can come back [1].
If you’re 60 or over and thinking about starting tablet MHT, there can be an extra risk of heart and blood vessel problems (including stroke), blood clots and dementia [1]. So a careful, personal chat with your practitioner matters even more.
The Australasian Menopause Society (AMS), the menopause specialist group for our region, adds: “For the majority of symptomatic women, the benefits of menopausal hormone therapy (MHT) outweigh the risks.” It also says that the extra risk of clots, stroke and breast cancer is very small [4].
On the heart, the AMS says: “there was no evidence of harm from cardiovascular disease for women commenced on MHT close to the menopause; there was a trend toward reduced risk for these women” [4].
What are body-identical, bioidentical and synthetic hormones?
Body-identical means the hormone has the same chemical structure as the one you’ve had in your body your whole adult life — and it still comes from a regulated, tested medicine. Think genuine Gucci. A look-alike, such as a progestin, is a lab-designed mimic. Not the same molecule as your own hormone up close. Think a good copy of Gucci. Almost all of these medicines are made in a lab, so the word “synthetic” doesn’t really help. The question is whether it’s the real molecule or a look-alike.
Compounded “bioidentical” hormones are different again — custom-made by some pharmacies, often as creams. The AMS does not recommend them. They aren’t tested the way approved medicines are, and progesterone creams aren’t reliably absorbed, so they may not protect the uterus [6].
Progestogen, progesterone, progestin
If you still have a uterus, oestrogen alone can thicken the lining, so a progestogen is usually added to protect it [5].
• Progestogen = the umbrella word for your own progesterone and lab-made versions.
• Progesterone = identical to the hormone your ovaries made before menopause. Example: Prometrium, on the Pharmaceutical Benefits Scheme (PBS) since 1 March 2025.
• Progestin = a lab-designed look-alike (what the WHI used).
The words sound alike. The products are not.
The AMS says micronised progesterone and dydrogesterone “appear safer than most synthetic progestogens” [4].
One small but important point: dydrogesterone is similar to our own progesterone, not identical. Long-term research is still limited. Breast cancer risk is part of why the type matters — so if nobody explains the difference, women can end up on a progestin that’s not the real thing, without knowing there’s a body-identical option that the AMS says appears safer.
Oestrogen: patch, gel or tablet — and clot risk
Oestrogen in MHT can be body-identical (oestradiol — the same molecule your ovaries made) or a different kind (for example conjugated equine oestrogens in some tablets — like the one in the WHI).
A patch or gel through the skin (transdermal) at usual doses has not been linked to extra blood clots. Oestrogen tablets roughly double your baseline clot risk, but the absolute numbers are still low — about 2–3 clots per 1,000 women a year on oral MHT, versus about 1 per 1,000 without it [4]. That absolute risk is higher if you smoke or already have clot risk factors. More detail is on the AMS Risks and Benefits of MHT information sheet [4].
Through the skin: the usual gels in Australia — Estrogel (and Sandrena) — are oestradiol, so body-identical. Patches used for MHT here (for example Estradot, Estraderm) are also usually oestradiol. Estrogel and Estrogel Pro have been on the PBS since 1 March 2025, so they’re much more affordable than they used to be.
How to check your packet: some tablets are body-identical oestradiol; some are not. Look for the active ingredient on the packet or Consumer Medicine Information. “Oestradiol” or “estradiol”, “oestradiol hemihydrate” (or estradiol hemihydrate) and “17β-oestradiol” (also written 17-beta-estradiol or 17β-estradiol) are generally signs it’s body-identical. If it says conjugated equine oestrogens (or Premarin), that is not body-identical.
Vaginal dryness? The guideline suggests considering vaginal oestrogen first [1].
What if I can’t take MHT/HRT?
MHT isn’t for everyone. Some medical reasons rule it out — unexplained bleeding, some cancers, heart disease, blood clots, stroke, clotting disorders, liver disease, or pregnancy [1].
Can’t use MHT, or don’t want to? See the AMS Non-Hormonal Treatments for Menopausal Symptoms information sheet [7] — and talk options through with your practitioner.
Exercise and looking after your weight still matter for your overall health. What the guideline won’t do is pretend those alone will fix hot flushes — the evidence for that is still shaky [1]. Keep exercising — and also have the hormone conversation if flushes are wrecking your nights.
Why so many women — and GPs — are still scared of hormones
In 2002, a big US study was stopped early, and scary headlines about breast cancer, heart disease, stroke and clots followed [3]. The catch: most women in that study were already in their 60s. And it tested one combined tablet — horse-urine oestrogen plus a lab-designed progestin. Not body-identical oestrogen. Not a patch or gel. Not body-identical progesterone.
That fear stuck — for women and for many GPs. Some women still hear “I don’t think you should be on HRT anymore,” which is the opposite of what the new Australian guideline says for most women with symptoms and no medical reason not to use it.
Absolute versus relative risk
Headlines love relative risk. That’s the percentage change — and percentages sound big and scary.
Absolute risk is the real number of extra cases. That tells a much calmer story.
In the WHI, breast cancer went from about 30 to about 38 cases per 10,000 women each year. That’s a 26% relative increase — but only about 8 extra cases per 10,000 women a year [3].
There were also about 7 extra heart events, 8 extra strokes and 8 extra blood clots in the lung per 10,000 women a year [3].
The percentages sounded terrifying. The actual numbers were small.
Where I fit
I’m a health coach, not a doctor, and I don’t prescribe hormones. Decisions about MHT belong with you and your practitioner. Where I can help is with sleep, food, movement, stress and the daily habits around that conversation.
In Australia, your GP can also do a menopause and perimenopause health assessment on Medicare (at least 20 minutes, once a year) [2].
If you’d like to see where you’re at, you’re welcome to do my quiz or book a discovery call.
References
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Management of vasomotor and genitourinary symptoms of menopause (C-Gyn 9). Clinical Guideline, Version 12, July 2026. https://ranzcog.edu.au/wp-content/uploads/Managing-Menopausal-Symptoms.pdf
Brisbane South PHN. New national clinical guidelines give doctors evidence-based standards for menopause care. Last updated 26 October 2026. https://bsphn.org.au/news/new-national-clinical-guidelines-give-doctors-evidence-based-standards-for-menopause-care
Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA. 2002;288(3):321–333. https://doi.org/10.1001/jama.288.3.321
Australasian Menopause Society. Risks and Benefits of MHT, information sheet. https://www.menopause.org.au/hp/information-sheets/risks-and-benefits-of-mht-hrt
Australian Government Department of Health, Disability and Ageing. Perimenopause and menopause: treatment options. https://www.health.gov.au/perimenopause/management-and-support/treatment-options
Australasian Menopause Society. Non-Hormonal Treatments for Menopausal Symptoms, information sheet. https://www.menopause.org.au/hp/information-sheets/nonhormonal-treatments-for-menopausal-symptoms