So, what exactly is HRT?
Hormone Replacement Therapy (HRT) – also known as Menopausal Hormone Therapy – involves replacing the hormones that naturally decline during perimenopause and menopause, most commonly oestrogen and progesterone (and sometimes testosterone).1
Perimenopause can begin up to 8-10 years before menopause, and this transition brings symptoms like hot flushes, night sweats, mood changes, sleep issues, anxiety, and brain fog. These are driven by fluctuating hormones – and for many women, those fluctuations can be life-disrupting.2
HRT helps stabilise those hormonal shifts, reducing symptoms and improving quality of life. But, whether or not it is right for you can only be determined by you and your doctor.
HRT helps stabilise those hormonal shifts, reducing symptoms and improving quality of life.
Why HRT can help in perimenopause
During perimenopause, oestrogen levels don’t just fall — they swing up and down dramatically. These fluctuations affect your brain, mood, skin, muscles, bones, and metabolism.2
HRT can help by:3,4,5,6,7
- Reducing vasomotor symptoms – hot flushes, night sweats, and disrupted sleep.
- Supporting mood and cognition – oestrogen has a role in serotonin and dopamine regulation, which affects anxiety, mood, and memory.
- Maintaining bone density – oestrogen protects against accelerated bone loss that starts in perimenopause.
- Improving vaginal and urinary health – local oestrogen can relieve dryness, discomfort, and recurrent urinary tract infections.
- Supporting muscle and metabolic health – balanced hormones contribute to better body composition and energy levels.
Safety, risk, and what to consider8,9
Modern HRT is not the same as the therapy from decades ago. Today, we use body-identical (bio-identical) hormones, which are molecularly identical to those your body naturally produces. These are available as prescription medications regulated by the Therapeutic Goods Administration (TGA) in Australia.
Like all medications, HRT has potential risks and benefits. The main considerations include:
- Breast cancer risk: For most women under 60 and within 10 years of menopause, the absolute increase in risk is very small. Risk depends on type, dose, and duration of HRT.
- Blood clots and stroke: These risks are lower with transdermal (through the skin) forms, such as patches, gels, or sprays, compared to tablets.
- Personal history: If you have a history of breast cancer, clotting disorders, or other conditions, HRT may not be appropriate – but that doesn’t mean you have no options.
For most healthy women who start HRT around the time of menopause, the benefits outweigh the risks. The key is personalisation - the right type, dose, and delivery form for you.
How to talk to your doctor about HRT
If you’re curious about whether HRT might help you, preparation makes all the difference.
- Track your symptoms. Bring a list or use a symptom tracker – it helps your GP understand how perimenopause is affecting your day-to-day life.
- Ask about body-identical options. These are the gold standard for most women and have a favourable safety profile.
- Discuss your personal health history. Your doctor will consider your medical and family background before recommending any therapy.
- Work as a team. Managing perimenopause is rarely “one solution fits all.” You might combine HRT with nutrition, movement, supplements, and lifestyle strategies for the best results.
The bottom line
HRT isn’t a one-size-fits-all solution – but for many women, it can be life-changing. The decision to start it should be made from a place of informed choice, not fear.
Perimenopause is not about “just putting up with it.” You deserve to feel well, energetic, and supported.
If you’re not sure where to start, book a conversation with a menopause-trained health professional who can guide you through your options and help you find the right fit for your body and your life.
Wrapping it all up
If you’d like a deeper dive into the science, nutrition, and practical strategies to thrive through this phase, Sarah Gray’s new book It’s Not You, It’s Perimenopause is available now – packed with evidence-based tools to help you understand what’s happening and take back control of your health.
For more information, visit her website at: www.thenutritionpharmacist.com/perimenopause-book
Sarah Gray
Pharmacist & Nutritionist, Founder – The Nutrition Pharmacist
Sarah Gray is one of Australia’s leading dual-qualified health professionals in pharmacy and nutrition, and a certified menopause practitioner with over 25 years of experience in the health and wellness industry. Her holistic approach focuses on supplements and science- based solutions for perimenopause and menopause. A trusted thought leader, Sarah has appeared on Channel 10’s My Market Kitchen and is a recognised voice across radio, print, digital media and podcasts. She is also a regular contributor to leading health blogs and
publications.
@the_nutrition_pharmacist
References
- https://www.healthdirect.gov.au/hormone-replacement-therapy
- https://my.clevelandclinic.org/health/diseases/21608-perimenopause
- https://menopause.org.au/hp/information-sheets/combined-menopausal-hormone-therapy-mht
- Cho, J.M.; Lee, J.; Ahn, E.-M.; Bae, J. Beyond Hot Flashes: The Role of Estrogen Receptors in Menopausal Mental Health and Cognitive Decline. Brain Sci. 2025, 15, 1003. https://doi.org/10.3390/brainsci15091003
- https://menopause.org.au/hp/information-sheets/osteoporosis
- Kiely BE, Liang R, Jang C, Magraith K. Safety of vaginal oestrogens for genitourinary symptoms in women with breast cancer. Aust J Gen Pract. 2024 May;53(5):305-310. doi: 10.31128/AJGP-02-23-6709. PMID: 38697062.
- Tiidus PM. Benefits of estrogen replacement for skeletal muscle mass and function in post-menopausal females: evidence from human and animal studies. Eurasian J Med. 2011 Aug;43(2):109-14. doi: 10.5152/eajm.2011.24. PMID: 25610174; PMCID: PMC4261347.
- https://www.canceraustralia.gov.au/resources/position-statements/hormone-replacement-therapy-hrt-and-risk-breast-cancer
- https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/
