Menopausal symptoms arise as women transition out of their reproductive years. This phase occurs when the ovaries stop releasing eggs and hormone production, particularly oestrogen and progesterone, gradually declines.

As hormone levels decrease, various symptoms may emerge, including, but certainly not limited to:

• Hot Flushes and night sweats

• Insomnia

• Vaginal dryness

• Reduced libido

• Brain Fog

• Mood swings

Many women accept these changes as a natural part of aging and may not seek help, often unaware that effective and safe treatments are available that can significantly improve their quality of life.

At Clinic 66, we offer tailored treatment plans based on your medical history, lifestyle, and health preferences. Through a shared decision-making process, our doctors will work with you to determine the best approach for managing your symptoms.

Menopausal Hormone Therapy (MHT) is a treatment designed to alleviate symptoms of menopause, which result from hormonal deficiencies, particularly low levels of oestradiol, progesterone, and testosterone.

MHT can be administered through tablets, patches, or creams that are absorbed into the body.

How has MHT evolved?

Over the past 20 years, MHT has evolved to include body-identical hormones, which are chemically identical to those produced by the ovaries. These include:

• Transdermal Oestrogen: Available as patches or gels, this method delivers hormones directly through the skin into the bloodstream, reducing clotting risks compared to oral tablets.

• Progestogen: Necessary for women with a uterus to reduce the risk of endometrial cancer, often provided via the Mirena® IUD or micronised progesterone tablets.

• Testosterone: Used to improve libido in some women, though it is not subsidised by the PBS. It is available in creams and gels.

What are body-identical hormones?

Body-identical hormones are the same as those naturally produced by the body, and are generally preferred over synthetic hormones due to their effectiveness and lower risk profile. They are not to be confused with bio-identical hormones.

What does Clinic 66 recommend?

At Clinic 66, we prescribe body-identical MHT for its proven effectiveness and safety. We do not support compounded hormones due to insufficient evidence regarding their safety and efficacy.

For women with genitourinary symptoms of menopause (GSM), we offer topical treatments like oestrogen and prasterone (DHEA) pessaries and oestrogen cream. And if you can get to our clinic, we can also offer MonaLisa Touch vaginal laser for those women who can't use the pessaries or creams.

If you’re considering MHT, we can help tailor the treatment to your individual needs and monitor its effectiveness.

Click here to download the checklist

Perimenopause is a clinical diagnosis that can be made by your Clinic 66 Online Doctor. Your Doctor will take into consideration your age, your symptoms, your health history and family history, if known.

Blood tests are often not needed to make this diagnosis but may be helpful in ruling out other conditions that may present with similar symptoms.

There are also some helpful online tools that can help your Doctor to make this diagnosis. Take a test here.

Q: What is perimenopause?

A: Perimenopause is the transition phase leading up to menopause, marking the end of a woman’s reproductive years. It typically begins in your 40s and can last from one to ten years. During this time, you may still get pregnant, and your menstrual cycle can become irregular.

Q: When does perimenopause start?

A: In Australia, perimenopause usually starts in your 40s. The average age for menopause is 51 to 52, but perimenopause can begin earlier and last several years.

Q: What happens during perimenopause?

A: Your ovaries gradually produce fewer eggs, leading to fluctuating hormone levels. This can cause irregular periods and a range of symptoms, including hot flushes, sleep disturbances, and mood changes.

Q: What are common symptoms?

A: Symptoms can vary, but common ones include:

• Hot flushes and night sweats

• Sleep issues and tiredness

• Headaches and body aches

• Vaginal dryness and sore breasts

• Mood swings and brain fog

Q: How can I manage perimenopause symptoms?

A: Management depends on your symptoms. Options include hormone therapy, non-hormonal medications, and lifestyle adjustments like using fans or dressing in layers. Your doctor can help tailor a plan to your needs.

Q: Can I still get pregnant during perimenopause?

A: Yes, you can still conceive if you have periods, as you may still be ovulating. Use contraception if you wish to avoid pregnancy.

Q: When should I see a doctor?

A: Consult your doctor if you have concerns about your symptoms, especially if they are disrupting your daily life.

Yes, you can still get pregnant during perimenopause!

Although natural fertility generally decreases with age, particularly after 45, the chances of conception are not zero.

Many women assume they cannot conceive during this time due to significantly reduced egg levels. However, perimenopause is characterised by erratic hormonal fluctuations that may occasionally trigger ovulation. These hormonal surges are unpredictable and do not necessarily align with your menstrual cycle.

Because of this, it is essential to continue using contraception until you have been menopause-free for one year (or two years if menopause occurs before age 50).

As you age, some contraceptive methods may become less suitable or even contraindicated, so it’s a good idea to discuss your options with your doctor. Being informed and proactive about your reproductive health is crucial during this transitional phase!

Weak Pelvic Floor Muscles: As menopause sets in, the pelvic floor muscles, responsible for preventing urine and faecal leakage, may weaken. This weakness can result in a frequent urge to use the toilet, decreased ability to hold on, and difficulty reaching the toilet in time. Weak pelvic floor muscles can also make it challenging to control flatulence and may contribute to the development of prolapse. ​ Less Elastic Bladder: Aging causes the bladder to become less elastic and have reduced stretching ability. This loss of stretchiness can irritate the bladder muscle, making it "overactive." An overactive bladder leads to increased urinary frequency. Combined with weakened pelvic floor muscles, this makes it more challenging to postpone or control the urge to urinate.

Vaginal Dryness: The decline in oestrogen during menopause results in vaginal dryness, as the vaginal lining produces less mucus. Similar changes occur in the urethra, the tube leading from the bladder. Vaginal dryness increases the risk of urinary tract infections as normal bowel bacteria can enter the urethra. Treatments like vaginal oestrogen cream or an oestrogen pessary can alleviate vaginal dryness, while maintaining proper personal hygiene is essential.

Weight Gain: Many women experience weight gain during menopause, which can strain the pelvic floor muscles responsible for supporting body weight. Weakened pelvic floor muscles fail to adequately support the bladder and bowel, leading to stress incontinence (leakage during coughing or sneezing) or urge incontinence (frequent or urgent need to urinate). Hysterectomy: Women who undergo a hysterectomy or prolapse repair surgery may experience bladder control issues. Pre- and post-surgery pelvic floor exercises should be incorporated into the treatment plan. Anal Trauma/Surgery: Some women may develop bowel control problems during menopause, especially if they have previously given birth. Trauma or damage to the anal sphincter during childbirth may manifest as issues later in life. Pelvic floor muscle exercises can help, but surgical intervention may be necessary for some women to repair the damage.

Understanding how menopause affects bladder and bowel control empowers you to seek appropriate treatment and management strategies. By addressing these concerns, you can improve your quality of life and regain control over your body.

If you're experiencing any of these issues, we encourage you to make a booking to speak to one of our experienced GPs. Let's get this sorted. You'll be surprised at how much we can help you via telehealth.

Menopause is a transformative phase in a woman's life, and it often brings about various changes, including difficulties with bladder and bowel control. If you're experiencing these issues, you're not alone. Many women encounter symptoms such as:

• Frequent urination and urgent need to urinate

• Urinary leakage with coughing, sneezing, or exercise

• Leaking urine before reaching the toilet

• Nighttime awakenings to urinate (nocturia)

• Frequent urinary tract infections

• Urgency to have a bowel movement

• Difficulty controlling flatulence

• Constipation

​ Ignoring these problems can lead to worsening symptoms over time, affecting your work, social activities, and personal relationships.

The good news is that incontinence can often be prevented, managed, and even cured.

Seeking help is crucial, so be sure to discuss your incontinence issues with your doctor when addressing your menopause symptoms. There is absolutely nothing to be ashamed of... we help women with the same issues... every... single... day!!

Genitourinary Syndrome of Menopause (sometime referred to as GSM or Vaginal Atrophy or Atrophic Vaginitis) affects many women and can have a significant impact on their quality of life and intimate relationships. It can cause permanent vaginal discomfort and/or urinary symptoms and should not be ignored.

Oestrogen plays a very important role in maintaining vaginal and vulval tissue. It helps to keep the area moist and the tissue healthy.

As our oestrogen levels decrease, this tissue is susceptible to becoming drier, thinner and more fragile and the vagina can lose elasticity. This can result in itchiness, recurrent urinary tract infections and pain or discomfort during sex. Often these symptoms are ignored and many think that it is just something they must put up with.

At Clinic 66 Online we can help. Hormones can assist but are not the only option, and you need to find something that works for you and your personal circumstances.

There is no need to suffer in silence anymore! Make an appointment with one of our women's health GPs who can help tailor a management plan that’s right for you.

Your Mental Health may be affected by the onset of Perimenopause or Menopause... or maybe not?

Mood changes can occur at the time of menopause and these may relate to hormonal adjustment, or they may relate to other life events such as teenage children, elderly parents, work dilemmas or relationship difficulties. Mental health issues such as depression and anxiety are extremely common, but easy to hide.

Let us help you work out the best way for you to deal with your depression or anxiety. Exercise, talking therapies (including computerised CBT) and medication are all effective. ​As GPs we can look after you with a Mental Health Care Plan, which means that Medicare will subsidise part of your treatment (if you have a Medicare card)

Urinary incontinence is the accidental leakage of urine, which is a common condition that can often be treated, managed, and sometimes cured.

Here’s a breakdown of what you need to know:

How does a normal bladder work?

A normal bladder:

• Holds up to 600 ml of urine

• Empties four to six times a day and up to once a night

• Empties completely when you urinate

• Allows you enough time to reach the toilet

• Does not leak urine

What are the types of urinary incontinence?

• Urge Incontinence: A strong, sudden urge to urinate that’s difficult to control, sometimes leading to frequent nighttime urination.

• Stress Incontinence: Leakage occurs when you cough, sneeze, laugh, or exercise.

• Mixed Incontinence: A combination of urge and stress incontinence symptoms.

• Overflow Incontinence: The bladder doesn’t empty completely, leading to leakage when it becomes overfull.

What causes urinary incontinence?

• Weakened or overactive pelvic floor muscles

• Pregnancy and childbirth

• Prolapse

• Constipation or straining

• Heavy lifting

• Being overweight or obese

• Chronic cough or sneezing

• Menopause-related changes

• Diabetes

• Pelvic or abdominal surgery

• Certain medications, like diuretics

How is urinary incontinence diagnosed?

Diagnosis involves discussing your symptoms and medical history with your doctor who may ask about:

• Frequency and volume of leakage

• Timing and triggers for leakage

• Any associated symptoms like burning or incomplete bladder emptying

• Fluid intake and urination patterns

They might also test for urinary tract infections or refer you for a pelvic floor muscle assessment.

What are the prevention and management strategies?

• Maintain a balanced diet and healthy weight

• Engage in regular physical activity

• Perform pelvic floor exercises correctly

• Practice good toilet habits, such as urinating only when necessary

• Consult your doctor about possible hormone treatments

If you experience urinary incontinence, it’s important to seek advice from a healthcare professional to determine the best course of action for your situation.

Yes it can, and yes, we do. Testosterone is not exclusive to men. Women produce it alongside oestradiol and progesterone, though its levels gradually decline with age. This drop can contribute significantly to feelings of imbalance and low libido.

Click here to find out more about Testosterone therapy.

Q: What is testosterone therapy and how can it help with low libido?

A: Testosterone therapy involves the use of testosterone, a hormone also present in women, to address low libido and other symptoms related to hormonal imbalance. For women experiencing reduced sexual desire, testosterone therapy can help restore libido and improve sexual function. In Australia, Androfeme® is a commonly prescribed testosterone cream designed specifically for postmenopausal women.

Q: How does testosterone therapy work?

A: Testosterone therapy works by supplementing low levels of testosterone in the body. For women, this therapy is usually administered through a 1% testosterone cream, such as Androfeme®, applied daily to the skin. The cream helps boost testosterone levels, which can enhance sexual desire and improve related symptoms.

Q: Who is a good candidate for testosterone therapy?

A: Women who experience Hypoactive Sexual Desire Disorder (HSDD) or significant drops in libido due to menopause or other hormonal changes may benefit from testosterone therapy. It is important to undergo a thorough assessment by a healthcare professional to determine if this therapy is appropriate for your specific needs.

Q: What are the potential side effects of testosterone therapy?

A: While testosterone therapy can be effective, potential side effects may include acne, facial hair growth, voice deepening, and other androgenic effects. It is crucial to follow the prescribed dosage and have regular follow-up appointments to monitor hormone levels and mitigate any adverse effects.

Q: How is testosterone therapy administered in Australia?

A: In Australia, testosterone therapy is commonly administered via Androfeme®, a body-identical 1% testosterone cream. This cream is applied daily to the skin in small, measured amounts. Your doctor will provide instructions on how to use the cream and monitor your progress with regular blood tests.

Q: How long does it take to see results from testosterone therapy?

A: It may take several weeks to a few months to notice the full effects of testosterone therapy. Results can vary among individuals, so it is important to be patient and maintain regular follow-ups with your doctor to assess progress and make any necessary adjustments to your treatment.

Q: Are there any alternative treatments if testosterone therapy isn't suitable for me?

A: Yes, there are alternative treatments for low libido and related symptoms, including other forms of hormone therapy, lifestyle changes, and psychological support. Your healthcare provider can discuss these options and help determine the best approach based on your individual situation.

Q: How can I get started with testosterone therapy at Clinic 66?

A: To begin testosterone therapy, you should schedule an appointment with one of our expert doctors at Clinic 66. We offer both in-person and telehealth consultations. During your visit, we will conduct a comprehensive assessment, discuss your symptoms, and determine if testosterone therapy is right for you.

Q: What should I expect during my follow-up appointments?

A: During follow-up appointments, your doctor will monitor your hormone levels through blood tests and assess how well the therapy is working. They will also check for any potential side effects and make adjustments to your treatment plan if necessary to ensure optimal results and safety.

Q: Is testosterone therapy covered by Medicare or private health insurance in Australia?

A: Testosterone therapy is often covered by Medicare for eligible patients, but the specifics can vary. It is advisable to check with Medicare and your private health insurance provider to understand your coverage and any out-of-pocket costs associated with the treatment.

If you have further questions or need personalized advice, please contact Clinic 66 for more information and to schedule a consultation.

Whilst there is little scientific evidence to recommend natural remedies, some women find them helpful. These include black cohosh, agnus castus, dong quai, or other herbal combinations.

Isolated symptoms may be effectively treated by non hormonal treatments such as Fezolinetant for hot flushes. Other medications that may be helpful for control of some symptoms are gabapentin, clonidine and oxybutinin. For women who are experiencing hot flushes and mood problems, such as depression, they may be prescribed SSRI or SNRI medication with good effect.

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The particular management package which is right for you, will not be the same for all women. We need to see you in person to find out what is important to you, what is safe for you, and what is likely to give you benefit.