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Menopause & Perimenopause

During the perimenopause and menopause, all sorts of things change in the body so it’s really important to look holistically at how you reduce your symptoms now and improve your future health.

At Ōtepoti Integrative health we provide comprehensive menopause assessments, discuss individualised risk and benefits of body identical hormone replacement therapy (HRT) to replace the hormone deficiency caused by the perimenopause and menopause. 


We also consider ways to optimise movement, nourishing food, sleep, stress management and relational health as these contribute to supporting your transition through menopause. 

Dr Deb Brunt will support you to not only survive menopause, but to thrive through it and beyond.

Assess your symptoms

Menopause is sometimes called 'the change of life'. The changes occur via a longer transitional period known as the menopause transition, perimenopause or climacteric.


The perimenopausal transition can take more than 10 years. The menopause marks the end of a woman's reproductive or fertility window and is an important hormonal transition during which healthy habits can really optimise women's health.


At menopause, eggs are no longer produced by the ovary and production of the 2 main reproductive hormones by the ovary, oestrogen and progesterone ceases. There is also a reduction in testosterone. The word "menopause" refers to the last or final menstrual period a woman experiences.

When a woman has had no periods for 12 consecutive months she is considered to be “postmenopausal”. Most women become menopausal naturally between the ages of 45 and 55 years, with the average age of onset at around 50 years.

"Early Menopause" occurs between 40 and 45 years.


“Premature ovarian insufficiency" or premature menopause may occur before the age of 40 due to either natural ovarian function ceasing, following surgery to remove the ovaries, or as a result of cancer treatments. Women whose periods stop prior to 45 years should see their doctor to exclude other medical causes such as thyroid issues or polycystic ovarian syndrome (PCOS). 


What are the symptoms of menopause?

Symptoms of preimenopause and menopause vary between women and also can change during the menopausal transition. Some women breeze through menopause with minimal symptoms and others have significant symptoms which impair quality of life, enjoyment and negatively affect home and work life. 


Common symptoms include:

  • Hot flushes

  • Light headed feelings

  • Headaches

  • Irritability

  • Depression

  • Unloved feelings

  • Anxiety

  • Mood changes

  • Sleeplessness

  • Unusual tiredness

  • Weight Gain

  • Brain Fog

  • Changes in periods such as irregular periods, lighter periods, heavy periods.

  • Backache

  • Joint pains

  • Muscle pains

  • New facial hair

  • Dry skin or itchy skin

  • Crawling feelings under the skin

  • Less sexual feelings

  • Vaginal dryness

  • Uncomfortable intercourse

  • Urinary frequency

  • Breast Pain

  • Food Craving

The Stages of Menopause

What is HRT Therapy?
(Hormone Replacement Therapy or Menopause Hormone Therapy)

Hormone replacement therapy is the use of hormones to replace the deficiency of reproductive hormones created by menopause.


It is the most effective way to control menopausal symptoms while also providing other health benefits such as reducing the development of heart disease, diabetes and osteoporosis. It is safe for most women to use during perimenopause, menopause and post-menopause.

At Ōtepoti Integrative Health we tailor the type of hormone treatment best suited to you depending on your medical history, family history, symptoms, risk factors and your preferences. 

There are multiple options available that come in tablets, gels, patches and creams, and they come as separate hormonal preparations or in combination products. Types of HRT regimes include:

  • Cyclical HRT - this mimics the normal menstrual cycle. Estrogen is taken every day and natural progesterone or progestogen for 12 to 14 days. When the progestogen is stopped, there is some bleeding as the progestogen is  “withdrawn” so the uterine lining (endometrium) is shed. Progestogen regulates bleeding and protects the endometrium from harmful pre-cancerous changes

  • Continuous combined therapy HRT (CCT) - this type of HRT combines an estrogen and progestogen. They are prescribed continuously to achieve period-free HRT. 

  • Estrogen-only HRT - this is normally prescribed to women who have had their uterus removed (hysterectomy). 

Body identical hormone replacement therapy is safer than non-body identical hormones.

Estradiol is a body identical estrogen. It has no increased risk of blood clot when used via the skin in a patch, gel or vaginal cream. 

Oral micronised progesterone has advantages over synthetic progestins as it is converted to allopregnanolone in the liver which helps support sleep. Funding for this type of HRT therapy was funded by PHARMAC in New Zealand from 1 Dec 2022.

Get in touch if you'd like to book an appointment.

HRT Risks

Blood Clots

Hormone replacement therapy tablets containing oestrogen does increase the risk of blood clots.


This includes:

  • deep vein thrombosis (DVT) - leg vein blood clots

  • pulmonary embolus (PE) - lung vein blood clots

  • stroke - brain vessel blood clots


Oral oestrogen tablets are NOT associated with an increased risk of heart attacks or heart disease.

Transdermal estrogen (estrogen that is applied via the skin as a cream, gel or patch) is NOT associated with blood clots.

Breast Cancer

Breast cancer risk with HRT is complex.

Women who use estrogen only HRT, whether oral or transdermal, have repeated been shown to have a reduced risk of breast cancer in both randomized controlled trials such as the Women's health initiative and in large-scale observational studies.


Different progestogens have different risk ratios for breast cancer.


Micronized progesterone (body identical progesterone) and dydrogesterone (similar in structure to natural progesterone) are safer than most synthetic progestogens.

In women using HRT short-term, there were 3 extra cases per 10,000 for oestrogen use and 9 extra cases per 10,000  for oestrogen plus synthetic progestogen use.

For women with a family history of breast cancer, their risk of breast cancer is the unchanged by use HRT. The exception to this is where women have BRCA gene or other genetic risk associated with estrogen-associated breast cancer

Women with a high body mass index (BMI) have an increased risk of breast cancer. Women who drink alcohol daily are at increased risk of breast cancer - as it is a known carcinogen.


HRT use in these women does not further increase their risk of breast cancer.

HRT Benefits

Use of oestrogen and progestogen HRT is associated with better health outcomes including reduced risks of:

  • osteoporotic fractures (44 fewer cases per 10,000),

  • diabetes (14 fewer cases per 10,000),

  • colon cancer (6 fewer cases per 10,000).

It is also associated with lower rates of heart attacks and all causes of death in women who use HRT compared to those who do not. 

Pink Blossom

Lifestyle Medicine for Menopause 

Menopause healthcare is not only relief of symptoms and improvement of quality of life, but also health screening to minimise risks of inflammation that drives future chronic disease such as heart disease, diabetes, stroke, osteoporosis, sarcopenia and Alzheimer's disease.


Integrative medicine supports women in perimenopause and menopause by supporting healthy habits that will hopefully last a lifetime and will reduce the risks of chronic disease. 

Hormone replacement therapy (see below) is often then 1st line treatment both for symptom relief and also for long term disease prevention when started in the first 10 years of menopause. However lifestyle plays a massive role in disease prevention.

1. Exercise

At least 150 minutes per week of moderate intensity exercise is ideal, but any exercise is better and beneficial for health than none. Exercise in 30-60 min sessions at the gym, walking to work, cycling, running, dancing or swimming.


You can also do snack size exercises multiple times during the day by setting a timer on your phone to jog on the spot or jumping jacks. Using a Fitbit or other device can help motivate and remind you of your goals. It can take some-time to make exercise a habit, but most people once they get going with an activity that they love, find it a pleasure to move their body.

Exercise during menopause and beyond should include these 3 important aspects:

  • Aerobic exercise that gets the heart rate increasing for heart, lung and brain health. 

  • Resistance exercise that increases muscle strength by making your muscles work against a weight or force. This is important to maintain muscle mass. Resistance exercises can be carried out with free weights, machines, resistance bands or using your own body weight.

  • Weight-bearing exercise - this is exercise that force you to work against gravity. This includes activities such as jogging, running, stair climbing and dancing. 

2. Real Food 

Fuelling the body and brain are important to support the phenomenal hormonal and metabolic changes occurring during menopause. To support hormones and metabolisms consider including in your diet:


  • Brassicas (cauliflower, broccoli, cabbage, bok choi etc) which are high in indole-3-carbinol and diindolylmethane (DIM) that help regulate estrogen metabolism.

  • Phytoestrogens such as lignans and isoflavones are beneficial for health. Non-ultraprocessed soy products such as whole soybean milk, miso, tofu, contain isoflavones. Flaxseeds contain lignans. 

  • Diverse plant foods are beneficial as they contain a variety of fibres and acts as  including fruit, veg, of many colours, whole grains such as steel cut oats, quinoa, buckwheat, nuts, seeds, legumes, lentils, herbs and spices.

  • Protein is important for fuelling the moving body, synthesizing protein essential for happy brains and maintaining bone and muscle function. Legumes such as beans, peas, lentils, peanuts, chickpeas and nuts such as walnuts and almonds are great protein sources. Lean meats such as chicken and fish. 

  • Green tea contains antioxidants and epigallocatechin gallate (EGCG). EGCG supports metabolism, helping stabilise body composition and increase bone mineral density. 

3. Sleep

Vasomotor symptoms of menopause such as hot flushes and night sweats can interrupt sleep. Additionally variations in hormones can lead to early waking, and difficulty sleeping resulting in non-restorative sleep for many women during menopause. Exercise, particularly morning or afternoon exercise can aid with sleep. There are a number of mind-body therapies which can be useful for improving sleep including cognitive behavioural therapy and yoga. 


Some women find support for sleep from magnesium, tart cherry, micronised progesterone or melatonin. 

Often the best treatment for impaired sleep is management of hormonal fluctuations with hormone replacement therapy (HRT).

4. Stress Management

Often menopause is occurring concurrently with a busy time in a woman's life. She may have children or older teens, or grandchildren to care for, she may be progressing in her career or making a mid-career shift. Some women are caring for aging parents and others are involved in relationship breakdown or discovering new relationships.

It is important to have strategies in place to maintain balance and boundaries and to avoid becoming too overloaded so that you can avoid burnout.

Stress management depends on adequate restorative sleep, and is aided by exercise. Additionally these are some strategies some people find useful in managing stress:

  • mindfulness, deep abdominal breathing or meditation

  • yoga

  • massage

  • positive affirmation

  • daily gratitude practice

  • prayer

  • journalling/creative activities

  • down-time/leisure/fun/laughter

5. Healthy Relationships


Perimenopausal and menopausal symptoms affect women in many different ways, for some, the mental and physical symptoms can be detrimental to relationships. Mood changes, brain fog and lack of sleep can compound to create irritability and unhappiness and difficulties in relaationships. Lower hormonal levels can also contribute to vaginal dryness, discomfort during sex, low libido and low sexual desire. 

Good communication is essential for maintaining healthy relationships. Utilising lubricants can help with vaginal dryness. If mood changes and menopause symptoms are having a negative impact on your relationship, hormone replacement therapy may be useful. You may also benefit from talk therapy.


It is important to seek help if your relationships are being affected as it's important for your health and wellbeing to be surrounded by loving, supportive relationships. 

Read more about Sexual Health Clinics Dunedin.

6. Minimising Harmful Substances


Some foods and substances can worsen symptoms during menopause so these are best avoided or minimised. 

  • Caffeine - coffee consumption exacerbates menopausal vasomotor symptoms--hot flashes and night sweats that occur due to the constriction or dilation of blood vessels. A cup a day is unlikely to have a detrimental effect, but several cups and especially coffee or caffeinated drinks later in the day are likely to contribute to symptoms and impair sleep.


  • Alcohol - unfortunately alcohol is bad news for the menopausal woman. It is one of the largest risk factors for breast cancer, and breast cancer is the most common cancer caused by alcohol among women globally. The good news is that alcohol is a modifiable risk factor for breast cancer, meaning cutting down consumption reduces the risk.

Learn More About Perimenopause and Menopause


Anderson FA, Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9-16.

Australasian Menopause Society. Risks and Benefits. Sep 2018


Australasian Menopause Society. Lifestyle and behavioural modifications for menopausal symptoms. May 2019.

Australasian Menopause Society. Menopause Basics. May 2019.

Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses. Menopause. 2024 Apr 9. 

Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019; 394:1159-68. 5.

Canonico M, Plu-Bureau G, Lowe GDO, Scarabin P-Y. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336(7655):1227-31.

Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. [Erratum appears in Breast Cancer Res Treat. 2008 Jan;107(2):307-8]. Breast Cancer Res Treat. 2008 Jan;107(1):103-11.


Ni S, Wang L, Wang G, et al. Drinking tea before menopause is associated with higher bone mineral density in postmenopausal women. Eur J Clin Nutr. 2021;75(10):1454-1464.

Scarabin PY. Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis. Climacteric. 2018:23.

World Health Organization. Alcohol is one of the biggest risk factors for breast cancer. Oct 2021.


Vinogradova Y, Coupland C, Hippisley-Cox J. Use of Hormone replacement therapy and risk of breast cancer: nested case control studies using the QResearch and CRPD databases. BMJ. 2020; 371: m3873.

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