It is dubbed the midlife crisis, middle age spread era, the climacteric, the change of life or simply “the change” and has even inspired a play, Menopause the Musical.

The variety of nicknames for menopause reflects the diversity of ways in which women are affected during this major turning point in their life.

Most women have a relatively easy time making their way through menopause, some completely breeze through without a whimper but there are the unfortunate ones who are hit hard by unrelenting symptoms.

Internationally renowned gynaecologist Dr Elizabeth Farrell, who specialises in menopause and is a founding Board member of the Jean Hailes Foundation for Women’s Health in Victoria, said that the majority of women would have mild to moderate symptoms and could probably manage without any added therapy.

About 20 per cent of women would experience no symptoms.

“Their periods will stop and they will feel fit and healthy and nothing will be different,” she said.

Another 20 per cent would have severe symptoms which impacted on their quality of life and were the women who really needed to have treatment.

For women in their perimenopausal and early-postmenopausal years, the use of hormone replacement therapy was considered safe.

“But it is contrary to people’s memories,” Dr Farrell said.

“They still have the study published in 2002 in the forefront of their brains.”

That study, the Women’s Health Initiative, reported a slightly increased risk of stroke, heart disease and thrombosis in women on long-term combined oestrogen and progesterone HRT.

Dr Farrell said that for women going through menopausal symptoms, the use of HRT was acceptable if they had no heart disease risks and were fit and healthy.

Although the WHI study showed that in those women taking oestrogen and progesterone, there was a small increase in the risk of breast cancer after five years of use, Dr Farrell said most of those women had been on HRT before the study. This was because the average age of participants was 63 years.

Women on oestrogen alone had no increased risk of breast cancer after seven years. In community studies, including the Nurses Health Study, there was no increased risk in women on oestrogen alone until after 15-20 years, Dr Farrell said.

Dr Farrell, who is president of the Australasian Menopause Society and also the Asia Pacific Menopause Federation, said it was worth having a medical check to rule out other possible causes – such as high blood pressure and hyper-thyroidism – for hot flashes and sweats.

Although venlafaxine (an antidepressant) could be used to alleviate hot flashes and sweats, it also caused them in about 20-30 per cent of women.

Evidence suggested that women who were suffering from a dry vagina could first try lubricants but if these were not sufficient, they could use one of the vaginal oestrogen products fairly safely, Dr Farrell said.

These included oestriol vaginal creams or pessaries which should be used only about twice a week in the longer term.

Women who wanted to navigate menopause naturally, without any medication, could take certain steps, Dr Farrell said.

Anxiety and stress can be triggers for flushes and sweats. “Some of the things that are recommended are meditation and yoga,” she said.

“Acupuncture hasn’t been shown to be effective but hypnosis has been shown to be effective in some women and things like paced respiration, doing the deep breathing like you do in labour, and biofeedback programs can be helpful.”

Another hazard was a teenage daughter dealing with puberty at the same time her mother was going through menopause. “Sometimes a little bit of family counselling can help,” Dr Farrell said.

Gynaecologist Dr Margaret Smith, who established the first menopause clinic in WA and is a foundation member of the Australasian Menopause Society, said that hormone replacement therapy was now called hormone therapy because the aim was not to attain premenopausal levels of oestrogen but to give small amounts for a short time to ease the symptoms of menopause, such as hot flashes, without causing breast soreness.

But Dr Smith said while some effects of oestrogen deficiency could be relieved, others could last for years. These included loss of bone density, which could lead to osteoporosis, and lack of oestrogens in the vagina which can lead to painful intercourse and urinary tract infection.

Hormone therapy could be given locally into the vagina and did not raise the risk of breast cancer or cardiovascular disease, she said.

And while women who smoked or had high cholesterol, diabetes or hypertension had a slightly increased risk of heart attack and stroke, transdermal hormone therapy might be useful once the risk factors were treated and reduced.