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Educational walkthrough · not a prescription

MHT Decision Stream

A guided, step-by-step teaching tool. Answer the clinical questions and it assembles the reasoning — target, suitability, route, regimen and specific options with their caveats.

Educational use only. This tool illustrates a reasoning pathway; it does not diagnose, does not replace history, examination, current product information or clinical judgement, and generates no prescription. Every decision — including whether to prescribe at all — rests with the treating clinician.
Step 1 / 7
01 · Timing

Where is she in the transition?

Timing sets the whole risk–benefit. The favourable window is under 60 or within 10 years of menopause. In POI it is replacement, not optional.

Used to flag late initiation (>60)
02 · Anatomy

Is the uterus present?

A uterus makes progestogen mandatory for endometrial protection. No uterus usually means oestrogen alone — with one exception.

03 · Target

What are we actually treating?

Match the treatment to the dominant problem. Systemic MHT is for bothersome vasomotor symptoms; genitourinary symptoms are often a local decision. Tick all that apply.

04 · Stop-and-assess

Any absolute contraindications?

These pause systemic MHT until investigated or resolved. If any are present, the stream will not build a hormonal regimen. Tick all that apply.

05 · Route modifiers

Anything that favours transdermal?

Most "contraindications" are really reasons to choose the patch, gel or spray rather than to withhold therapy. Tick all that apply.

06 · Contraception

Is contraception still required?

MHT is not contraception. A perimenopausal woman can still conceive — 2 years after the LMP if under 50, 1 year if over 50.

07 · Preference

Route preference?

Shared decision-making matters for adherence. Preference is weighed against the risk profile, not instead of it.

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Sources

References & resources

  1. Davis SR et al. (Women's Health Research Program, Monash University). A Practitioner's Toolkit for Managing Menopause. Climacteric 2023; toolkit current to May 2025. monash.edu
  2. Magraith K, Stuckey B. Making choices at menopause. Aust J Gen Pract 2019;48(7). racgp.org.au
  3. Management of menopause. Aust Prescr 2023. australianprescriber.tg.org.au
  4. Australasian Menopause Society — information sheets, MHT dose guide, bleeding & GSM resources. menopause.org.au
  5. The Menopause Society (formerly NAMS). 2022 Hormone Therapy Position Statement. menopause.org.au
  6. Fezolinetant (Veoza)Aust Prescr 2024;47:162–3; TGA hepatotoxicity safety update & PI monitoring, Oct 2025. tga.gov.au
  7. Elinzanetant (Lynkuet). Panay N et al, JAMA Intern Med 2025;185(11); TGA registration (ARTG) 2025. tga.gov.au