Help Centre
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Answers about appointments, prescriptions, HRT, payments and more — from New Zealand's specialist menopause clinic.
Other fees: some pharmacies charge a small private script fee when dispensing private prescriptions — this depends on the pharmacy and is not set by Menodoctor. Doctor's letters and blood tests/scans requested outside a consultation are charged per request.
Menodoctor is one of New Zealand's leading dedicated menopause clinics, founded by Dr Linda Dear and her husband Dan Dear. We provide specialist, evidence-based care for women experiencing perimenopause and menopause, with 45-minute initial consultations available virtually anywhere in New Zealand or in person in Tauranga.
Dr Linda Dear (MB BS London, FRNZCGP, BA (Hons) Psychology, DRCOG, MSCP) is Menodoctor's founder and Clinical Director. She studied medicine at University College London, completed GP training in New Zealand, and is a Certified Menopause Practitioner and member of The Menopause Society.
She is a leading voice on menopause in New Zealand and appears regularly across national media.
Our menopause doctors are Dr Linda Dear (Founder & Clinical Director), Dr Carolyn Bulman, Dr Catherine Forshaw, Dr Dawn Herbert, Dr Emily Loan, Dr Janice Vermaak, Dr Pam House, Dr Zoe Carlino and Dr Zoë Cruse.
All are NZ- or internationally-trained doctors with a special interest in menopause. Our health practitioner team includes Jess Thorns (Registered Nutritionist), Claire Baker (Pelvic Physiotherapist) and Emily Searle (Health & Cancer Coach).
We focus entirely on perimenopause and menopause. Initial consultations are 45 minutes — much longer than a typical GP appointment — giving time to properly explore your symptoms, history and treatment options.
Care is evidence-based, follows current menopause guidance, and includes a written plan for you and your GP.
Book online at menodoctor.com/pages/bookings. Choose a virtual or in-person consultation, select a time, and complete the booking form. Payment is made at the time of booking through our secure checkout.
No. You can book directly — no GP referral is needed. If you'd like your GP to share your medical history with us, they can send a referral via Healthlink (EDI: menodocs) or through the referral form at menodoctor.com/pages/referrals.
Yes. Most of our consultations (around 80%) are conducted by secure video, so you can access specialist menopause care from anywhere in New Zealand. No physical examination is required for menopause consultations, which makes virtual appointments effective for most women.
Yes — a limited number of in-person consultations are available at our Tauranga clinic (6/33 Hairini Street, Hairini, Tauranga 3112). Please arrive 10 minutes early. On-site parking and wheelchair access are available.
Your initial consultation is 45 minutes with one of our menopause doctors. The fee includes: review of your detailed new-patient questionnaire (symptoms, medical/family history, lifestyle); the 45-minute consultation; a personalised management plan; your first prescription sent to your chosen pharmacy; blood test or scan requests if needed; referrals to other specialists if needed; and a comprehensive letter for you and your GP within 4 weeks.
A standard follow-up is 20 minutes and is done online only. An extended follow-up is 45 minutes and can be virtual or in person. Book a standard follow-up if you've been seen within the last 12 months; book an extended follow-up if it's been more than 12 months since your last appointment or you have more complex issues (more than two topics) to discuss.
A standard follow-up is required within 3 months of your initial consultation for us to continue prescribing. After that, you need to be seen at least every 12 months to continue receiving prescriptions from us.
Your appointment takes place by secure video call right in your web browser — nothing to download. On the day, go to the Virtual Waiting Room at menodoctor.com/pages/waitingroom, choose your clinician and click to enter.
You'll need a device with a camera (laptop, tablet or phone) and a stable internet connection. Your doctor will join you when they're ready — if they're running a little late, stay in the waiting room.
You'll be sent a New Patient Registration form from our practice system (check your spam folder if it hasn't arrived). It takes about 10–15 minutes and covers your medical and surgical history, medications, symptoms, family history and lifestyle. The form must be completed at least 24 hours before your consultation — otherwise your appointment may be reduced to 30 minutes or cancelled with a no-show fee.
If you have relevant medical records to share, get in touch via our contact page and include your full name, date of birth and NHI number if known.
No. You do not need any blood, saliva or urine tests before your first consultation (and we specifically advise against expensive tests like the Dutch test). Hormone levels fluctuate so much in perimenopause that symptoms are a more reliable guide.
If tests are needed, your doctor will order them after your consultation.
Availability varies with demand, but most women can book within a few weeks. All available appointment times are shown online on the booking pages.
Use the change/cancel link at the bottom of your booking confirmation email. You can reschedule free of charge up to 72 hours before your appointment. Changes cannot be made within 72 hours of the appointment time — see the cancellation policy below.
Your doctor will wait 10 minutes while we try to contact you. After 10 minutes, the appointment is deemed missed and no-show fees apply.
Yes, we can offer advice to women outside New Zealand, but we cannot prescribe medications overseas. We can advise on how to approach your local doctor and provide a referral-style letter summarising your symptoms and suggested options.
Yes — partners are welcome to join your consultation, whether virtual or in person.
Initial consultation (45 min): $369 with one of our menopause doctors, or $419 with Dr Linda Dear (Clinical Director). Standard follow-up (20 min, virtual only): $199, or $219 with Dr Linda Dear.
Extended follow-up (45 min): $369, or $419 with Dr Linda Dear. All prices are NZD and include GST. Current prices are always shown at menodoctor.com/pages/pricing.
Nutrition consultation: $170 virtual or $195 in person (60 minutes, includes a personalised plan emailed afterwards). Pelvic physiotherapy: $170 (60 minutes, in person only — covers bladder instability, incontinence, prolapse and painful sex).
Health coaching: $165 (60-minute introductory session, virtual or in person).
Payment is made upfront at the time of booking through our secure online checkout, powered by Stripe. We accept Visa, Mastercard, American Express, Apple Pay, Google Pay, Afterpay, Klarna, and bank transfer (bank transfer is available when your appointment is at least 3 business days away).
Yes. Afterpay and Klarna are built into our checkout. When you book, you'll be taken to a secure payment page where you can choose Afterpay or Klarna and split the cost into interest-free instalments.
Your appointment is reserved and confirmed as soon as payment is made — no separate link or waiting.
Yes. If you don't have Afterpay or Klarna, we can set up a "pay in 4" payment plan using GoCardless — all you need is a New Zealand bank account. Call us on 07 242 4600 to set this up.
For held bookings on a payment plan, payment must be completed in full no later than 7 days before your appointment.
If your policy includes private GP cover (for example with Southern Cross), you may be able to claim back some or all of the consultation cost, depending on your policy and limits. Note this is different from specialist cover — Menodoctor doctors are classified as Specialist GPs, and insurers often classify specialists differently.
Check your policy wording or ask your insurer. You pay for the appointment first, then request an invoice from us afterwards to submit your claim — use the Insurance Invoice request in the Patient Hub (menodoctor.com/pages/invoice-request).
Nearly all the HRT we prescribe is funded by Pharmac, so the medication itself usually costs little. However, our prescriptions are private prescriptions, and some pharmacies charge a small private script fee when dispensing them — this depends on the pharmacy and is not set by Menodoctor.
You can reschedule free of charge up to 72 hours before your appointment using the link in your confirmation email. If you cancel 72 hours or more before your appointment, you can choose either a non-expiring voucher for the full amount, or a full refund minus a $20 processing fee (covering payment-gateway and admin costs).
A no-show fee applies: $100 for initial consultations or $50 for follow-ups. You can choose either a refund of your booking minus the no-show fee, or to pay the no-show fee and receive a voucher to rebook. The fee covers the clinician's reserved time.
The new patient form must be completed at least 24 hours before your consultation. If it isn't, we may either charge a no-show fee and cancel the appointment, or reduce your appointment to 30 minutes so the doctor has time to review your form.
No refunds are given once a consultation has taken place, for prescriptions issued, or for personal or prescription products sold.
Physical products (supplements, equipment, health aids) can be returned within 14 days of receipt if unused, with security seals intact, in original packaging and with proof of purchase.
Medicines and pharmaceuticals, personalised products, personal care goods, sale items and gift cards cannot be returned. Contact us via our contact page first to request a return — approved refunds go to your original payment method within 10 business days.
If your treatment plan includes new medication such as HRT, your prescription is emailed directly to your nominated pharmacy on the same day. Any blood tests or scans are ordered at the same time.
Your clinic letter — summarising your consultation and treatment plan — is emailed to you within 4 weeks (usually 2–4 weeks), and to your GP unless you opted out on your registration form.
Unfortunately no — like most private clinics, we don't have capacity to provide medical advice by email or phone. Please check this Help Centre for common questions, or book a follow-up consultation for personalised advice.
For non-medical queries (admin, forms, invoices), call 07 242 4600, Monday–Friday 9am–5pm.
Prescriptions are emailed directly to your chosen pharmacy on the same day as your appointment, and you can usually collect your medication that day. If your pharmacy hasn't received it, ask them to check their spam/junk folder.
If it's still missing, call 07 242 4600 or message us via our contact page and we'll resend it promptly.
Our prescriptions are usually written for three months of medication. If the pharmacy doesn't have enough stock, they may dispense one month and you can return later for the remainder — no new prescription needed.
Call other nearby pharmacies to find one with stock, then message us via our contact page and we'll send your prescription to that pharmacy instead. Note: one charge applies per script per pharmacy, so splitting medications across pharmacies counts as separate scripts.
All Menodoctor prescriptions are private prescriptions, and some pharmacies charge a small private script fee when dispensing them. This depends on the pharmacy and is not set by Menodoctor.
Request a repeat through the Patient Hub at menodoctor.com/pages/patients. There is a $35 charge per script, and scripts are typically sent within 3–5 days of the request. You must be an existing Menodoctor patient.
Because we send your treatment letter to your GP, they may also be able to provide repeats. If it has been more than 12 months since your last Menodoctor appointment, you'll need a follow-up consultation before further repeats can be issued.
Not all patients need blood tests. If you've had a general health check within the last six months, further tests may not be needed. Your doctor will advise during your consultation.
Any blood testing lab in your area. In most regions we send the request electronically, so you just go to the lab and give your name — no paper form needed. In areas without the electronic system, we'll email you a form to print and take with you.
We apologise — this is occasionally due to a technical failure or oversight. Call 07 242 4600 or message us via our contact page and we'll create a new request promptly.
Yes. We aim to send your results to you within two weeks of the test or scan, with a written interpretation. Please note we cannot upload results into GP patient portals such as Manage My Health, Tend Health or Health365.
Scans (such as a pelvic ultrasound or bone density scan) are only ordered when your doctor needs more information. If no scan request was sent, your doctor didn't feel one was required. If a scan was discussed but you haven't received the request, contact us via our contact page.
Use the request form to book directly with a local private radiology service — just phone them to arrange a time. Menodoctor can only provide private referrals, so the scan will be charged; costs vary by provider and may be claimable through health insurance.
For a publicly funded referral, see your GP.
Yes. Every patient receives a clinic letter summarising the appointment, treatment plan and any test or referral recommendations, emailed within 4 weeks. If you consented on your registration form, we send a copy directly to your GP — you don't need to do anything.
If you selected "no", the letter goes only to you. We encourage sharing with your GP so they can support your ongoing care and provide repeat prescriptions.
If your doctor feels a referral is appropriate, we'll provide a referral letter. This is a private referral, so specialist appointments may involve private costs. For a publicly funded referral, you'd need to see your GP.
As a private clinic we aren't connected to public GP systems and don't hold your full medical record. We're happy to prescribe an occasional one-off medication where a previous GP prescription can be verified, but ongoing non-menopause medications should be managed by your GP.
We help women of any age who are in perimenopause or postmenopause and experiencing symptoms affecting their quality of life, or who want advice on managing menopause. Our patients range from their 30s to their 80s and beyond.
Yes to both. Some women experience hormonal changes early (including premature ovarian insufficiency before 40), and some experience symptoms for many years — we treat symptoms at any age.
In many cases, yes — including breast cancer. Treatment options depend on your individual history and are discussed carefully during your consultation.
Yes. Many symptoms begin years before menopause itself. Menopause is technically the 365th day after your final period — before that point you're perimenopausal. Perimenopause usually starts in your 40s, but for some women it starts in their 30s.
Common symptoms include hot flushes and night sweats, poor sleep, anxiety, low mood or irritability, brain fog and poor concentration, fatigue, low libido, vaginal dryness or painful sex, irregular or changing periods, weight changes, joint aches, bladder symptoms, and many more.
If you're unsure whether your symptoms are hormone-related, we can explore this in your consultation — or try our quiz at menodoctor.com/pages/quiz or the Symptoms Checker at menodoctor.com/pages/symptoms-checker.
No. Treatment may include hormone therapy, non-hormonal medications, lifestyle changes, or a combination. While HRT is the gold standard for menopause symptoms, our doctors can discuss non-hormonal options and other approaches if HRT isn't right or isn't wanted.
Yes. We work alongside your GP — with your permission we send them a detailed summary letter after each consultation so your ongoing care stays connected. Your GP may also provide repeat prescriptions.
Menopause is the point when periods stop permanently — technically the 365th day after your final period, confirmed after 12 consecutive months without a period. It happens because the ovaries stop producing eggs and hormones (estrogen, progesterone and testosterone).
In New Zealand the average age is 51, and most women reach it between 45 and 55. It is not a disease — it's a natural transition, but the symptoms can significantly affect quality of life and effective treatments exist.
Perimenopause is the transition phase before menopause, when hormones fluctuate — surging and dropping unpredictably. It usually starts in your 40s (sometimes 30s) and can begin while periods still seem normal.
Early symptoms often include fatigue, brain fog, anxiety or mood changes, sleep problems, headaches and joint aches — often before hot flushes appear. Blood tests are usually normal during perimenopause, which is why diagnosis is based on symptoms.
Postmenopause is all the years after menopause. Hormones settle at lower, stable levels, but symptoms can continue or change. Genitourinary symptoms (vaginal dryness, urinary urgency, recurrent UTIs) often become more noticeable in postmenopause — over 50% of postmenopausal women have genitourinary syndrome of menopause (GSM), but fewer than 10% are treated, despite safe, effective long-term treatments.
Early menopause is menopause between 40 and 45. Premature ovarian insufficiency (POI) is when ovaries stop working properly before 40 — it affects about 1 in 100 women before 40 and 1 in 1000 before 30.
Diagnosis involves infrequent or absent periods plus a high FSH level on two blood tests at least 4 weeks apart. HRT is recommended for almost all women with POI until at least the average age of menopause (~51) to protect bones, heart and brain.
Induced menopause happens when the ovaries stop working because of surgery (removal of ovaries), chemotherapy, radiation, or certain medications. Symptoms come on suddenly and are often more intense.
HRT is usually recommended, particularly for younger women — research (Nurses' Health Study) showed ovary removal before 50 without HRT increased all-cause mortality risk by 41%, and HRT removed this excess risk.
Yes — contraception is still needed during perimenopause. Standard HRT is NOT contraception (unless a Mirena coil is part of your HRT). Contraception is advised for 12 months after your last period if you're over 50, or 24 months if under 50.
It varies widely. Around 80% of women get symptoms. Hot flushes and night sweats typically last 4–8 years, but more than 10% of women still have symptoms after 10 years. You don't need hot flushes or period changes to be perimenopausal.
For most women, no. Symptoms are a more reliable indicator of perimenopause or menopause than blood tests, because hormone levels fluctuate daily — even hourly — at this stage. A single test may show "normal" levels even when symptoms are severe.
If you're over 45 with typical symptoms, no blood test is needed for diagnosis. Blood tests are useful if you're under 45 (to confirm early menopause or rule out other causes such as thyroid problems), if your symptoms don't fit the usual pattern, or to check estrogen absorption on HRT.
No. Saliva and urine hormone tests are not scientifically validated for diagnosing menopause or monitoring HRT — they capture a single moment, vary with diet and hydration, and don't reflect blood or tissue levels.
Major menopause societies (British, Australasian and North American) do not recommend them. They can also be expensive. If testing is needed, standard blood tests ordered by a doctor are the only reliable option.
In younger women with regular cycles, tests are sometimes timed (day 2–5 for FSH, LH and estradiol; day 21 for progesterone). In perimenopause, cycles are irregular and hormones fluctuate so much that timing rarely adds value — symptoms are a better guide.
We prescribe pharmaceutical-grade bio-identical (body-identical) hormones — estradiol, micronised progesterone and testosterone — tailored to each woman. These have the same molecular structure as your body's own hormones and are fully regulated.
We do NOT prescribe compounded hormones, because their purity, consistency and quality cannot be guaranteed.
For most healthy women who start HRT under 60 or within 10 years of menopause, benefits outweigh risks. Combined HRT (estrogen + progesterone) very slightly increases breast cancer risk with long-term use — around 8 extra cases per 10,000 women per year, and only after about 5 years of use.
This is a smaller risk than being overweight or drinking two or more alcoholic drinks daily. Estrogen-only HRT (after hysterectomy) has been linked to a reduced breast cancer risk. Modern body-identical HRT with micronised progesterone carries lower risks than the older synthetic products studied in the WHI trial.
Oral estrogen tablets slightly increase clot risk because they're processed by the liver, which increases clotting factor production. Transdermal estrogen (patches or gel) bypasses the liver and does not increase clot risk. This is why patches and gel are our preferred first choice, especially for women with any clot risk factors or migraines.
There's no strict time limit. Many women continue long-term when benefits outweigh risks. Regular reviews (at least yearly with us) reassess symptoms and risks.
Yes — you can stop at any time without tapering, and stopping does not cause harm. Your menopausal symptoms may return, though.
Yes — patches or gel are preferred, as they give more stable hormone levels and are less likely to trigger migraines.
HRT can still be considered after 60, but risks (such as clots or stroke) are somewhat higher, so decisions are individualised with your doctor.
Cyclical (sequential) HRT is used in perimenopause while you're still having periods: estrogen daily, progesterone for about 2 weeks of every month, producing a monthly bleed. Continuous HRT is used once periods have stopped (usually 12 months without a period): both hormones daily, no scheduled bleed.
Nearly all the HRT we prescribe is funded by Pharmac. Examples: Estradot/Mylan patches, Estrogel, Utrogestan, Progynova, Ovestin and Provera are funded; Sandrena gel, Climara patches and Androfeme testosterone cream are not funded; the Mirena coil device is funded (insertion is not).
Non-hormonal medications (such as SSRIs, SNRIs, gabapentin or clonidine) can help vasomotor symptoms, alongside lifestyle measures — exercise, diet, sleep routine and stress management. Our doctors can build a non-hormonal plan tailored to your symptoms.
We advise against all of these. Compounded bioidentical hormones are unregulated and their hormone content varies batch to batch. Rhythmic HRT (e.g. the Wiley Protocol) uses very high hormone doses with safety concerns (clots, cancer, stroke) and no supporting evidence.
Imported "natural" creams are unregulated and may not contain what they claim. Major menopause societies advise against them — as do we. Licensed, pharmaceutical-grade bio-identical HRT provides the same "natural" hormones, safely and reliably.
Tablets: Progynova (funded), Estrofem (part funded), Premarin (part funded), plus combination tablets (Kliogest, Kliovance, Trisequens). Patches: Estradot, Mylan, Estraderm (twice weekly, funded); Climara (weekly, not funded).
Gel: Estrogel (funded), Sandrena (not funded). Vaginal: Ovestin cream/pessaries (funded). The safest route is transdermal (patch or gel), which carries no increased clot risk.
Apply to clean, dry skin on your lower belly, back, buttocks or thigh. Change twice a week (e.g. every Monday and Thursday), rotating the position slightly each time to avoid irritation. You can shower, swim and bathe with a patch on, though hot water (spas) and frequent swimming may loosen it.
Make sure skin is clean, dry and free of oils, creams or sunscreen. Try the buttocks or lower abdomen. If patches still won't stick, a different brand or switching to gel may help — ask your doctor. Glue residue removes easily with baby oil and a dry flannel.
Change it as soon as you remember. There's no risk of too much estrogen — the patch simply stops releasing estrogen at the end of its dose.
Yes. Patches can be safely cut into halves, thirds or quarters to adjust the dose. Store the unused portion in the original packet.
For mild irritation, try an antihistamine or a thin layer of steroid cream before applying the patch, and rotate sites. If irritation is significant or persistent, talk to your doctor about switching brands or to gel.
Apply once daily (morning or evening), spread thinly on the skin — don't rub in aggressively — and let it dry for about 5 minutes before dressing. Estrogel goes on the arm or thigh; Sandrena on the lower abdomen or thigh.
Higher doses can be split into morning and evening applications. Avoid water on the area for at least an hour after applying, and wait an hour before applying other lotions or sunscreen to the same area.
Once dry (after about an hour) it won't transfer. Avoid skin-to-skin contact with others on the application area for the first hour.
Yes, some women use a combination for better symptom control — but discuss this with your doctor to get the dose balance right.
Stay on the same dose for at least 6 weeks to let it settle. If symptoms like hot flushes, night waking or mood swings haven't improved by then, a dose increase may be reasonable — but this needs to be agreed with your doctor at a follow-up appointment.
Common signs include nausea, breast pain, feeling "wired" or anxious, headaches, bloating, and heavier or more painful periods. If these appear after a dose increase, a reduction may be needed — discuss with your doctor.
Standard licensed maximums are 100mcg patches or 4 pumps of gel daily. Higher doses are occasionally used off-license for poor absorbers, but only under specialist supervision.
Take it as soon as you remember. If it's nearly time for the next dose, skip the missed one. Never double up.
There are approximate dose equivalents, but absorption differs between women, so switching usually involves some adjustment guided by your doctor.
Estrogen taken alone can thicken the womb lining and cause abnormal cells, increasing womb cancer risk. Progesterone balances estrogen's effects and keeps the lining safe. Any woman with a womb taking estrogen needs progesterone too. (After hysterectomy, estrogen-only HRT is usually appropriate.)
Utrogestan is micronised (body-identical) progesterone — the only prescribed bio-identical progesterone in New Zealand, and fully funded. It carries lower risks of breast cancer, heart disease and clots than synthetic progestogens, and has a mild sedative effect, so take it at night on an empty stomach (1 hour before or 2 hours after food).
Cyclical (still menstruating): 200mg (2 capsules) at night for 2 of every 4 weeks. Continuous (no period for 6–12+ months): 100mg (1 capsule) every night. Your doctor will confirm the right regimen for you.
Yes — inserting the capsule vaginally at bedtime often reduces side effects for women who don't tolerate it orally. Discuss the right vaginal dose with your doctor.
Day 1 is the first day of spotting or bleeding. Count 14 days from day 1, then take your progesterone for two weeks, then stop for two weeks — regardless of when your next period arrives.
If your cycle is irregular (common in perimenopause), just keep to the 2-weeks-on / 2-weeks-off rhythm as closely as you can; it doesn't need to be perfect. If your period comes at the "wrong" time, keep taking progesterone as planned — it's still safe and effective.
Yes. Continuous use avoids monthly bleeding and is usual once periods have stopped. Some women get irregular bleeding at first, which usually settles within a few months.
Bloating, breast tenderness, low mood, sedation or headaches can occur, and usually settle. Some women tolerate vaginal Utrogestan better than oral.
Some women are particularly sensitive to progesterone, with PMS-like symptoms: anxiety, low mood, bloating, headaches, breast pain, greasy skin or acne. Options include switching to body-identical Utrogestan (if on a synthetic), using Utrogestan vaginally, trying a different progestogen (Provera or norethisterone/Primolut), or a Mirena coil for womb protection.
Sometimes adjusting the estrogen dose improves tolerance. Only four options in NZ protect the womb: Provera tablets, Primolut tablets, the Mirena coil, and Utrogestan capsules.
Yes, where appropriate. Testosterone can help with low libido, energy, fatigue, brain fog, muscle strength and mood. Suitability is assessed individually at your consultation, and monitoring blood tests are arranged afterwards.
Androfeme — a cream specifically formulated for women, bio-identical, licensed in Australia, applied daily to the lower abdomen or upper thighs; available privately (not funded). Note AndroFeme 1 contains almond oil — avoid if you have an almond allergy. Testogel — made for men but usable in smaller female doses, and funded by Pharmac since 1 April 2024.
Testosterone is not licensed for women in NZ, so prescribing is off-label under specialist guidance.
A blood test before starting (to confirm levels are in the lower range), a recheck at about 6 weeks, then every 6–12 months. Our testosterone monitoring blood test review costs $50 and includes the test request, interpretation, and a letter with any dose adjustment.
At correct female doses side effects are rare, but can include acne, excess hair growth (sometimes at the application site) or, rarely, voice changes. Testosterone won't masculinise you at female-range doses.
It can take weeks to months to work — if there's no benefit by 6 months, it's usually stopped.
Ovestin (estriol cream or pessaries — fully funded in NZ) treats vaginal and urinary symptoms of menopause: dryness, soreness, itching, pain during sex, urinary frequency or urgency, and recurrent urine infections.
These symptoms are part of genitourinary syndrome of menopause (GSM). Vaginal estrogen works locally, is not classed as systemic HRT, needs no added progesterone, and is not linked to breast cancer or clots.
Use the supplied applicator or simply apply with your finger — it doesn't need to go high inside the vagina; lower down is sufficient. You can also apply it externally to the vulva or clitoris for soreness, and around the urethra for urinary symptoms.
Typically every night for the first 1–2 weeks until symptoms improve, then twice a week for maintenance. It's safe to use long-term — even indefinitely — if symptoms persist. Mild irritation when starting usually settles within 1–2 weeks.
The Mirena releases progestogen directly into the womb, protecting the lining from estrogen. It often stops periods altogether, allows estrogen doses to be adjusted more easily, provides contraception (which standard HRT does not), and lasts 5 years for HRT purposes.
The device is funded in NZ; insertion is not.
Yes — many women use it purely for womb protection alongside estrogen.
Irregular bleeding in the first months after insertion is common. Some women notice mood changes, acne or bloating, though most tolerate it well. If you suspect it has moved or fallen out, or you have persistent pain, see your GP for assessment.
Yes — bleeding is common in the first few months after starting or changing HRT and usually settles within 3–6 months. Some women on cyclical HRT have a monthly period-like bleed, which is expected (and doesn't mean fertility has returned).
See a doctor if bleeding continues beyond 6 months after starting HRT, beyond 3 months after a dose change, is very heavy or painful, or starts unexpectedly after you've been stable on HRT.
Women with higher womb-cancer risk factors (BMI over 30, diabetes, PCOS, family history of womb cancer) should seek advice sooner. A pelvic ultrasound is sometimes advised to check for fibroids or lining changes.
Very heavy bleeding (needing to change protection every 30 minutes, or passing clots) is not typical. Options include reducing estrogen, increasing progesterone, or switching to a Mirena coil — and a pelvic scan is often recommended to rule out fibroids or other causes.
Book a follow-up or see your GP.
Especially in the first weeks: breast tenderness, spotting or bleeding, pelvic cramps, headaches, nausea, bloating, gut symptoms or mood changes. Most are mild and settle. Starting low and increasing gradually reduces side effects; your doctor can also change the hormone type, delivery method or dose.
If symptoms are severe or persistent, stop the HRT and contact your doctor.
Most women do not gain weight from HRT — some find it helps with weight control. Weight changes around this time are more often due to menopause itself (and ageing) than HRT.
Strength training (muscle raises metabolism), adequate protein (about 30g per meal), and for some women time-restricted eating combined with a Mediterranean-style diet. Where appropriate, our doctors can also prescribe weight-loss medications such as Saxenda or Wegovy — discuss at your consultation.
Yes. HRT improves bone density and reduces fracture risk — falling estrogen is a key driver of bone loss after menopause. Bone benefits last while you're on HRT and gradually reduce after stopping. HRT reduces fracture risk but doesn't eliminate it entirely.
Yes — bisphosphonates, denosumab, raloxifene and teriparatide, prescribed when HRT isn't suitable or alongside it. Lifestyle matters too: weight-bearing and resistance exercise, adequate calcium and vitamin D, not smoking, limiting alcohol, and fall prevention.
Yes. Mood symptoms are among the most common — and often earliest — perimenopause symptoms, sometimes starting up to 5 years before physical symptoms. At least 40% of peri/menopausal women report depressive symptoms.
Estrogen supports mood-regulating brain chemicals (serotonin, noradrenaline, dopamine), so fluctuating levels affect mood. UK NICE guidance supports HRT as a first-line option for menopause-related mood symptoms (where there's no separate clinical depression diagnosis), alongside lifestyle measures and talking therapy.
Women with a history of depression, PMS or postnatal depression are more vulnerable at this time.
Yes — difficulty concentrating, word-finding trouble and forgetfulness are very common in perimenopause and early postmenopause. For most women, memory after the transition returns to being as good as before.
Sleep, mood and general health also play a role. Staying physically, mentally and socially active, eating well and managing cardiovascular risk factors all help.
It can. Falling and fluctuating estrogen affects dopamine, which can worsen ADHD symptoms — and menopause brain fog, poor concentration and sleep problems overlap with ADHD symptoms.
Management can include ADHD medication and/or therapy, lifestyle changes, and treating the menopause symptoms themselves (including HRT). Several of our doctors have a special interest in neurodiversity/ADHD.
Hormone fluctuations can trigger headaches, especially in women with a history of menstrual migraines. Hormonal headaches typically improve once hormones stabilise after menopause. For HRT users with migraines, patches or gel are preferred for their steady hormone levels.
Insomnia is very common around menopause — from night sweats, but also anxiety, restless legs, sleep apnea and other causes. Good sleep routine helps (regular hours, cool room, limiting caffeine). If hot flushes are the main cause, HRT usually helps significantly.
Low libido is common in the 40s and 50s and has many contributors — hormonal (falling testosterone and estrogen), vaginal discomfort, sleep, mood and relationship factors. Treatments include addressing vaginal dryness (vaginal estrogen), systemic HRT, and testosterone where appropriate.
If you or someone you know needs support, free NZ helplines include: Need to Talk — call or text 1737; Lifeline — 0800 543 354 (or text 4357); Depression Helpline — 0800 111 757; Samaritans — 0800 726 666. In an emergency, call 111.
A digital video course by Dr Linda Dear — over 50 short videos (3.5 hours) in three parts: The Science (stages and types of menopause, hormone testing), The Impact (effects on heart, gut, bones and metabolism), and The Management (nutrition, exercise, herbal remedies, non-hormonal medications and HRT).
The regular price is $120 (currently on sale from $89.99 — see menodoctor.com/products/guide for the current price). It works on any device, includes downloadable handouts, and access lasts 2 years. nib members get free access via the mynib app.
Questions: contact us via our contact page.
Take the 1-minute quiz (menodoctor.com/pages/quiz) or the Symptoms Checker (menodoctor.com/pages/symptoms-checker), explore The Menopause Guide, or read the Learn pages on our website. When you're ready, book at menodoctor.com/pages/bookings.
Complete our free Symptoms Questionnaire (menodoctor.com/pages/symptoms-questionnaire) and take it to your appointment. Book a longer or double appointment if possible, know your key history (periods, contraception needs, screening, family history of breast cancer, current medicines), and ask reception whether any GP has a special interest in menopause.
Trusted further reading: Australian Menopause Society (menopause.org.au), British Menopause Society (thebms.org.uk), Balance (balance-menopause.com).
Yes — Menodoctor at Work (menodoctoratwork.com) provides workplace menopause talks and training.
For admin queries call 07 242 4600 (Mon–Fri 9am–5pm) or use the contact page. For personalised medical advice, book a consultation.
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