Menopause & Oestrogen Cessation

Please note: This page refers to processes typically associated with menopause; like ovulation, menstruation and changes in our bodies. Language used here may not be used by all trans people experiencing menopause. It is up to the person themselves to define what words feel best to refer to their body and their experiences.

Menopause impacts people of all genders, including trans and gender diverse people. Currently, the experiences of trans people of all genders navigating menopause remain significantly understudied and underrepresented.

This page outlines symptoms that might be related to menopause (and how to manage them) and might be helpful if you are wondering how menopause could affect you as a trans person. The information is relevant for trans and gender diverse people who have undergone medical affirmation through hormone therapy or surgery as well as trans people who have not.

What is menopause?

Menopause is a point in time and occurs when a person (who is not using any hormone therapy) has stopped menstruating for one year. It typically happens between the ages of 45–55 but can occur earlier5 or later. Perimenopause is the period leading up to menopause; it is caused by decreasing ovarian function and fluctuating hormones and is characterised by irregular periods.

Symptoms associated with menopause are experienced during perimenopause and, for some people, some years afterwards, during the so called ‘post-menopause’ period. For simplicity, we’ll use the term ‘menopause’ to cover the whole transition from perimenopause through menopause and into the post-menopause period.

Some people don’t go through perimenopause but go straight into menopause because they have had surgery to remove the ovaries or some other medical treatments.1   This is usually referred to as “medically-induced menopause”.Your individual experience of menopause can depend on a variety of factors including1,2, 6:

  • Your social and cultural context.
  • Whether you’re on hormone therapy (like testosterone) or blockers.
  • Surgeries you’ve undergone, e.g. some gender-affirming surgeries.
  • Other medical treatment, such as some cancer treatments.
  • Your ethnicity7
  • Your social and cultural context.

Symptoms of Menopause

Symptoms that might be related to menopause include:

  • Hot flushes (feeling waves of heat) 
  • Sweating at night 
  • Trouble sleeping 
  • Muscle and joint pains 
  • Heart beating quickly or strongly 
  • Brain fog (difficulty concentrating) 
  • Forgetfulness 
  • Less sexual desire 
  • Dryness or discomfort in genital areas
  • Anxiety 
  • Itchy skin 
  • Tiredness 
  • Wee (urinary) problems 
  • Irregular or absent menstruation.
  • Mood changes (feeling unhappy or irritable)

Many of these symptoms can start in the lead up to menopause and some may continue into post menopause. However, bleeding after a menopause diagnosis has been received i.e after 1 year with no menstruation is abnormal and we recommend speaking to your GP and seeking medical advice.

Note: Menopausal symptoms are non-specific and may be caused by other medical conditions. It is best to speak to your health professional if you are experiencing any troubling symptoms.

What if I have had a hysterectomy?

A hysterectomy is the removal of the uterus and may or may not include removal of the ovaries. If you’ve had your ovaries removed, you’ll experience medically induced menopause1,2,

Post-surgery, if you are already using testosterone at a standard rate, you are unlikely to experience menopausal symptoms. However, if you are not taking testosterone or are only taking a low dose, you may experience symptoms of menopause after surgery. If you’re having or have had a hysterectomy, you may need to start or adjust your hormone therapy before or after the procedure.

If menopausal symptoms occur after surgery, managing them may involve menopause hormone therapy (MHT) or other evidence-based treatments like Cognitive Behavioural Therapy (CBT)8.  These options can be tailored to your transition goals and healthcare needs.

 If you are considering MHT, either with oestrogen or testosterone, ask your doctor about what you may experience on these treatments and what your options are.

What if I am on hormone therapy?

Testosterone and masculinising hormones

There’s very little data on menopause in people who have ovaries and are receiving testosterone-based hormone therapy2,3..

This is because menopause generally doesn’t occur if someone is using adequate doses of testosterone. Estradiol levels may be low, but testosterone makes up for it. Testosterone therapy does not cause estrogen levels to decrease significantly (only slightly) and does not in itself cause menopausal symptoms.

While hormone therapy brings a whole host of wanted effects, you can talk to your prescribing doctor about managing unwanted symptoms, such as genital dryness/discomfort, libido and hot flashes.

Connecting with other trans people who receive gender-affirming hormone therapy and are experiencing menopause-like symptoms can be helpful too. The Facebook group All-Gender Peri/Menopause Support is a peer-to-peer mutual aid support group for all kinds of people currently going through, or who have gone through, all kinds of perimenopause and/or menopause.

Sian Ferguson writes:

Even if you’ve never had ovaries, using and stopping estrogen-based gender affirming hormonal treatment (GAHT) can cause you to experience menopause-like symptoms. – Healthline, 2023

Oestrogen and feminising hormones

Trans women and gender diverse people taking oestrogen may also experience menopause-like symptoms if their hormone levels decrease or if they stop treatment4. Symptoms might include:

  • Hot flushes.
  • Night sweats.
  • Mood changes.

For some, symptoms can be managed by adjusting hormone levels in collaboration with a knowledgeable healthcare provider. You can also connect with other trans people who receive gender-affirming hormone therapy and are experiencing these oestrogen fluctuations. The Facebook group All-Gender Peri/Menopause Support is a peer-to-peer mutual aid support group for all kinds of people (including trans women) currently going through, or who have gone through, all kinds of perimenopause and/or menopause.

Finding gender-affirming menopausal care

When you are looking for a health care provider, many trans people will be looking for clinicians who are affirming, supportive and respectful. It is also important to find someone with the relevant skills and experience to be able to support you.

Below are several ways to safely avoid menstruating, and also some information about unsafe ways to do so. 

Finding comprehensive healthcare as a trans or non-binary person can be frustrating and discouraging. But you’re not alone, and there are knowledgeable, caring healthcare professionals out there who will take you and your health seriously.

Soren Hodshire, Healthline (2023).

Green flags to look for when finding providers

In their article ‘How to Find Gender-Affirming Menopause Care’ Soren Hodshire notes some ‘green flags’ that you can keep an eye out for:

  • Having previous experience with trans and gender diverse clients.
  • Use of inclusive language on their website or in their clinic.
  • Client in-take form that asks appropriate questions about a patients’ trans-status.
  • Gender neutral restrooms.
  • Membership in professional organisations, such as AusPATH.

You can also check out our gender-affirming doctors list here to find doctors in your area, or search the AusPATH registered clinicians list. Trans.au also hosts a community-led directory of trans-inclusive doctors and services across Australia.

For more information about finding an affirming doctor you can see our gatekeeping page.

Questions to ask your healthcare provider

Once you actually get in the room with your clinician, you can start by explaining some of the symptoms that brought you there today. Here are some questions you may want to ask, depending on your particular situation and needs:

  • What can I do to manage mood changes from menopause?
  • Should I consider hormone therapy? What are my options and what kind of menopause symptoms will hormone therapy treat for me?
  • How can I address sexual health concerns like dryness or discomfort?
  • Will a hysterectomy cause menopause? 
  • Do I need regular screenings after menopause (e.g., Pap tests, mammograms)?
  • I haven’t had a period in years. Will I ever go through menopause?
  • Could my hormones affect me in a negative way?
  • Could I have gender dysphoria? What happens if I do?

Questions adapted from ‘How to Find Gender-Affirming Menopause Care’ by Soren Hodshire, 2023.

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