Menopause and menopause replacement therapy

Developed in collaboration with CASA Medical.

Information about menopause

The term “menopause” is often used as a catch-all for the symptoms, signs and experiences related to changes in female hormones over time, particularly leading up to the cessation of menstruation.

Menopause is defined as the point at which a woman has not had a menstrual bleed for 12 months. The time leading up to that point is termed “perimenopause”, the time after that point is termed “post-menopause”. Essentially this is caused by the reduction in production of oestrogen by the ovaries. In women aged less than 40 years, the term “premature ovarian insufficiency” or POI is used to describe these hormonal changes. The term “menopause” will be used in this Clinical Practice Guideline to cover the entirety of the peri- and post-menopausal and POI period.

The timeline and age for the experience of menopause (no menstrual bleeding for 12 months) varies widely, but the most common experience is for menstruation to stop around age 49-51 years, and for the experience of symptoms and signs to start 1-2 years before, and resolve around 1-2 years after, the cessation of menstruation.

Symptoms of menopause also vary in severity and nature between women, but commonly include:

• Hot flushes
• Mood changes
• Cognitive changes
• Sleep disturbance
• Musculoskeletal pain
• Urogenital changes
• Skin changes
• Menstrual irregularity

Most symptoms can be managed so that there is minimal impact on operational or organisational performance, and no impact on aviation safety. In fact, awareness of the symptoms of menopause and how to manage them are likely to result in overall better and safer operations and improved organisational performance through recruitment, retention and the extension of benefits across the industry – not just to women experiencing menopause.

Pilots and controller information

In most situations symptoms of menopause and medication prescribed by a medical practitioner or authorised health professional are compatible with aviation safety. In these circumstances you do not need to inform your ME or CAA.

If symptoms of menopause are distracting or otherwise impacting performance:

• Seek advice from your health care providers
• Seek review by your ME 

If systemic menopausal hormone therapy (MHT) is commenced:

• Seek advice from your health care providers
• Seek review with your ME if you have distracting side effects
• Include information about any symptoms and treatment at the next aviation medical examination. 

If antidepressant and neurokinin B (NKB) blocking medications are used for vasomotor symptoms:

• The following are approved medications for aviation activities:
  • Venlafaxine up to 75mg daily
  • Desvenlafaxine up to 100mg daily
  • Escitalopram up to 20mg daily
  • Fezolinetant 45mg daily
• Self-suspend from aviation duties on commencement and cessation of this medication
• There is a one-month ground trial on commencement on the above medication - One week ground trial for dose change and/or cessation of medication - Return to aviation duties only after ME clearance for commencement, dose change and/or cessation 

If non-prescription preparations are used (over-the-counter, herbal, naturopathic or alternative preparations):

• Seek advice from your Medical Examiner before starting these preparations
• If your ME recommends a ground trial return to aviation duties only after ME clearance

For more information, see Medical Manual: Menopause.