If you have worked out that what is happening to you is menopause, the next question is what you can do about it here. That answer is different in Japan than it is at home, and most of it is written down only in Japanese.
The treatment information below comes from the guidebook the Japan Society for Menopause and Women's Health publishes for patients, which is drawn from the treatment guideline the society produces jointly with the Japan Society of Obstetrics and Gynecology. It is the closest thing to an official answer, and it is linked at the bottom of this page along with the other sources used.
What counts as menopause here
The Japanese term is 更年期 (kounenki). The society defines it as a ten-year window: the five years before your last period and the five years after. Menopause itself is judged to have happened once twelve months have passed without a period, and the guidebook gives the average age for it as around 50.
The symptoms themselves are not our subject and are better read about from a medical source. What matters here is the second word you will meet: 更年期障害 (kounenki shougai). The guidebook uses it for the case where those symptoms are disrupting daily life. It is the situation the treatment below is aimed at.
Which clinic to go to
There is no menopause department as such, and the sign on the door will not say so. These are the four you will hear mentioned.
| Where | When it fits |
|---|---|
| 産婦人科 Obstetrics and gynaecology |
Where the society tells you to go. The usual first stop for menopausal symptoms |
| 更年期外来 Menopause clinic |
A dedicated clinic, where you want a longer conversation with someone who specialises in it |
| 内科 Internal medicine |
If you already have a doctor you see, if there is no gynaecology clinic near you, or if it is not clear whether the symptoms are menopause or something else |
| 心療内科 Psychosomatic medicine |
When the main trouble is low mood, irritability or sleep |
The society certifies doctors who specialise in this area and publishes a directory of them by region, though that directory exists only in Japanese.
If you only take one thing from this page. Where the society addresses the reader directly, it says the same thing each time: if menopausal symptoms are disrupting your life, do not sit with it on your own, go to a 産婦人科 (obstetrics and gynaecology) and talk to a doctor. It repeats that for painful sex, and again for anyone under 40 who has gone three months or more without a period. The other departments in the table are alternatives, not the default.
The three medicines
The society sets out three kinds of drug treatment, to be chosen with a doctor according to your symptoms and health.
HRT
ホルモン補充療法
Replaces the oestrogen you have stopped producing
Kampo
漢方
Herbal medicine, aimed at the balance of mind and body
Antidepressants
抗うつ薬・抗不安薬
Acts on the nervous system, for the mental side
HRT (hormone replacement therapy)
Replaces the oestrogen your ovaries have stopped producing. The society credits it with two things: easing menopausal symptoms, and heading off conditions that become more likely after menopause. The list it gives covers hot flushes and sweating, low mood, joint pain, thinning of the vagina and vulva and painful sex, loss of collagen and moisture in the skin, osteoporosis, abnormal blood lipids and arterial hardening.
It comes in three forms. Of the tablet the society says only that it is the long-established one. Of the patch and the gel it says they are absorbed through the skin straight into the bloodstream, and carry a low risk of blood clots. It does not put that note against the tablet.
The society sets out two patterns. Where you still have your uterus, oestrogen is given together with a progestogen, to guard against cancer of the uterine lining. Where the uterus has been removed, oestrogen is given on its own.
Kampo
Traditional herbal medicine, prescribed by a doctor. The society describes it as working less by suppressing a symptom than by drawing the person as a whole towards a balanced state, without separating mind from body. Two people reporting the same complaint may be given different kampo, depending on how the balance has gone and on their constitution.
Antidepressants and anti-anxiety medication
Listed as the third option, acting on the nervous system, for when the mental and emotional side is the harder part.
Not drugs alone. Before it reaches any of the three, the guidebook says that improving daily habits, meaning eating, exercise and sleep, matters, and that counselling can help too. Drug treatment is what it suggests considering where symptoms are strong and disrupting daily life. It also asks readers not to lose sight of self-care, both before treatment and while on it: doing the things your mind and body are glad of.
What insurance covers
Where menopausal symptoms are coming from oestrogen fluctuating or falling away, and they are disrupting your life, the guidebook says insurance applies. That covers HRT and, with some exceptions, kampo.
Its 2023 edition puts the medication itself at ¥1,000 to ¥2,500 a month under insurance, depending on which preparation you are on. That is the drug cost, not the consultation, and it is a 2023 figure. What you actually pay turns on your own insurance category and on fees that get revised, so read it as a scale rather than a quote.
HRT aimed at heading off future illness and holding onto quality of life is, in the society's view, possible. It asks that you go through the risks as well as the benefits with the doctor first, and notes that this use can fall outside health insurance, so ask.
Far fewer women here choose HRT
This is the part that catches people out. If you have come from a country where HRT is the routine answer to menopause, Japan will not look like that.
| Study | Who | Rate |
|---|---|---|
| Nagata et al., Maturitas, 1996 | 8,791 women aged 45–64 living in one Japanese community, surveyed 1992 | 2.5% using at the time, 6.3% had used before |
| Yasui et al., J Epidemiol, 2022 Japan Nurses’ Health Study |
7,915 nurses, public health nurses and midwives, surveyed from 2001, taken from a cohort of 15,019 by setting aside those still having regular periods | 13.8% had used at some point |
The gap between those two numbers is not one to average. One counts women using HRT at a single moment; the other counts anyone who had ever used it. And the second surveyed nurses, public health nurses and midwives, who work in healthcare and are not a cross-section of the population.
The nurses study set its own figure against comparable cohorts abroad, which is the fairer comparison. A Danish nurse cohort followed between 1993 and 1999 came out at 37.2%. The American nurses' study, over 1980 to 1994, came out at 15.8%. So Japan sits well below Denmark, and close to the American figure, though the periods studied differ and none of these numbers is current.
Low uptake is not the same as unavailable. HRT is prescribed here, it is covered by insurance, and the society publishes patient material to help people understand it. You are unusual in choosing it, not blocked from it.
If HRT is not for you
Some women cannot take HRT. The guidebook sets out two lists: conditions that rule it out, among them breast cancer now or in the past, certain cancers of the uterus, unexplained bleeding, possible pregnancy, severe liver disease and a history of blood clots, heart attack or stroke; and a longer list of conditions that call for caution rather than a bar. Both are questions for the doctor, who will go through your history before anything is prescribed. Others simply would rather not take it.
The guidebook addresses this directly. Where HRT is ruled out by a history of breast cancer or for some other reason, it says kampo and supplements can still be used, and that treatments other than HRT can help. What it lists:
- Kampo and supplements. Some plant-derived supplements, soy isoflavones among them, have a weak oestrogen-like action
- Therapies other than medicine where back pain or stiff shoulders are the trouble, massage and acupuncture among them
- A headache clinic (頭痛外来) if headaches persist
- Psychiatry or a mental health clinic if your mental balance has gone
There is also what you can buy without seeing anyone. The herbal medicines sold over the counter in Japanese drugstores are covered on our Women's Health page, with ingredients and dosage taken from the Japanese package inserts.
On the breast cancer question
Breast cancer is the worry that comes up most often around HRT, and the guidebook gives it a column of its own.
The society's position is that the risk has turned out lower than was once feared. Below five years of use it reports no clear difference against not using HRT at all. Beyond five years it puts the risk on a par with, or below, lifestyle factors already known to raise it: alcohol, smoking, obesity. It adds that the risk also varies with which progestogen is used alongside the oestrogen, which is a question for the doctor rather than something to settle in advance. It notes too that one woman in nine develops breast cancer regardless of HRT, and that you should keep up regular screening whether you take it or not.
The society is not a disinterested bystander here: the guidebook exists, in its own words, to advance the correct understanding of HRT. But this is its own published guidance for patients, drawn from the clinical guideline it produces with the Japan Society of Obstetrics and Gynecology.
Timing matters
One point from the guideline belongs in the consultation. Starting HRT within ten years of your last period, or before 60, is associated in large studies with a reduced risk of heart attack. Starting after 60, or more than ten years after your last period, loses that protective effect and raises the risk of stroke and deep vein thrombosis instead.
The society's own wording is that where menopausal symptoms are troubling you around the time of menopause, starting HRT then draws out its effect most safely and most fully. It also calls healthy daily habits the thing that matters most for taking HRT safely.
Starting after 60 is not ruled out. The society says it can be done, but only where the benefit of the symptoms you want relieved outweighs the risk, and that it calls for careful thought before going ahead.
The bleeding nobody warns you about
Better to know this before you start than after. If you still have your uterus, the society puts the chance of breakthrough bleeding on HRT at 40 to 60 per cent. It is commonest in the first three months, and in most cases settles within six months to a year.
It is not something to sit on. The society says the dose can sometimes be adjusted to reduce it, and that heavy bleeding, or bleeding still going on more than six months in, should be looked at. Either way it is a reason to go back to the doctor.
The other side effects it lists are breast tenderness or pain, a full feeling in the abdomen, nausea and vaginal discharge. It says these vary from person to person and often ease off, and to raise them with the doctor if they are hard to live with.
If you have had cancer
This section is about gynaecological cancer, meaning cancer of the cervix, the lining of the uterus or the ovaries. Breast cancer sits in the list above and is treated differently.
Do not assume treatment for one of those rules you out. The guidebook goes through all three one at a time, and for each it describes situations where HRT can be considered after treatment.
It also says there are cases where HRT is better not done, depending on the type of cancer, the stage of treatment and your own health, and that the doctor following up your cancer care should be part of the decision. This is a conversation for them, not a question to settle from a web page.
And how long you stay on it
The other question people arrive with is when to stop. The society's answer is that there is no fixed rule: no age you must stop by, and no number of years after which you must stop.
Some large studies abroad have shown breast cancer risk rising where HRT was continued beyond five years. The society cites them, and is explicit that they do not make five years a cut-off. What it asks instead is that you stop and take stock with your doctor at least once a year: what this HRT is doing for you, and whether that still outweighs the risks and the burden, cost included. It suggests using that conversation to revisit the alternatives and self-care as well.
On one point the society is firm. Keep up breast cancer screening for as long as you are on HRT, and it says that if breast cancer is found to be present, HRT has to stop.
It also notes that HRT is not the only treatment for abnormal blood lipids or for osteoporosis. If those are what is keeping you on it, that is a point to raise.
Sources
- Japan Society for Menopause and Women's Health, ホルモン補充療法の正しい理解をすすめるために (patient guidebook, October 2023, in Japanese), drawn from the 2017 HRT Guideline produced with the Japan Society of Obstetrics and Gynecology
- Nagata C, Matsushita Y, Shimizu H. Prevalence of hormone replacement therapy and user's characteristics: a community survey in Japan. Maturitas 1996;25(3):201–207
- Yasui T, Ideno Y, Shinozaki H, Kitahara Y, Nagai K, Hayashi K; JNHS Research Group. Prevalence of the Use of Oral Contraceptives and Hormone Replacement Therapy in Japan: The Japan Nurses’ Health Study. J Epidemiol 2022;32(3):117–124. doi:10.2188/jea.JE20200207
- The descriptions of the four departments are summarised from Japanese patient-information pages, principally Kracie's MenotechLife guide to menopause consultations (in Japanese)
This page explains how care is organised in Japan. It is not medical advice, and nothing here replaces a conversation with a doctor.