Menopause hormone therapy (MHT)
What menopause hormone therapy is, when it's indicated, what benefits and risks it has and how it's monitored.
What menopause hormone therapy is
Menopause hormone therapy replaces, at the lowest effective dose, the oestrogen the ovary stops producing, combined with progesterone if you still have your uterus. It's the most effective treatment for hot flushes and night sweats, and it also improves sleep, vaginal dryness and, in many women, mood and quality of life. It also protects bone.
For years it carried fears that current evidence has significantly softened: we now know that, in the right woman, at the right time and with follow-up, it's a safe treatment for most. But it isn't for everyone, which is why the decision is always individual.
Who it suits and who it doesn't
It's indicated when menopause symptoms affect your quality of life, especially in the first years after your last period. It generally isn't recommended with a history of breast cancer or other hormone-dependent tumours, thrombosis or established cardiovascular disease: in those cases non-hormonal alternatives are also assessed at the appointment.
How it's done
Before starting: a full history, examination and whatever tests your case needs. Then, whichever form suits you best — there's an oral route, transdermal patches or gel, and local treatments for vaginal dryness — and regular reviews to adjust the dose, check it's suiting you and reassess each year whether it's still worth continuing. Starting isn't a lifelong commitment: it's trying it with a safety net.
When what's missing is hormones ahead of time — because of ovarian insufficiency or surgical menopause — we're talking about something different: hormone replacement therapy.
Frequently asked questions
Does hormone therapy cause cancer?
The risk depends on the type of treatment, the age at which it is started, the duration and your medical history; for most healthy women who start close to the menopause, the benefit-risk balance is favourable. That is exactly what is assessed with you, using your own data, before starting.
How long can hormone therapy be taken for?
There is no universal expiry date: it is reassessed every year. As long as the benefit outweighs the risk in your case and you want to continue, it can be maintained; the duration is decided by you and your gynaecologist, not by a calendar.
How do I know if I am a candidate for hormone replacement therapy?
It is assessed at the appointment, weighing up symptoms, age, time since the menopause and personal and family history. It is more favourable when symptoms affect quality of life and when it is started in the first years after the menopause. There are situations in which it is contraindicated, and that is why the decision is an individual one.
When is hormone therapy recommended?
When hot flushes, night sweats or insomnia are affecting your daily life, with vaginal dryness that does not improve with local treatment, and in early menopause or ovarian insufficiency, where it also protects bone and the cardiovascular system. It is used at the lowest effective dose and with follow-up.
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Content reviewed by Tatyana Krasnichenko