What is HRT — now called MHT?

What MHT can help with — and where caution matters

MHT replaces hormones that decline around menopause. It is the most effective treatment for hot flushes and night sweats, can improve sleep when symptoms are disrupting it, and helps prevent bone loss while it is used. Local vaginal oestrogen can be particularly useful for vaginal and urinary symptoms; it is a different treatment from systemic MHT and usually does not require a progestogen.

For many women with bothersome symptoms who are under 60 or within 10 years of menopause, and without contraindications, the benefit–risk balance is favourable. This is not a universal recommendation or a strict age cut-off. A history of hormone-sensitive cancer, blood clots, stroke, cardiovascular disease, unexplained bleeding or liver disease may change what is appropriate and sometimes requires specialist advice.

Combined systemic MHT is associated with a small increase in breast cancer risk that rises with duration. The risk appears lower with body-identical hormones: transdermal estradiol — through a patch, gel or spray — generally has a more favourable clot-risk profile than oral oestrogen, and micronised progesterone appears to carry a lower breast cancer risk than older synthetic progestogens. The size of any risk depends on both the treatment and the woman’s baseline health. MHT should not be prescribed solely to prevent heart disease or dementia, or presented as an anti-ageing guarantee.

If you still have a uterus, systemic oestrogen generally needs an adequate progestogen alongside it to protect the womb lining. The schedule depends on your bleeding pattern and stage of menopause. MHT is not contraception: pregnancy can still be possible during perimenopause, so contraception needs a separate conversation. Non-hormonal treatment options are available too.

A short word on bioidentical hormones

‘Bioidentical’ means that a hormone has the same molecular structure as one made by the human body. Regulated prescription products such as estradiol and micronised progesterone are often called body-identical MHT. Estradiol can be given through patches, gels, sprays or tablets, while micronised progesterone is one option for protecting the womb lining.

‘Natural’ is not a safety guarantee. Choosing a treatment should be about evidence, appropriate dosing and follow-up — not a marketing label.

Care that starts with the woman, not just the hormone

In my daily clinical work, I treat women navigating hormonal changes, including perimenopause and menopause. I begin with their symptoms, menstrual history, medical and family history, and what they want to feel able to do again. Treatment can include MHT when appropriate, but also attention to sleep, strength, nutrition, mental wellbeing and other causes of symptoms.

The aim is not to chase a perfect hormone number. It is to make an informed, shared decision, assess how you respond, and adjust care as your needs change. This article is general information, not an individual prescription.

Bring to your consultation

• A note of your period pattern, symptoms and how they affect everyday life.
• Your medicines, contraception, and personal and family medical history.
• The questions that matter to you: benefits, risks, bleeding, treatment options and follow-up.
• Ask what else might explain your symptoms and whether hormonal or non-hormonal care is right for you.

References

1. NICE. Menopause: identification and management (NG23).
2. NHS. Menopause and perimenopause: treatment.
3. The Menopause Society. The 2022 hormone therapy position statement.
4. Sundhedsstyrelsen. Hormonbehandling i klimakterie og menopause. Den Nationale Rekommandationsliste, 2021.