What Is Menopause Hormone Therapy (MHT)?

If you’ve started looking into treatment for perimenopause or menopause, you’ve probably come across a lot of different terms: HRT, MHT, estrogen therapy, progesterone, bioidentical hormones.

It can get confusing quickly.

So, let’s simplify it.

What is menopause hormone therapy?

Menopause hormone therapy (MHT) is the use of hormones — most commonly estrogen, with progesterone when needed — to treat symptoms related to perimenopause and menopause.

You may also hear it called hormone replacement therapy (HRT). The terms are often used interchangeably, although MHT is increasingly used because it more accurately describes what we’re doing: using hormone therapy to manage symptoms and support health during the menopause transition.

Estrogen is the hormone that does most of the heavy lifting when it comes to treating common menopause symptoms such as:

  • Hot flashes and night sweats

  • Sleep disruption related to vasomotor symptoms

  • Vaginal and urinary symptoms

  • Some menopause-related joint discomfort

  • Bone loss

If you still have a uterus and are using systemic estrogen, progesterone (or another progestogen) is generally also needed to protect the lining of the uterus.

There are different ways these hormones can be taken. Estrogen may be given through a patch, gel, spray or pill. Progesterone is often taken orally.

There is no single prescription that is right for every woman.

Can you take MHT during perimenopause?

Yes.

This is something women are often surprised to learn.

You do not necessarily have to wait until your periods completely stop before discussing hormone therapy.

If you're experiencing bothersome perimenopause symptoms, MHT may be an option depending on your age, symptoms, menstrual pattern, medical history and individual risk factors.

Is hormone therapy safe?

This is where the conversation needs more nuance than simply saying MHT is either “good” or “bad.”

For many healthy women who are younger than 60 or within 10 years of menopause onset, the benefits of hormone therapy for bothersome menopause symptoms generally outweigh the risks when there are no contraindications.

But MHT isn't appropriate for everyone.

Your personal and family history matter. So do factors such as cardiovascular health, blood clot risk, breast health, migraines, unexplained vaginal bleeding and other medical conditions.

The type of hormone, dose and how it is delivered also matter.

This is why I don't think the decision about hormone therapy should start with, “Should every woman take HRT?”

A better question is:

“Is hormone therapy a good option for me?”

Do you need hormone testing before starting MHT?

Not necessarily.

For many women over 45 with typical perimenopause or menopause symptoms, treatment decisions are based largely on symptoms, menstrual history, age, health history and individual risks rather than trying to achieve a particular hormone level on bloodwork.

Sometimes testing is appropriate — but it should have a purpose.

I’m much more interested in understanding the woman sitting in front of me than chasing a “perfect” estrogen number.

My approach to hormone therapy

I see MHT as one tool in the toolbox.

For the right woman, it can be an incredibly helpful tool. But prescribing hormones doesn't replace conversations about strength training, protein, sleep, cardiovascular health, bone health, alcohol, stress and the other things that become increasingly important as we age.

I also don't believe women should feel pressured in either direction.

Choosing MHT isn't failing to do menopause “naturally.”

Choosing not to use it doesn't mean you're doing menopause wrong either.

The goal is to understand your options, your individual risks and the potential benefits — and then make a decision that makes sense for you.

Because good menopause care shouldn't be about convincing women to take hormones.

It should be about giving women enough good information to make an informed choice.

Wondering if menopause hormone therapy is right for you?

I work with women throughout British Columbia to navigate perimenopause and menopause, understand their treatment options and develop an individualized approach to their health.

Book a perimenopause or menopause consultation with Dr. Jenny Ma, ND, MSCP.

This article is for educational purposes and is not a substitute for individualized medical advice.