Menopausal hormone therapy (MHT / HRT): benefits, risks and who it's for

Menopausal hormone therapy (MHT) — also called hormone replacement therapy (HRT) — uses estrogen, usually with a progestogen if you have a uterus, to relieve menopause symptoms. It is the most effective treatment for hot flashes and night sweats and helps prevent bone loss. Whether it suits you depends on your age, time since menopause and health history.

MHT vs HRT

The two terms describe the same treatment. Medical societies increasingly use "menopausal hormone therapy" or simply "hormone therapy"; "HRT" remains the common everyday name.

What it's used for

• Moderate to severe hot flashes and night sweats.
• Prevention of bone loss and fractures.
• Vaginal dryness and pain with sex (low-dose vaginal estrogen is preferred when these are the only symptoms).

Estrogen alone vs estrogen plus progestogen

If you still have a uterus, a progestogen is taken with estrogen to protect the uterine lining from overgrowth, which can lead to endometrial cancer. People without a uterus generally take estrogen alone.

Timing matters

The Menopause Society's 2022 position statement says that for people under 60 or within 10 years of menopause onset, without contraindications, the benefit–risk ratio is favorable for treating bothersome symptoms and preventing bone loss. Starting later is associated with greater absolute risks of heart disease, stroke, blood clots and dementia.

Risks to discuss

Risks depend on the type, dose, route and duration of therapy and on personal factors. They include blood clots and stroke (lower with transdermal estrogen in observational data), and breast cancer risk with longer use of combined estrogen–progestogen. FDA advises using hormones at the lowest dose that helps, for the shortest time needed, with regular review.

Who usually shouldn't take it

• History of breast cancer or other estrogen-sensitive cancers.
• History of blood clots, stroke or heart attack.
• Active liver disease.
• Unexplained vaginal bleeding.

When to talk with a healthcare professional

• You're considering starting, stopping or changing hormone therapy.
• You have a personal or family history of breast cancer, blood clots, stroke or heart disease.
• You're over 60 or more than 10 years past menopause and considering starting.

When to get prompt care

• Seek emergency care for chest pain, sudden shortness of breath, sudden weakness or trouble speaking, or a painful swollen leg while on hormone therapy.

How Dot can help

Dot helps you track how symptoms respond over time and prepare questions for your clinician. Prescribing and clinical decisions happen with a licensed clinician — for example through Kindr Care — not in Dot.

How Dot works · Kindr Care clinical care

Related topics

• Oral vs transdermal estrogen
• Systemic vs local hormone therapy
• Vaginal estrogen
• Nonhormonal menopause treatment
• Estradiol
• Hot flashes & night sweats
• Menopause
• HRT guide

Sources

1. The Menopause Society. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767–794 (2022).
2. U.S. Food and Drug Administration. Menopause: Medicines to Help You.
3. National Institute on Aging (NIH). Hot Flashes: What Can I Do?.

This page is educational and not medical advice. Dot does not diagnose or prescribe. See our editorial policy.