Menopausal Hormone Therapy

Benefits, Risks, and What You Need to Know

MHT (formerly HRT) is the most effective treatment for menopausal symptoms. Here's what the latest evidence says.

If you're struggling with hot flushes, night sweats, or vaginal dryness, you've probably heard about Menopausal Hormone Therapy (MHT). But confusion and fear still surround this treatment — largely due to a landmark study from 2002 that was later reinterpreted.

Let's cut through the noise.

What Is MHT?

Menopausal Hormone Therapy (MHT) — also known as Hormone Replacement Therapy (HRT) — replaces the hormones your body stops producing during menopause. It's available in several forms:

• Tablets (oral)

• Skin patches

• Gels and sprays

• Vaginal creams, rings, or tablets (for local symptoms)

The Benefits

MHT is the most effective treatment for:

• Hot flushes and night sweats

• Vaginal dryness

• Reducing menopausal symptoms to improve quality of life

• Reducing the risk of postmenopausal bone fracture, including hip fracture

A recent narrative review published in 2025 confirms that MHT confers modest improvements in sleep, mood, intercourse, and overall quality of life. Vaginal oestrogen therapy for genitourinary syndrome of menopause (GSM) is not known to be associated with significant risks.

The Risks — What the Evidence Actually Says

Here's what many women don't know: the risks depend heavily on when you start and how you take it.

If you are healthy and younger than age 60 or within 10 years of menopause, the risks of MHT are low. However, depending on your personal health history, MHT may slightly increase the risk of blood clots, stroke, or breast cancer — especially with long-term use or starting MHT later in life.

Key findings from recent research:

• Starting MHT in the first 10 years after menopause carries no increase in cardiovascular risk and may confer some cardiovascular protection

• Early MHT initiation has no effect on cognitive function, whereas late initiation may increase dementia risk

• A slight increased risk of dementia was seen after 5–10+ years of combination MHT (oestrogen with a progestogen) in women younger than 60

The "Window of Opportunity"

Most experts agree that starting therapy earlier in menopause, with shorter duration, with low-dose transdermal therapy, is the safest approach and most likely to reduce harm. This is called the "window of opportunity" — the idea that MHT is most beneficial when started within 10 years of menopause onset.

Who Should Consider MHT?

MHT is recommended for:

• Women with moderate to severe hot flushes and night sweats

• Women with vaginal dryness and discomfort

• Women with premature ovarian insufficiency (early menopause)

Who Should Avoid MHT?

MHT is not appropriate for everyone, particularly women with:

• A history of hormone-dependent cancer

• Unexplained vaginal bleeding

• Certain cardiovascular conditions

• Increased risk of blood clots

The Bottom Line

MHT is not a one-size-fits-all treatment. The decision should be made through shared decision-making between you and your healthcare provider, weighing the benefits against your personal risks.

What to ask your doctor:

1. "Am I a good candidate for MHT?"

2. "What form and dose would be safest for me?"

3. "How long would I need to take it?"

4. "What are the specific risks based on my health history?"

Sources:

• Australasian Menopause Society: Menopausal Hormone Therapy

• PubMed: Menopausal Hormone Therapy — Risks, Benefits and Emerging Options

• PLOS ONE: A consideration of the potential benefits and harms of menopausal hormone treatment