A practical guide on Menopause Hormone therapy (MRT/HRT) for menopause: FAQs
- 18 hours ago
- 9 min read
Updated: 1 minute ago
Medical information in this blog is reviewed by Dr. Rubina Shanawaz, MS, FICS (OB-GYN. Bangalore) and Dr. Greeshma Jagarapu, MS (OB-GYN, Hyderabad).
While hormones are commonly prescribed for several conditions like PCOS (polycystic ovarian syndrome), PMS (pre-menstrual syndrome), period cycle correction, fertility treatments and pregnancy support, menopausal hormone therapy is often villainized. In fact, hormone therapy gained popularity in the late 1900s as it was considered a preventive measure for chronic diseases (heart conditions and bone loss) and a way of “staying young” after menopause.
Fear and concerns around menopausal hormone therapy (MHT) mainly stem from the findings of a Women's Health Initiative (WHI) study published in the early 2000s, which reported increased risks of blood clots, breast cancer, and stroke. Obviously, this led to a sharp decline in the use of MHT due to the widespread media attention.
However, long-term follow-up studies exposed the shortcomings of the initial study and revealed that its conclusions were flawed. For example, the statistical analysis included data from study dropouts and women who were more than 10 years post-menopausal (in this group, the observed effects are more related to age than hormone levels). More recently, new research using body-identical hormones has been crucial in dispelling the negativity surrounding MHT. Nonetheless, public apprehension is deep-rooted and remains hard to break, especially due to the limited media coverage of these new developments.
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MHT/HRT : One piece of the menopause kit
MHT (Menopausal Hormone Therapy) is the modern, preferred term for HRT (Hormone Replacement Therapy) and refers to hormonal treatments for the symptoms of menopause. We would like to remind you that MHT is just one modality in the toolkit towards better health during menopause.
It involves supplementation of the deficient hormone according to the symptoms and their severity. Slowly, medical professionals and women, especially those with debilitating menopause symptoms, are opening up to the scope of body-identical hormone therapy based on increasing efficacy and safety data.
Stories of women from around the world who have benefited from hormone replacement are encouraging.
Here are some comments from a discussion in the Miyara WhatsApp Community:
“I have a friend who said her life changed immeasurably for the better after going on HRT. Indeed it is not a one size fits all”
“I could easily be that friend too... it has given me a second life!”
Nevertheless, a vast majority are unsure or hesitant of HRT, primarily due to the lack of/ incomprehensible information (jargon and info overload) available to them.
In this article, we present bite-sized, digestible answers to some of the common queries on HRT/ MHT we get from women we interact with.
Who is eligible for MHT?
In general, hormone replacement therapy is prescribed in the following scenarios:
Primary ovarian insufficiency (POI)
Surgical menopause - oophorectomy
Medical menopause- radiation/ chemotherapy
Disruptive peri/menopausal symptoms
However, the decision is always subject to underlying medical conditions, family history and disease risk.
Who can prescribe MHT/HRT for menopause?
A registered gynecologist or endocrinologist with expertise in hormone therapy.
What benefits does MHT/HRT offer for women undergoing menopausal transition?
When administered in the window of opportunity (peri- and early post-menopause), HRT can offer protection from chronic diseases, such as osteoporosis, heart disease, diabetes, cognitive decline, colon cancer, skin conditions, and pelvic disorders.
HRT can help alleviate crippling menopausal symptoms and improve quality of life by positively impacting the heart, bones and muscles, brain, the pelvic organs, and skin.
The hormones can also improve gut health, which in turn enhances focus, cognition, and mood, mitigates weight gain, supports metabolism, and improves vasomotor symptoms (hot flashes).
It also prevents chronic inflammation, a common underlying cause for many age-related health concerns and disease onset.
If the uterus is present, progesterone therapy is a must as it protects the uterine lining and counteracts the uterine cancer risk likely posed by estrogen-only therapy.
Libido, focus, mood, and fatigue issues can be managed with low doses of testosterone.
How effective is MHT/HRT in alleviating menopause symptoms?
Can be a game-changer and life-preserving for women undergoing premature menopause (both natural and medical/ surgical menopause), especially for long-term disease prevention and healthy aging.
Although the dose, frequency and the route of administration (transdermal patches/ gels versus oral) of hormones can be optimized for best results, MHT/HRT alone is not a magic pill for all perimenopausal symptoms.
Lifestyle modifications like regular exercise (resistance training, mobility and moderate cardio), phytoestrogen/ protein/ fiber-rich diet, and supplements (as needed) must be incorporated for ideal health outcomes.
When is the best time to start MHT/HRT during the menopause transition?
Hormone therapy is most effective when commenced during perimenopause or shortly after menopause, ideally within ten years. Nevertheless, in some cases, hormone therapy can also be started in women beyond the age of 60 after necessary tests and an overall risk-benefit evaluation prior to initiation. However, for this age group, beneficial health outcomes are heavily reliant on the type (E2 vs conjugated estrogen), dose (low doses preferred) and route of administration (vaginal/ transdermal over oral). Most women who begin hormone therapy experience benefits related to well-aging, such as improved bone density, cognitive function, and muscle strength. Therefore, if hormone therapy contributes positively to one's health, it is advantageous to continue its use. Vaginal estrogens can be used by everyone in requisite doses, even those with estrogen-dependent disease conditions, as prescribed by the medical professional.
What are the potential risks?
The risk of heart disease, stroke, invasive breast cancer and venous thromboembolism is generally high in older women (> 65 years)and those who start therapy 10 years after menopause.
However, the individual risk profile can be influenced by age, family history, and existing medical conditions like hypertension and heart or blood-clotting disorders. Therefore, in all cases, a thorough risk-benefit analysis is necessary before and at regular intervals during hormone therapy.
Body-identical hormones demonstrate much better breast cancer and heart disease risk profiles than synthetic hormones. Particularly, the choice of progestogen (micronised vs synthetic) can reduce the cancer risk. The duration of hormone therapy and the timing are also major factors to be considered. The longer the duration, the higher the breast cancer risk, and the risk declines after 10 years of stopping therapy.
Route of hormone administration matters for clots: Oral estrogen raises VTE (venous thromboembolism) risk; transdermal estradiol shows little/no increase vs non-use in multiple studies
The transdermal route and body-identical hormones are also preferred for their lower risk of stroke and coronary heart disease.
Similar benefits are reported for both synthetic and rBHRT concerning bone health, hot flashes, sleep, and mood-related symptoms
Does estrogen therapy increase the risk of breast cancer?
A Women's Health Initiative study published in 2002, linking conjugated equine estrogen and medroxyprogesterone acetate to increased breast cancer risk, stroke, and coronary heart disease, has limited women's access to hormone therapy. However, multiple follow-up studies have clarified data misinterpretations in this study and concluded that estrogen-only therapy is safe for most women, especially those without a uterus.
While the negative impression based on the first study gained global media attention, the newer long-term follow-up study by the same WHI that reported a significant 22% reduction in breast cancer hardly got any media coverage, thus retaining the fear implanted in the public’s mind. Estrogen-progesterone combination therapy has been associated with a slightly higher risk of breast cancer vs. no hormone replacement. Further research is underway to understand the implications of progesterone in cancer risk and particular circumstances (different populations, HRT formulations) in which this risk must be considered.
Should MHT/HRT be taken for life?
Not necessarily. It is decided on a case-by-case basis, usually for 5 years/ till the age of 60. Lifestyle factors can also be major determinants of HRT duration, and dosages may be adjusted accordingly.
Although there is no upper age limit, HRT is usually prescribed only till the pros outweigh the cons. If the symptoms subside, the dose can be tapered and even stopped; the risk-benefit analysis can be repeated as a follow-up, as necessary.
HRT is not commonly advised for women in the 70+ age group; non-hormonal options are safer for them
What hormones are included in MHT/HRT? Does this vary between individuals?
Estrogen, progesterone and testosterone can be included in HRT. However, individual HRT schedules vary depending on underlying health conditions and symptoms.
For instance, for those without a uterus (post-hysterectomy), estrogen-only therapy is recommended as it poses fewer long-term risks.
As progesterone is primarily needed to protect the uterine lining, it is included for women with a uterus.
continuously for post-menopausal women
cyclically for women in early menopause or perimenopause (who still menstruate, even if irregularly) to mimic the menstrual cycle with bleeding.
Progestrone can also be included in low doses to manage sleep issues and hot flashes. Testosterone (usually transdermal) is prescribed for low libido and disruptive fatigue and mood changes.
Should I take the hormones every day?
The schedule varies based on the menopause stage, as mentioned above. For perimenopause management, the hormones are spaced to mimic the natural menstrual cycle and induce bleeding at the end of the cycle.
For post-menopausal women, the pattern is based on the route of administration. If oral, the hormones are continuously dosed every day throughout the month.
If transdermal, the patches/ gels are to be changed as per the dosage prescribed by the doctor.
I hate popping pills. I have heard people talk about estrogen gels and patches. Can I pick a preferred formulation?
Yes, you can talk to your doctor about your preference. If your choice of formulation satisfies your hormonal needs and will help you adhere to the therapy schedule, there should not be a problem.
Oral, transdermal, and vaginal are the common modes of menopausal hormone therapy. Dose and mode adjustments may be necessary based on symptom severity, dose tolerance and hormone absorption.
While estrogen gels are available in India at this point (Aug 2025), transdermal patches are not. Testosterone patches are also available in India.
What side effects can be expected?
In the initial phase, MHT/HRT can worsen existing menopause symptoms or add new symptoms like breast tenderness, nausea, vaginal bleeding, bloating, headaches and mood swings because every individual responds differently. However, these are usually short-lived and can be waited out till the body gets adjusted. If the symptoms persist, the dosage, mode of administration and formulation can be adjusted to achieve the best outcome.
How do I know my best hormone option with minimal side effects?
The choice between BHRT and traditional HRT depends on individual needs, preferences, and medical history. Some women prefer BHRT because they believe it is more natural, while others opt for traditional HRT due to its extensive research and approval by regulatory bodies. It's crucial to consult with a healthcare provider to determine the most appropriate treatment based on your specific symptoms and health profile.
How can I know that I need MHT/HRT?
An important consideration is assessing the risks associated with not undergoing hormone therapy. Educating oneself on this topic is vital, as proper consultation and approaches to aging and menopause are key.
Although there is no single test to indicate perimenopause, testing for FSH and AMH (anti-mullerian hormone) can give an idea about ovulation and the egg reserve, respectively.
FSH tests may be repeated at intervals to monitor the trend; however, they can fluctuate largely during perimenopause and may stabilize only a few years after menopause. Similarly, Day 20 estradiol and progesterone levels may indicate close to their actual maximum levels.
However, if these levels are in the normal range or the cycles are irregular, the symptoms experienced are considered the primary context/ indicators of the menopausal stage. The symptoms are graded on a standardised scale.
What should I do if my consulting doctor tells me that I am not a candidate for MHT/HRT?
You can discuss the reasoning behind this conclusion with the doctor. The only kind of candidates for whom MHT/HRT is an absolute no is those with a current history of breast cancer. If the reason quoted is anything else and is not convincing, you can take a second opinion from another empathetic practitioner who has HRT experience and is pro-lifestyle modifications that support hormone therapy and the menopausal transition.
What are the steps to get started?
Some menopause societies do not recommend hormone testing for women over 45 due to either regular checkups or inadequate funding. However, in private settings, checking baseline levels can be beneficial. Steps to start BHRT include consulting with a doctor with good experience in this field, as adjustments (mode of administration, dose, etc.) may be necessary based on tolerance and absorption. An individualized and personalized approach is crucial, especially during perimenopause and menopause. Consulting with a trained professional who can provide ongoing support is advisable.
Got more questions?
References:
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About the author
With 10+ years of experience in science communication, Dr. Ayshwarya Ravichandran ensures evidence and science-backed information are conveyed to women in understandable and comprehensible language and visualization. She is also a passionate women's health advocate engaging the Miyara community in different ways.