A Practical Guide on Menopause Hormone Therapy (MHT/HRT)
- Aug 27, 2025
- 6 min read
Miyara Women | Aug 27, 2025 | Updated: Feb 8, 2026Written by: Dr. Ayshwarya Ravichandran | Medically reviewed by Dr. Rubina Shanawaz, MS, FICS (OB-GYN, Bangalore) and Dr. Greeshma Jagarapu, MS (OB-GYN, Hyderabad)
While hormones are commonly prescribed for conditions like PCOS, PMS, period cycle correction, fertility treatments, and pregnancy support, menopausal hormone therapy is often villainised. Fear around MHT mainly stems from a Women's Health Initiative (WHI) study published in the early 2000s, which reported increased risks of blood clots, breast cancer, and stroke, leading to a sharp decline in its use.
Long-term follow-up studies exposed the shortcomings of that initial study. The statistical analysis included data from study dropouts and women more than 10 years postmenopausal. A 2024 review in Gynecological and Reproductive Endocrinology and Metabolism, re-examining 21 years of WHI data, found that when the widely cited "increased risk" of breast cancer is converted to absolute risk, the increase amounts to just 0.08% per year, or 0.40% over 5 years of combined MHT use. This contextualisation is almost never communicated to patients. New research using body-identical hormones has since been crucial in dispelling the negativity surrounding MHT. Public apprehension, however, remains deep-rooted and hard to break.
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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). It involves supplementation of the deficient hormone according to symptoms and their severity. MHT is just one modality in the toolkit towards better health during menopause. Slowly, medical professionals and women, especially those with debilitating menopause symptoms, are opening up to 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!”
Who Is Eligible, and Who Can Prescribe?
Hormone replacement therapy is generally prescribed for primary ovarian insufficiency (POI), surgical menopause following oophorectomy, medical menopause caused by radiation or chemotherapy, and disruptive peri/menopausal symptoms. The decision is always subject to underlying medical conditions, family history, and disease risk. MHT can be prescribed by a registered gynaecologist or endocrinologist with expertise in hormone therapy.
What Benefits Does MHT/HRT Offer?
When administered during perimenopause or early postmenopause, HRT can offer protection from chronic diseases including osteoporosis, heart disease, diabetes, cognitive decline, colon cancer, skin conditions, and pelvic disorders. It alleviates menopausal symptoms and improves quality of life by positively impacting the heart, bones and muscles, brain, pelvic organs, and skin. It improves gut health, which in turn enhances focus, cognition, and mood; mitigates weight gain; supports metabolism; and improves vasomotor symptoms, including hot flashes. It also prevents chronic inflammation, a common underlying cause of many age-related health concerns.
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How Effective Is MHT, and What Are Its Limits?
MHT can be a game-changer and life-preserving for women undergoing premature menopause, especially for long-term disease prevention and healthy ageing. That said, MHT alone is not a magic pill. Dose, frequency, and route of administration can all be optimised for best results, and lifestyle modifications including resistance training, moderate cardio, phytoestrogen and protein-rich diets, and targeted supplements must be incorporated for ideal outcomes.
When Is the Best Time to Start MHT/HRT?
Hormone therapy is most effective when commenced during perimenopause or shortly after menopause, ideally within ten years. This is the basis of the "timing hypothesis" or "critical window", supported by the 2023 WHI reappraisal in Maturitas, which found that the benefits of MHT are most pronounced when initiated early and diminish or reverse when started in older women more than a decade post-menopause.
In some cases, MHT can also be started in women beyond age 60 after necessary tests and a risk-benefit evaluation. For this age group, transdermal and body-identical hormones are preferred. Vaginal estrogens can be used by everyone in requisite doses, even those with estrogen dependent conditions, as prescribed.
What Are the Potential Risks of MHT/HRT?
The risk of heart disease, stroke, invasive breast cancer, and venous thromboembolism (VTE) is generally higher in women over 65 and those who start therapy more than 10 years after menopause. Body-identical hormones demonstrate significantly better risk profiles than synthetic hormones: in particular, micronised progesterone (MP) used for up to 5 years is not associated with increased breast cancer risk, unlike synthetic progestins, which carry an odds ratio of 1.28 for breast cancer risk. Duration and timing are major factors; the longer the duration, the higher the breast cancer risk, though the risk declines after 10 years of stopping therapy.
Oral estrogen raises VTE risk; transdermal estradiol shows little to no increase versus non-use across multiple studies. The transdermal route and body-identical hormones are also preferred for their lower risk of stroke and coronary heart disease.
Does Estrogen Therapy Increase the Risk of Breast Cancer?
A 2002 WHI study linking conjugated equine estrogen and medroxyprogesterone acetate to increased breast cancer risk has limited women's access to hormone therapy for decades. Multiple follow-up studies have since clarified data misinterpretations and concluded that estrogen only therapy is safe for most women, especially those without a uterus.
The long-term WHI follow-up, as cited by CA: A Cancer Journal for Clinicians (2024), found that estrogen alone therapy showed a 23% reduction in breast cancer diagnosis and a 40% reduction in breast cancer death, based on WHI's own data. These findings received virtually no media coverage, leaving the original fear intact in public consciousness. WHI investigators themselves conceded in a 2023 Menopause journal article that HT yielded considerable net benefits.
Should MHT/HRT Be Taken for Life?
MHT is not necessarily a lifelong prescription. Duration is decided on a case-by-case basis, usually for 5 years or until age 60. There is no upper age limit, but HRT is generally prescribed only while the pros outweigh the cons. If symptoms subside, the dose can be tapered and stopped. HRT is not commonly advised for women in the 70+ age group, for whom non-hormonal options are safer.
What Hormones Are Included, and How Are They Taken?
Estrogen, progesterone, and testosterone can all be included in an MHT regimen, but individual schedules vary by health conditions and symptoms. For those without a uterus (post-hysterectomy), estrogen-only therapy is recommended. Progesterone is included for women with a uterus, given continuously for postmenopausal women and cyclically for perimenopausal women. Testosterone (usually transdermal) is prescribed for low libido, fatigue, and mood changes.
The schedule varies by menopause stage and route: for perimenopause, hormones are spaced to mimic the natural menstrual cycle; for postmenopausal women on oral therapy, hormones are continuously dosed daily; transdermal patches or gels are changed as per the doctor's prescription.
Can I Choose My Preferred Formulation?
Yes. Oral, transdermal, and vaginal are the common modes of delivery. Estrogen gels are available in India (as of August 2025); transdermal patches are also available but less frequently. Testosterone patches are available in India. Dose and mode adjustments may be necessary based on symptom severity, tolerance, and hormone absorption.
The choice between BHRT and traditional HRT depends on individual needs, preferences, and medical history. Some women prefer BHRT, believing it to be more natural; others opt for traditional HRT due to its extensive research base and regulatory approval. Consultation with a healthcare provider is essential for a personalised decision.
What Side Effects Can Be Expected?
In the initial phase, MHT/HRT can worsen existing symptoms or add new ones: breast tenderness, nausea, vaginal bleeding, bloating, headaches, and mood swings, as every individual responds differently. These are usually short-lived. If symptoms persist, dosage, mode of administration, and formulation can be adjusted.
How Do I Know If I Need MHT/HRT?
There is no single test to confirm perimenopause. Testing for FSH and AMH (anti-Müllerian hormone) can give an idea of ovulation status and egg reserve, respectively. FSH tests may be repeated at intervals to monitor trends, though they can fluctuate during perimenopause. Where hormone levels are in the normal range or cycles are irregular, symptoms are considered the primary indicators of the menopausal stage.
What If My Doctor Says I Am Not a Candidate?
The only absolute contraindication to MHT is a current history of breast cancer. If the reason given is not convincing, a second opinion from an experienced, empathetic practitioner who is pro-lifestyle modifications is entirely reasonable.
How Do I Get Started?
Consult a doctor with good experience in this field. Baseline hormone level checks can be beneficial in private settings. An individualised approach is crucial: adjustments in dose, mode, and formulation may be necessary based on tolerance and absorption.
Endorsed by: Indian Menopause Society | The British Menopause Society | The North American Menopause Society | International Menopause Society
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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.
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