Menopausal hormone therapy

Previously called HRT or hormone replacement therapy

Easy-to-read information about menopausal hormone therapy – what it is, how to take it safely and possible side effects.

On this page, you can find the following information:

What is menopausal hormone therapy?

During menopause, the amount of oestrogen produced by a woman's body reduces and this can cause symptoms such as hot flushes, night sweats, sleep problems, muscle and joint pains, mood changes, vaginal dryness and discomfort with sex. Read more about menopause.

Menopausal hormone therapy (MHT) is the use of hormone therapy (tablets, patches or cream) to replace the oestrogen that your ovaries no longer make during and after menopause. It can help relieve some of the symptoms of menopause. 

What's the difference between MHT and HRT?

You may be more familiar with the term hormone replacement therapy or HRT, but hormone therapy is used for other reasons also. To be clear about the use of hormone replacement therapy for relieving symptoms of menopause, it is now called menopausal hormone therapy or MHT.

What are the different types of MHT?

Menopausal hormone therapy may have oestrogen alone or oestrogen plus progestogen

The main factor in deciding which MHT to use will depend of whether you still have a uterus or whether it has been removed surgically (an operation called hysterectomy).  

  • For women who still have their uterus, MHT will have both oestrogen and progestogen. This is because oestrogen alone can overstimulate the cells lining your uterus, causing an increased risk of endometrial cancer (cancer of the uterus). To counter this risk, women who have a uterus are advised to take progestogen together with oestrogen.
  • In women who have had their uterus removed, MHT will have oestrogen alone.

In addition, the choice of MHT will depend on your individual overall balance of benefit, risk, symptoms and convenience. 


Image credit: MHT Australasian Menopause Society

Menopausal hormone therapy is not recommended in certain situations

MHT is not recommended in certain situations, such as for women who have a history of breast cancer, are at risk of heart disease, or have had a blood clot or are high risk of having a blood clot. Ask your doctor or nurse prescriber whether MHT is right for you – there are also other non-hormone options that can help with menopausal symptoms.  

Note that MHT does not provide contraception. A woman may get pregnant after her last menstrual period for 2 years if under 50 years, and for 1 year if over 50 years of age. Ask your doctor or nurse prescriber about suitable contraception options if needed.

Examples of menopausal hormone therapy

MHT is available as oestrogen alone or as oestrogen with progestogen. It is also available in different formulations such as creams, pessaries, tablets and skin patches. Some of these are used every day, while others may be used only for a few days or once or twice a week.

The following are examples of MHT products available in Aotearoa New Zealand. The choice of product depends on your individual circumstances and preferences. When using MHT, use the lowest dose that eases your symptoms for the shortest time and get your treatment reviewed at least once every year to assess whether to continue it or not.

MHT Description
Oestrogen (vaginal) Vaginal oestrogen is available as a cream or as pessaries that are inserted into your vagina. It is used to ease bladder and vaginal symptoms of menopause, such as vaginal dryness, burning or itching, and recurrent urinary tract infections (UTIs). It only acts on your vagina and bladder and is suitable for most women. 
  • Ovestin cream®
  • Ovestin pessaries®

Read more about Ovestin cream and pessaries. 

Oestrogen (tablets)
  • Estriol (Estrofem®)
  • Estradiol valerate (Progynova®)
  • Estriol (Ovestin®)
  • Estrogens (Premarin®)
Oestrogen
(skin patch)

These patches are applied to your skin 1 or 2 times a week:

  • Estradiol Estradot® (change patch 2 times a week)
  • Estradiol Climara® (change patch once a week).
Oestrogen plus progestogen (tablets)
  • Estradiol and norethisterone (Trisequens®, Kliogest®, Kliovance®)
Bazedoxifene plus oestrogen 
  • Also called Duavive® tablets.
  • This is a combination of oestrogen plus a non-hormone medicine, bazedoxifene.
  • It is an option for women who have a uterus but for whom taking progestogen is unsuitable. 
Tibolone
  • Also called Livial® tablets.
  • This isn’t oestrogen or progesterone, but it works in a similar way.
Progestogens 
  • These are used together with oestrogen in women who still have their uterus.
  • Examples of progestogen tablets and capsules are Utrogestan®, Primolut N® and Provera®.
  • It is also available as a gel called Crinone®. 

What are the benefits of MHT?

Without treatment, menopausal symptoms such as hot flushes, night sweats, sleep problems and headaches may last for a few years. Most women manage their menopause symptoms themselves, but some may need help from their doctor or nurse prescriber. MHT has been found to:

  • reduce the number and severity of hot flushes and night sweats
  • improve symptoms of vaginal dryness and soreness
  • help to reduce recurrent urine infections
  • lower the risk of osteoporosis, because oestrogen slows bone thinning and helps increase bone thickness
  • slightly reduce the risk of diabetes.

What are the risks of MHT?

When assessing the risks associated with MHT, remember that not all women have the same risk of these effects.

  • Risks vary based on how old you are, when you start MHT and how long you take it for. 
  • Short-term use in early menopause has fewer risks than when it is started later in menopause.
  • Risks generally increase as you get older.
  • The risks of developing blood clots while taking MHT is much higher for women who are obese, have severe varicose veins or have a close family member who has had deep vein thrombosis or pulmonary embolism.
Women who take MHT have slightly higher rates of  the following conditions:

  • Blood clots: 
    • Women who take MHT in tablet form have a small increase in the risk of blood clots in their veins. The increase in risk is between 1 and 2 per 1000 each year for women aged between 50 and 60 years.
  • Breast cancer:
    • Long-term use of combined MHT may be associated with an increased risk of breast cancer. This risk is less than 1 in 1000 women, and is not seen for 7 years in women using MHT for the first time. Oestrogen-only therapy does not increase breast cancer risk and the chance of dying from breast cancer is not increased in women using MHT.
  • Heart disease and stroke if older than 60 years or used MHT for more than 10 years.
  • Gallstones.
  • Worsened urinary incontinence.

For most women with moderate to severe menopausal symptoms, the benefits of MHT outweigh the risks, especially when they are within 10 years after the onset of menopause or aged less than 60 years.

What are the side effects of MHT?

MHT can cause side effects such as breast tenderness, fluid retention, mood changes, menstrual spotting and bleeding. If you get any of these side effects, talk to your doctor or nurse prescriber as you may need a change of dose. MHT does not cause weight gain.

Contact your general practice or urgent care centre immediately if you get any of the following symptoms while taking MHT:

  • Sudden severe chest pain (even if it isn't radiating to your left arm).
  • Sudden breathlessness.
  • Unexplained swelling or severe pain in the calf of one leg.
  • Severe stomach pain or yellowing of your skin.
  • Serious neurological effects, including the following:
    • unusual severe, prolonged headache, especially if it is the first time or getting progressively worse
    • sudden partial or complete loss of vision
    • sudden disturbance of hearing or other perceptual disorders
    • difficulty with your speech
    • bad fainting attack or collapse
    • first unexplained epileptic seizure
    • leg or arm weakness or a droopy face
    • very marked numbness suddenly affecting one side or one part of your body.

If you are taking MHT and have recently had surgery or a leg injury and you are unable to walk around, contact your healthcare provider for advice.

If you are taking MHT and decide to stop, ask your doctor or nurse prescriber about how to stop safely. You may need to stop slowly over several weeks.

Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

Do complementary therapies work?

Many women consider using complementary therapies such as phytoestrogens. These oestrogen-like compounds are found in all plants but are in highest quantities in legumes, including beans and soy products. Some women find these compounds helpful, although scientific studies have found them no better than a placebo. A lack of response after 6 weeks should be seen as a reason to stop.

Scientific studies have also found the following to be no better than a placebo: black cohosh, dong quai, evening primrose oil, red clover, ginseng and vitamin E. Due to possible adverse effects on your liver, it is recommended that black cohosh treatment be ceased after 6 months.

All complementary therapies may have side effects and may interact with prescription medicines, so tell your doctor or nurse prescriber if you are using or planning to use these.

Are there any non-hormonal treatments available?

You may want to consider non-hormonal treatments if you don't want to, or are unable to, take MHT, and lifestyle changes such as improving your diet, exercising and stopping smoking are not enough to manage your symptoms.

Other possible treatments for menopause symptoms include:

  • Some antidepressants (usually low doses) can help with severe hot flushes and sweats.
  • Some epilepsy medicines can also help with hot flushes and sweats.
  • High blood pressure medication can help with mild menopausal symptoms.

Talk to your doctor or nurse prescriber if you want to explore any of these options.

Learn more

The following links have more information on MHT. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.
Menopause Family Planning, New Zealand 
Menopause health information Australasian Menopause Society
Menopause and HRT  Patient Info, UK

Medsafe Consumer Information Sheets:

Ovestin cream and pessaries 
Oestrogen tablets: Estrofem Progynova Ovestin Premarin 
Oestrogen skin patch: Estradot Climara
Oestrogen plus progestogen tablets: Trisequens Kliogest Kliovance 
Baezedoxifene plus oestrogen: Duavive
Tibolone: Livial 
Progestogens: Utrogestan Primolut N Provera Crinone 

References

Additional resources for healthcare professionals

Hormone replacement therapy NZ Formulary
Menopausal hormone therapy – where are we now? BPAC, NZ, 2019
Marjoribanks J, Farquhar C, Roberts H, et al. Long term hormone therapy for perimenopausal and postmenopausal women Cochrane Database Syst Rev. 2012 Jul 11;7. 
Panay N, Hamoda H, Arya R, et al. The 2013 British menopause society & women’s heath concern recommendations on hormone replacement therapy Menopause International May 2013;19(2):59-68.

Credits: Sandra Ponen, Pharmacist. Reviewed By: Lisa Harris, RN, Dip. Nsg, PGDip Nsg Last reviewed: 13 Jul 2022