The lowdown on menopausal hormone therapy (MHT)

Up to 60% of women (and some gender diverse people) will experience mild to moderate symptoms as they navigate perimenopause and menopause. For around 20%, these symptoms will be severe.¹

While many manage their symptoms with lifestyle workarounds and complementary therapies such as massage, counselling and acupuncture, there are also medications and other treatments available that can help.

The primary medical treatment for symptoms of menopause is menopausal hormone therapy (MHT). You might know this by its former title of hormone replacement therapy (HRT).

HRT and MHT are essentially the same thing, with the newer term reflecting how menopause is a natural life stage, rather than a deficiency that needs to be replaced.

When hormone levels (oestrogen and progesterone) naturally decrease during menopause, this can have physical and emotional side effects.

These may include hot flashes, night sweats, vaginal dryness, poor sleep, mood swings and loss of self-esteem.

It may also impact bone health and carry some cardiovascular risks. MHT helps to reduce these side-effects by replacing some of the ‘lost’ hormones until your symptoms subside. There are 2 types of MHT²:

• Combined MHT contains oestrogen and progesterone,and is used for those who still have a uterus. This is because taking oestrogen on its own can lead to uncontrolled growth of the lining of the uterus and increase your risk of developing endometrial cancer. If you’ve had a partial hysterectomy, you may still have some uterine lining present, so you’ll likely need to take both hormones.
• Oestrogen-only MHT is generally suitable for those who’ve had a total hysterectomy to remove the uterus and cervix.

MHT is available as tablets, creams, skin patches and gels. Your GP or gynaecologist will discuss the options with you.

MHT can help relieve common symptoms of menopause² as listed above. It can also help to maintain vaginal muscle tone, which may help reduce urinary incontinence.

Other benefits of MHT may include improved skin and hair health, reduced headaches, mood swings and aches and pains, and an increased libido.

Low oestrogen levels can also weaken your bones during menopause, which may cause them to break more easily. This is a condition known as osteoporosis. MHT can help reduce that risk in the long term.

All medications have some risk, however, MHT is generally safe for most people going through menopause. Common side effects of MHT can include2:

• breast tenderness
• leg cramps
• headaches
• feeling sick
• bloating and fluid retention with swelling of the ankles or face.

If you do experience side effects, most will get better within a couple of months. If they don't improve, your GP may suggest you try a different type of MHT.

Combined MHT is associated with an increased risk of breast cancer.³ Although the risk is not high, it does increase the longer you take MHT.

If you’re taking MHT, review your needs every 6 months with your doctor, and ensure you have regular mammograms and are breast aware. This means getting familiar with how your breasts look and feel, knowing what changes to keep an eye out for, and regularly performing a self-check.

If you're worried about any changes to your breasts, see your GP straight away. Those who have had breast cancer in the past are not advised to take MHT.

For some people, MHT can increase the risk of developing serious health conditions² including:

• stroke
• endometrial cancer (with oestrogen-only MHT, see above)
• deep vein thrombosis (DVT)

Your risk of developing these conditions is small, but your GP or gynaecologist will talk to you about them before starting any treatment. You generally won’t be prescribed MHT if you’ve had one of these problems in the past.

If you’re considering taking MHT to treat menopause symptoms, be sure to discuss it with your GP or gynaecologist so you can weigh up the risks and benefits with all the facts.

Things to discuss might include⁴:

• your age
• your symptoms, and how severe they are
• your personal and family medical history
• results of relevant tests
• your preferences and expectations

How long you should take MHT is also a decision for you to make with your doctor’s advice and support.

Jean Hailes for Women's Health provides online resources and tips on how to stay healthy during menopause and manage your symptoms.

Australasian Menopause Society has more information on the efficacy and safety of MHT. You can also search their database to find a doctor who specialises in menopause.