Hormone therapy, explained without the fear

What is HRT / MHT?

You will see this called both HRT (hormone replacement therapy) and MHT (menopausal hormone therapy). MHT is the term current guidelines prefer, but HRT is still what most people search for, so this page uses both. Either way, it means replacing the estrogen — and, if you still have a uterus, a partnering progestogen — that your ovaries are producing less of during the transition.

It can help with hot flashes and night sweats, sleep problems, mood swings, brain fog, vaginal dryness, bone protection, muscle strength and skin changes. It is not automatically right for everyone, and it is not a single product — it is a category of treatment that gets individualised to you.

What actually happened with HRT

HRT was never banned. What happened is more specific — and more fixable — than that.

In 2002, the Women's Health Initiative (WHI), a large US trial launched in 1991, published results that were widely reported as "HRT causes breast cancer and heart disease". Prescribing collapsed almost overnight, worldwide, and has never fully recovered. But the trial had real limitations that took years to become widely understood:

• The progestin used was medroxyprogesterone acetate — a synthetic progestin now known to carry a worse risk profile than the micronised progesterone commonly used today.
• Participants were on average 63 years old and more than 12 years past menopause — much older than the women who typically start HRT for menopausal symptoms.
• In the estrogen-alone arm (women without a uterus), 20-year follow-up data actually showed a reduced breast cancer risk and reduced breast cancer mortality — a finding that got far less coverage than the original headlines.

Since then the evidence base has matured considerably. In November 2025 the US FDA announced the removal of the boxed warning from estrogen-containing menopausal hormone therapy products — a label that had shaped two decades of prescribing caution. Current guidance from menopause societies supports individualised HRT use rather than blanket avoidance.

Is it safe? Who is it for?

For most women under 60, or within 10 years of menopause, the risk-benefit balance for HRT is generally favourable — this is sometimes called the "window of opportunity". Outside that window the calculation changes and needs individual review.

This table is a starting orientation, not a substitute for your own history being reviewed individually.

How is it actually taken?

Estrogen comes in several delivery forms, and the route matters clinically — not just for convenience:

• Oral — a daily tablet. Simple, but it passes through the liver first, which is part of why it carries a higher clot and stroke risk than transdermal routes.
• Transdermal (gel, patch or spray) — absorbed through the skin, bypassing the liver. Associated with more stable hormone levels and, importantly, without the increased clot and stroke risk seen with oral estrogen.
• Vaginal (cream, tablet or ring) — for genitourinary symptoms specifically. Delivers estrogen locally with minimal absorption elsewhere, so a progestogen partner is usually not needed at these doses.

If you still have a uterus, estrogen needs to be paired with a progestogen — either micronised progesterone or a synthetic progestogen such as dydrogesterone — to protect the uterine lining. Women who have had a hysterectomy can generally take estrogen alone.

How long should it continue?

As a general starting point: continue until at least the average age of natural menopause (around 50 to 51), then reassess. For bone or heart protection, or in premature or early menopause, longer use can be appropriate — this is individualised and reviewed periodically rather than decided once.

Risks, in real numbers

Headlines tend to report relative risk, which sounds dramatic in isolation and means very little without the absolute risk it is built on. For most healthy women starting HRT within 10 years of menopause, the absolute increase in breast cancer risk is small, and for estrogen-alone therapy long-term data actually shows a reduction. The real, individual numbers — including your own history — are something to work through in a consultation, not to estimate from a general chart.

If HRT is not right for you

Non-hormonal options exist for many symptoms — certain non-hormonal medications for hot flashes, vaginal moisturisers and lubricants for dryness, cognitive behavioural approaches for sleep and mood, and the lifestyle foundations on the diet, exercise and lifestyle page, which matter regardless of whether you take HRT. Which tests inform that decision is covered under tests and diagnostics.