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Menopausal Hormone Therapy (HRT / MHT)

What You Need to Know

What is MHT?
Menopausal Hormone Therapy (formerly called Hormone Replacement Therapy or HRT) is the use of estrogen—either alone or combined with progesterone/progestin—to relieve symptoms caused by the natural decline in hormone levels during the menopause transition.

Who Can Benefit from MHT?

MHT is most beneficial and safest for healthy women under age 60 or within 10 years of menopause who are experiencing moderate to severe symptoms, such as:

  • Hot flashes and night sweats (vasomotor symptoms)
  • Vaginal dryness or painful intercourse
  • Sleep disturbances
  • Mood swings or irritability
  • Early menopause (before age 45) or premature ovarian insufficiency

For these women, MHT can significantly improve quality of life and prevent bone loss.

So, What Does the Research Say?

The Women’s Health Initiative (WHI) study in the early 2000s initially raised concerns about risks of breast cancer, heart disease, and stroke. However, follow-up analyses have since refined our understanding:

  • Age and timing matter. Starting MHT within 10 years of menopause or before age 60 carries much lower risk and may even provide cardiovascular protection.

  • Estrogen alone does not increase breast cancer risk and may slightly reduce it.

  • Combined estrogen and progestin (for women with a uterus) does have a small increased risk of breast cancer after 3–5 years of use. At Rooted Naturopathic Clinic, we use only micronized progesterone, which is identical to the progesterone that your body produces. 

  • Progesterone carries additional benefits, like improved sleep, and reductions in anxiety.

  • Risk of blood clots and stroke is very low in younger women, especially when using transdermal (patch, gel) forms instead of oral pills. At Rooted Naturopathic Clinic, we ONLY use topical / transdermal estrogen.

TRUE OR FALSE?

Women who are still have a period can't start MHT. 

  • FALSE!
    Some of the most distressing symptoms start in perimenopause, when periods may still be occurring. 

Don’t wait to seek help if you feel you’re experiencing hormonal symptoms related to perimenopause

Types of MHT

  • Topical / Transdermal Estrogen: Gold therapy / most effective treatment for the occurrence of hot flashes and night sweats. Body-identical and available at all pharmacies.

  • Oral or Vaginal Progesterone therapy: combined with transdermal estrogen in the vast majority of cases. Important for prevent endometrial hyperplasia in response to estrogen therapy. Additional benefits include sleep, mood (anxiety), and bone health.

  • Local estrogen (vaginal rings, creams, tablets): For women with Genitourinary Syndrome of Menopause (GSM). GSM is a collection of symptoms due to the changes in the genital and urinary systems in response to lowering estrogen levels. These symptoms can include vaginal dryness, irritation, pain during intercourse, and urinary problems like frequent urination or urinary incontinence. 

You may be prescribed one of the above, or all of them, depending on the nature of your concerns and your health history.

 

TRUE OR FALSE?

I have to have my hormones compounded in order for them to be 'bio-identical'. 

  • FALSE!
    Bio-identical is an older term that is not longer used, especially by industry leaders and experts. Transdermal estrogen and micronized progesterone ARE body-identical - meaning they are identical to the hormones your body produces. 

They are available at any pharmacy, and are covered by drugs plans. You do not need a compounded format (and in fact, you may increase your risk of certain side effects if you choose compounded hormones).

How Long Can You Use MHT?

  • There’s no mandatory cutoff, but most experts suggest re-evaluating yearly. We like to see you twice per year to maintain your prescription and get regular updates on your health.

  • Many women use MHT for 5–7 years, but longer use can be considered for persistent symptoms and with ongoing risk-benefit assessment.

Is MHT Right for You?

MHT is a personal decision. It depends on:

  • Your symptoms

  • Age and how long it’s been since menopause

  • Personal and family health history (especially of breast cancer, heart disease, stroke, or blood clots)

Women with a history of hormone-sensitive cancer, stroke, heart disease, or blood clots may need alternative treatments.

What Are the Alternatives?

If MHT isn’t an option, alternatives include:

  • Non-hormonal medications (e.g., SSRIs, SNRIs, gabapentin)
  • Lifestyle changes (cooling techniques, regular exercise, stress management, alcohol avoidance)
  • Evidenced based supplements and dietary recommendations (phytoestrogens like flax seeds, soy, and black cohosh menopausal symptoms, sage for heat and sweating, vitex for early perimenopausal and PMS symptoms)
  • Cognitive behavioral therapy (CBT)
  • Vaginal moisturizers/lubricants for genitourinary symptoms

Bottom Line

MHT is a safe and effective option for many women when used appropriately—especially early in the menopause transition. If you’re experiencing disruptive symptoms, talk to a healthcare provider who understands menopause to weigh your individual risks and benefits.

Book Your Initial Appointment

Should you wish to discuss your perimenopausal /  menopausal treatment strategy further, please book your initial appointment with Dr. Katie Rothwell, ND using our online booking system or by calling the office at 705-792-6717

Book Your Initial Appointment