Hormone therapy (HRT) for menopause

Menopausal hormone therapy (MHT) — commonly called hormone replacement therapy (HRT) — is graded Strong evidence by The Menopause Society as the most effective treatment for hot flashes and night sweats, and is proven to prevent postmenopausal bone loss and fracture. For the bigger picture of what matters after menopause, see our long-term health checklist and life after menopause guide.

Guides in this section

• Who HRT may suit, and who needs specialist advice: The timing window, and situations that call for a specialist rather than a routine appointment.
• Types of HRT: Combined vs. estrogen-only, sequential vs. continuous, and how to choose.
• Estrogen in HRT: What estrogen itself does, and who takes it alone vs. with a progestogen.
• Progesterone and progestogens in HRT: Why it's added, and the open question around micronised progesterone.
• Testosterone for women in menopause: When it's considered, and why it's currently off-label.
• HRT patch vs. gel vs. pill: Why the route changes your blood clot and stroke risk.
• Starting and stopping HRT: What to expect at each end, and your choices when stopping.
• The HRT timing window: What "under 60 or within 10 years" actually means, and the timing hypothesis.
• HRT side effects: What's common early on, and NICE's 3-month review schedule.
• HRT and breast cancer risk: How combined and estrogen-only HRT differ, in NICE's own terms.
• HRT and blood clot risk: Why patch and gel carry a different risk profile than pills.
• Bioidentical vs. compounded hormones: What ACOG's 2023 consensus says about compounded "bioidentical" products.
• Hormone pellets: Why we don't recommend this delivery method.
• Vaginal estrogen: How low-dose local vaginal creams, tablets, and rings treat vaginal dryness, painful sex, and recurrent UTIs.
• The FDA HRT boxed warning change, explained: What the FDA removed from hormone therapy boxed warnings in 2025–2026, what remained, and where medical societies agree and disagree.
• Menopause treatments overview: Compare hormonal, non-hormonal, and evidence-graded lifestyle options.

How clinicians weigh benefits and risks

1. Timing window: For women under age 60 or within 10 years of menopause onset who have no contraindications, the benefit-risk ratio of systemic HRT is favorable. Starting more than 10 years after menopause or after age 60 is associated with higher absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.
2. Uterine protection: Women with an intact uterus who take systemic estrogen also need a progestogen to protect the uterine lining against endometrial hyperplasia and cancer; unopposed systemic estrogen retains an FDA boxed warning for endometrial cancer.
3. Individual contraindications: Systemic HRT is generally avoided in people with a history of estrogen-sensitive breast cancer, unexplained vaginal bleeding, active liver disease, or prior blood clots or stroke.

Prepare for your appointment

Use our interactive treatment conversation builder to print a personalized question sheet for your clinician, and compare telehealth providers that prescribe FDA-approved HRT in our menopause telehealth comparison.