Menopausal hormone therapy

What is menopause?

Menopause is your final period. You know you’ve reached menopause if you have not had your period for 12 months.

Menopause can cause a range of symptoms, for example hot flushes, night sweats and mood changes.

If menopausal symptoms affect your quality of life, it’s important to get help. There are many ways to manage your symptoms, but no other treatment has been shown to be as effective as menopausal hormone therapy (MHT).

What is menopausal hormone therapy (MHT)?

Menopausal symptoms are caused by lower levels of oestrogen that occur during this time. MHT is medication that contains oestrogen, progesterone and sometimes testosterone. It is used to manage the symptoms of menopause when they interfere with your daily life.

MHT is available in different dosages and forms, for example, pills, patches, gels, vaginal creams and intrauterine devices (IUDs).

MHT and premature or early menopause

Women who go through premature or early menopause will benefit from MHT.

Premature menopause is when you have your last period before the age of 40 years.

Early menopause is when your final period happens between the ages of 40 and 45 years.

Premature or early menopause results in reduced levels of oestrogen. This can increase the risk of long-term health conditions such as:

• cardiovascular disease
• osteoporosis (a disease that makes your bones less dense and more fragile)
• dementia
• Parkinson’s disease.

MHT should be taken until the expected age of menopause to reduce these risks.

MHT for menopausal symptoms

MHT is effective for relieving symptoms such as:

• hot flushes
• vaginal dryness
• disturbed sleep with night sweats
• joint pain
• itchy skin.

It may also improve:

• skin and hair health
• headaches
• aches and pains
• irritability
• sleeplessness
• sex drive
• balance
• dizziness and vertigo.

Added benefits of MHT

Depending on the dose and duration, MHT can reduce the risk of some chronic conditions that may affect postmenopausal women, including:

• osteoporosis and bone fractures
• heart disease
• endometrial cancer
• bowel (colon) cancer
• type 2 diabetes
• cataracts.

Side effects of MHT

Each woman reacts to MHT differently. Some women may not have any side effects. Others may experience symptoms such as:

• nausea
• fluid retention
• sore breasts
• vaginal bleeding (see your doctor if bleeding continues after 6 months of taking MHT).

Most symptoms settle within the first 3 months of taking MHT.

MHT-related health risks

A recent review of scientific evidence on MHT found it is an effective and safe treatment to relieve menopausal symptoms in healthy women. The data showed that MHT had low risks for women aged 50 to 60 years, or when used within 10 years of their final period.

Like all medications, there are some risks associated with MHT. These risks depend on:

• when you start using MHT
• how long you use MHT for
• the type and dose of medication
• your medical history.

MHT is not recommended if you have had hormone-dependent cancer (such as breast cancer and some uterine cancers). Your doctor may also advise you not to use MHT if it could increase your health risks, for example, if you have undiagnosed vaginal bleeding or heart disease.

MHT and weight

Any weight gain around the time of menopause is likely due to age and other lifestyle factors, for example, reduced physical activity. But hormonal changes at menopause can cause fat to be stored around the abdomen (belly). There is some evidence that MHT may help to reduce belly fat after menopause.

MHT and contraception

MHT is not a form of contraception. While your fertility declines as you get older, it’s still possible to get pregnant before your periods stop, but not after menopause.

If you are younger than 50 years, you should use contraception for at least 2 years after your final period. If you are aged 50 years and above, you should use contraception for at least one year after your final period.

Other treatments for menopausal symptoms

There are many other treatment options for women who can’t use MHT, or who want to try other treatments for menopausal symptoms. These include:

• non-hormonal prescription medications such as antidepressants, epilepsy medications and medications for high blood pressure (these have been shown to reduce hot flushes and sweating)
• cognitive behavioural therapy (CBT)
• hypnotherapy
• lifestyle changes – such as exercise, healthy diet and weight loss
• complementary medicine and therapies, and over-the-counter products (although many of these are not proven to be of benefit).

When to see your doctor

You should see your doctor if:

• your menopausal symptoms interfere with your daily life
• your symptoms affect your eating and sleeping habits
• you have strong emotions, anxiety or low mood.

More information

For more detailed information, related resources, articles and podcasts, visit Jean Hailes for Women’s Health.

Where to get help

• Your GP (doctor)
• Gynaecologist
• Jean Hailes for Women's Health