What is MHT (or HRT)?

Menopausal Hormone Therapy (MHT) also known as Hormone Replacement Therapy (HRT), is a treatment that increases the hormones that your body makes less of during perimenopause and menopause. 

What types of MHT are there?

MHT usually involves a mix of different hormones, depending on your body, your symptoms, and whether you still have a uterus. 

In this course, we’ll explore all of the MHT options—so you understand what each one does, who it’s for, and how to find the right fit for you.

Here's a simple breakdown of the types of hormones you might hear about or be prescribed.

Estrogen

Estrogen is the main hormone used in MHT. It helps relieve many common symptoms like hot flushes, mood changes, and poor sleep.

• It's usually body-identical (meaning it matches the estrogen your body naturally makes).
• It most often comes as a patch or a gel.
• It can also be taken as a pill, but this may carry a slightly higher clotting risk.

Progestogen

If you still have a uterus, you’ll also need a hormone called a progestogen. This helps protect the lining of your womb from becoming too thick, which can lead to cancer over time.

There are two main types:

• Progesterone – the body-identical version (often taken as a capsule)
• Progestin – a synthetic version (comes as tablets or in a device like the Mirena IUD)

If you have a Mirena intra-uterine device (IUD), this often covers your progestogen needs.

If you’ve had surgery to remove your uterus (a hysterectomy), you usually don’t need progestogen. But some people still choose to take it for its calming or sleep-supporting effects, especially if they have endometriosis or still have their cervix.

Testosterone

Yes - women make testosterone too! Levels drop with age, and some women find that replacing a small amount can help with energy, libido, mood, and mental clarity.

Topical estrogen (for vaginal symptoms)

Topical estrogen isn’t technically part of MHT, but it's worth mentioning. It comes as a cream or pessary (inserted into the vagina).

Topical estrogen can be helpful for local symptoms like:

• Vaginal dryness or discomfort
• Pain with sex
• Itchiness or irritation
• Bladder infections or UTIs

Because it works just in the vaginal area, it has very little effect on the rest of the body and is considered very safe - even for people who don’t use full MHT.

Glossary of terms

Endometrium
The medical name for the lining of the uterus.

Endometrial cancer
A type of cancer that starts in the lining of the uterus (the endometrium).

Progestogens
A group of hormones (including both natural and synthetic types) that act like progesterone in the body. They help protect the lining of the uterus when you're taking estrogen.

Progesterone
The natural form of progestogen made by your body. In HRT, it's often used in a capsule form (called Utrogestan) and is body-identical.

Progestins
Synthetic versions of progesterone. These are found in some tablets or in devices like the Mirena IUD.

Lesson Summary

Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT), is a treatment that increases hormones that decrease during perimenopause and menopause. The types of MHT include:

• Estrogen: The main hormone used in MHT, often body-identical and available as patches, gels, or pills.
• Progestogen: Necessary if you have a uterus to protect the womb lining. Types include Progesterone (body-identical) and Progestin (synthetic).
• Testosterone: Some women benefit from replacing a small amount to help with energy, libido, mood, and mental clarity.
• Topical Estrogen (for vaginal symptoms): Available as creams or pessaries for issues like dryness, discomfort, pain with sex, itchiness, or bladder infections.

Additional information:

• If you have a Mirena IUD, it might cover your progestogen needs.
• If you've had a hysterectomy, progestogen might not be necessary, unless for specific reasons like endometriosis or desire due to certain effects.
• Topical estrogen for vaginal symptoms is very safe and has minimal effect on the rest of the body.

Glossary of related terms:

• Endometrium: The uterus lining.
• Endometrial cancer: Cancer starting in the uterus lining.
• Progestogens: Hormones (natural and synthetic) protecting the uterus lining.
• Progesterone: Natural progestogen used in capsule form in HRT (e.g., Utrogestan).
• Progestins: Synthetic progestogens found in tablets or devices like the Mirena IUD.

Prescribing hormone replacement therapy: key considerations for primary care physicians; Rima Chakrabarti, Rini Chakrabarti; British Journal of General Practice 2023; 73 (732): 330-332. DOI: 10.3399/bjgp23X73347

Panay, N., Ang, S. B., Cheshire, R., Goldstein, S. R., Maki, P., & Nappi, R. E. (2024). Menopause and MHT in 2024: addressing the key controversies – an International Menopause Society White Paper. Climacteric, 27(5), 441–457. https://doi.org/10.1080/13697137.2024.2394950