Using other medications alongside MHT

💊 What else might be part of the picture?

Menopause hormone therapy (MHT) usually refers to systemic estrogen and progesterone. But other medicines can play a complementary role in supporting symptoms of menopause. In Aotearoa New Zealand (other than the contraceptive pills in low risk individuals) are only available on prescription by a doctor. (In the UK vaginal estrogen can be bought over the counter!!)

〰️ Vaginal estrogen
Targets local genital symptoms like dryness, irritation, or discomfort. It doesn’t count as systemic MHT, but can be life-changing for urogenital health. Vaginal estrogen cream can be used with or without systemic MHT.

〰️ Testosterone
Often prescribed for low libido. Anecdotally, some women also notice improvements in energy, mood, and body pain, though strong evidence is still limited.

〰️ Contraceptive pills
Can sometimes be continued or started during perimenopause, depending on needs (e.g. contraception, heavy bleeding, convenience, or symptom control).

〰️ Antidepressants
Some antidepressant medications may help with mood symptoms or hot flushes in certain cases. MHT isn't the first-line for menopause-related depression (as it isn't as effective), but when depression or other mood disorders are present, they can be more effective. (Dopamine likes estrogen!). This topic is fairly new to medical practice but it's an area that I'm really interested in!.

〰️ Statins and other medications
Other medicines may be part of a broader midlife health plan, particularly if cardiovascular risk is a concern. Starting statins alongside transdermal estradiol may even provide extra anti-inflammatory benefits compared with estradiol alone.

Understanding how these work with MHT helps you and your doctor create a personalised plan that’s both safe and effective.

HRT after Myocardial Infarction; Tool for Clinicians; The British Menopause Society; March 2024 | Link

Nick Panay, Seng Bin Ang, Rebecca Cheshire, Steven R. Goldstein, Pauline Maki, Rossella E. Nappi & on behalf of the International Menopause Society Board (13 Sep 2024): Menopause and MHT in 2024: addressing the key controversies – an International Menopause Society White Paper, Climacteric, DOI: 10.1080/13697137.2024.2394950 | Link

Leonhardt M. Low mood and depressive symptoms during perimenopause – Should General Practitioners prescribe hormone replacement therapy or antidepressants as the first-line treatment? Post Reproductive Health. 2019;25(3):124-130. | Link