What is MHT/HRT?

Menopausal hormonal therapy (MHT), formerly called hormone replacement therapy (HRT), is when hormones are used to treat the symptoms of menopause, especially hot flushes and night sweats. There are benefits and risks with MHT, so it is important to talk to your doctor if you are considering it.

The main types of MHT are based on hormones, such as oestrogen, progesterone and testosterone, that occur naturally in the body.

During menopause, hormone levels go up and down, resulting in symptoms such as hot flushes and night sweats.

MHT helps restore hormone levels, which may improve some menopause symptoms.

How is MHT/HRT used?

The main hormone used in MHT is oestrogen. In women who have not had a hysterectomy, progesterone needs to be taken at the same time to reduce the risk of endometrial cancer.

Some women benefit from a low-dose testosterone replacement to improve low libido, lack of energy and fatigue.

Other forms of MHT are Tibolone or Duavive tablets.

MHT can be taken as:

• oral tablets
• gels or patches (hormones are absorbed through the skin)
• creams and tablets placed in the vagina
• a hormonal intrauterine device (IUD)

What are the benefits of MHT/HRT?

MHT/HRT is usually helpful if you experience problems with hot flushes and night sweats. Mood, sleep and sex drive problems may also improve. Some women also say they find improvements in joint aches, vaginal dryness and incontinence.

What are the risks of MHT/HRT?

The main risk is that some types of MHT lead to a slightly increased risk of developing breast cancer or thrombosis (blood clots in the legs or lungs). However, it can prevent other conditions such as osteoporosis, heart disease, fractures, diabetes and some types of cancers.

Current international recommendations say that the benefits outweigh the risks in women who are having significant symptoms from menopause, and that MHT is effective and safe for most healthy women.

Some women have side effects such as nausea, fluid retention, bloating, breast tenderness and swelling, and irregular bleeding. These often go away with time.

MHT may not be suitable for you if you have or have had:

• breast cancer, endometrial cancer or other cancers that are dependent on hormones
• undiagnosed vaginal bleeding
• untreated uterine lining thickening
• raised risk of thrombosis
• coronary heart disease, stroke or dementia
• blood clots in the legs or lungs
• untreated high blood pressure (if you have high blood pressure that is treated, talk to your doctor about MHT)

The risks of MHT depend on your age, the type and dose of hormone therapy you take, duration of treatment, and your medical history.

Talk to your doctor to find out which risks apply to you. If you are unable to take MHT, your doctor may suggest other medications that may be helpful.

How to reduce the risks associated with MHT/HRT

You can minimise the risks associated with MHT by:

• taking it for less than 5 years and at the lowest effective dose. Review the dose regularly with your doctor and stop as soon as you don’t need it any more
• exercising regularly, not smoking, limiting alcohol consumption and keeping to a healthy weight
• carefully managing your high blood pressure and diabetes, if these affect you

If you are interested in taking MHT, please talk to your doctor to see if it is right for you.