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MHT, or menopausal hormone therapy, is what most Australians now call what was previously known as HRT. The name change isn't just semantic: it reflects a shift in how the medical community frames the treatment, not as hormone "replacement" for something lost, but as therapy that supports the body through a physiological transition. If you've been searching for clarity on MHT menopause treatment, the core idea is straightforward. Oestrogen, and in most cases progesterone, drops significantly as a woman moves through perimenopause and into menopause. MHT adds those hormones back in doses designed to reduce symptoms and protect long-term health.
What MHT actually contains
Most MHT prescriptions in Australia combine two hormones: oestrogen and a progestogen. Oestrogen does the heavy lifting on symptom relief. It's the hormone whose decline drives hot flushes, night sweats, vaginal dryness, poor sleep, and the joint pain and brain fog that many women don't immediately connect to menopause. Progestogen is added to protect the uterine lining. Women who have had a hysterectomy don't need it, so they're typically prescribed oestrogen alone.
The progestogen in modern MHT formulations is usually micronised progesterone, often sold under the brand name Prometrium in Australia. This is body-identical, meaning it's chemically identical to the progesterone your body produces. Earlier generations of progestogen-only pills used synthetic progestogens, which carried different risk profiles. The distinction matters when assessing evidence, because much of the older safety data came from studies using synthetic progestogens, not micronised progesterone.
Forms and delivery methods
MHT comes in several forms, and the delivery method changes the risk and benefit profile. Oral tablets are the most familiar, but transdermal options (patches, gels, and sprays) have become the preferred choice for many clinicians. Here's why: oestrogen taken by mouth is metabolised by the liver before it enters the bloodstream, which can slightly increase clotting factors. Transdermal oestrogen bypasses the liver entirely. The evidence, including data from large European studies, suggests transdermal delivery carries a lower risk of blood clots and stroke compared to oral oestrogen.
Patches are applied to the skin once or twice a week. Gels are rubbed onto the arm or thigh daily. Sprays work similarly. Each delivers oestrogen directly through the skin into the bloodstream. For women managing hot flushes as their main concern, transdermal oestrogen at low to moderate doses is typically the first recommendation from menopause specialists.
What the evidence actually says
The reputation of MHT took a major hit in 2002, when the Women's Health Initiative (WHI) study published results suggesting increased risks of breast cancer, heart disease, and stroke. Those findings were widely reported, and prescribing rates dropped sharply across Australia and globally. What was less widely reported was the significant methodological criticism that followed. The WHI study used a specific synthetic progestogen and oral conjugated equine oestrogen, started therapy in women who were on average 63 years old (well past the menopause window), and drew broad conclusions that didn't account for age at initiation.
Later reanalysis of the WHI data, combined with large observational studies in the UK and Scandinavia, produced a more nuanced picture. For women who start MHT within 10 years of their final menstrual period (or before age 60), the cardiovascular risks are not elevated and may even be protective. The breast cancer risk associated with oestrogen-only MHT is low. Combined MHT using micronised progesterone carries a smaller breast cancer signal than formulations using synthetic progestogens.
The current position of the Australasian Menopause Society is clear: for most healthy women under 60 or within 10 years of menopause, the benefits of MHT outweigh the risks. This reflects the positions of peak bodies in the UK, US, and Europe.
Who MHT suits and who it doesn't
MHT suits most women experiencing significant menopausal symptoms. Hot flushes and night sweats are the most common reason women seek it, but MHT also addresses vaginal dryness and urinary symptoms, joint and muscle pain, mood instability, poor sleep, and reduced bone density. Women with premature ovarian insufficiency (early menopause before age 40) are particularly advised to use MHT at least until the natural age of menopause, because the health risks of early oestrogen loss are significant.
There are situations where MHT isn't recommended. Women with a personal history of oestrogen-sensitive breast cancer, certain clotting disorders, or active liver disease are generally advised against systemic MHT. This is a conversation to have with a GP or a menopause specialist who can weigh individual risk factors. Knowing your own AMS symptom score before that appointment gives the conversation a useful starting point: it helps both you and your doctor quantify how much your symptoms are affecting daily life.
Starting MHT: what to expect in the first weeks
Most women don't notice full symptom relief in the first two weeks. Oestrogen levels need time to stabilise, and the dose may need adjusting. Hot flush frequency typically reduces within four to six weeks. Sleep usually improves within a similar timeframe. Mood stabilisation can take a little longer. Some women experience breast tenderness or light spotting in the early weeks, particularly when a progestogen is introduced. These effects generally settle within three months.
Dose is not one-size-fits-all. A GP who is experienced in menopause management will start at a low dose and titrate up based on symptom relief and any side effects. If a particular form (say, a patch) isn't working well, switching to a gel or adjusting the delivery method is straightforward. The aim is the lowest effective dose that controls symptoms and maintains quality of life.
How long to use MHT
There's no fixed limit. Guidance that MHT should be used for no more than five years came from the earliest, now-criticised interpretations of the WHI study. Current evidence doesn't support a blanket five-year cap. Decisions about duration are individual, based on ongoing symptom benefit, personal health history, and a woman's own preferences. Some women use MHT for a decade or more. Annual reviews with a GP or specialist are the norm, not because the treatment is inherently risky but because health circumstances change and dosing should keep pace with them.
Women who want to stop MHT are generally advised to taper down gradually rather than stop abruptly, to minimise the return of symptoms. Some women find symptoms have resolved by the time they discontinue; others find the symptoms return and choose to continue.
MHT versus other menopause treatments
MHT is not the only option, and it's not right for every woman. Non-hormonal prescription medications (including certain antidepressants and the newer neurokinin receptor antagonist fezolinetant) can reduce hot flush frequency. Cognitive behavioural therapy has solid evidence for managing the psychological dimension of menopause symptoms. Lifestyle changes including strength training, sleep hygiene, and dietary adjustment contribute meaningfully to symptom management. But for women with moderate to severe vasomotor symptoms, MHT remains the most effective single intervention available. No supplement, lifestyle change, or non-hormonal medication matches it for symptom control in head-to-head evidence.
The decision is yours to make with accurate information. If MHT hasn't come up in a GP appointment and you're experiencing significant symptoms, it's worth asking directly. The conversation has changed considerably in the past few years, and most GPs working in this space now follow updated guidelines that are more supportive of MHT than the post-2002 period of caution.