Menopausal hormone therapy: what it does well, and what the evidence really says

Last reviewed: October 2026

Menopausal hormone therapy, or MHT (you may also know it as HRT), is one of the most studied treatments in women’s health. Yet many women still carry worries from headlines more than 20 years old. Here is what MHT is, what it does well, and what the evidence now shows.

What is MHT?

Around menopause, the ovaries make much less oestrogen. MHT replaces some of it. Women who still have a uterus (womb) also take either progesterone (the body-identical hormone) or a progestogen (a synthetic version), which protects the lining of the uterus. Oestrogen can be taken by mouth or absorbed through the skin.

What MHT does well

Hot flushes and night sweats. MHT is the most effective treatment available for these symptoms. The Australasian Menopause Society (AMS) and the North American Menopause Society (2022) both recognise this. Evidence: strong.

Sleep. When night sweats are waking you, easing them often means better sleep. Evidence: good, mostly through relief of night sweats.

Vaginal and urinary symptoms. Dryness, discomfort during sex and some urinary symptoms often improve with oestrogen, including low-dose vaginal oestrogen used locally. Evidence: strong.

Bones. Oestrogen helps prevent the bone loss that speeds up after menopause. In the large Women’s Health Initiative (WHI) trial, women taking combined MHT had about 24% fewer fractures overall than those on placebo. Evidence: strong.

Many women also notice improvements in mood, joint aches and general wellbeing. The research here is more mixed, but for some women these changes make a real difference.

The 2002 scare, looked at again

In 2002, early results from the WHI trial linked combined MHT with higher rates of breast cancer, heart disease, stroke and blood clots. Use of MHT fell sharply around the world.

Since then, researchers have looked much more closely at the data, and the picture is far more reassuring for women around the age of menopause:

• The average WHI participant was 63, often more than a decade past menopause. That is older than most women who start MHT for symptoms today.
• Women in their 50s had a much more favourable balance of benefits and risks than older women.
• After around 18 years of follow-up, women who took MHT during the trial had no increase in deaths from any cause.

Evidence: strong that the original scare was overstated for younger women near menopause.

Risks, in perspective

Every treatment has some risk, and the best way to understand it is in real numbers.

Breast cancer. For combined oestrogen-plus-progestogen (or progesterone) therapy, the extra risk is small. The British Menopause Society estimates that among 1,000 women aged 50 to 59 over five years, about 4 extra would be diagnosed with breast cancer while on combined MHT. For comparison, drinking two or more standard drinks a day is linked to about 5 extra cases, and obesity to about 24 extra. The risk rises the longer combined MHT is used, which is one reason to review your treatment regularly.

For women without a uterus who take oestrogen alone, the long-term WHI results were reassuring: breast cancer was less common, not more, compared with placebo. Evidence: strong for these trial findings.

Blood clots. Oestrogen taken by mouth slightly increases the risk of clots in the veins. A large UK study found oestrogen absorbed through the skin was not linked to a higher clot risk. This gives many women a useful option. Evidence: moderate to strong.

Who is MHT for?

For many healthy women under 60, or within 10 years of their last period, expert bodies such as the AMS consider that the benefits of MHT for troublesome symptoms generally outweigh the risks. There is no automatic cut-off after a set number of years. The plan is reviewed over time.

MHT is not the right fit for everyone. It may not be suitable for women with certain conditions, such as a history of breast cancer, unexplained vaginal bleeding or a past blood clot or stroke. Some women simply prefer other approaches, and non-hormonal options are available too.

An individual decision worth a proper conversation

Menopause symptoms are not something you simply have to put up with. MHT is an effective, well-researched option, and for many women it is a reasonable choice. The right decision for you depends on your symptoms, your health history and what matters most to you. It is worth a proper, unhurried conversation with a practitioner who can walk you through the evidence.

References

1. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://doi.org/10.1097/GME.0000000000002028
2. Australasian Menopause Society. Consumer fact sheets. https://www.menopause.org.au/consumer-information/fact-sheets/
3. Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA. 2003;290(13):1729–1738. https://doi.org/10.1001/jama.290.13.1729
4. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353–1368. https://doi.org/10.1001/jama.2013.278040
5. Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials. JAMA. 2017;318(10):927–938. https://doi.org/10.1001/jama.2017.11217
6. British Menopause Society / Women’s Health Concern. Understanding the risks of breast cancer (infographic). 2025. https://thebms.org.uk/wp-content/uploads/2025/12/01-NEW-INFOGRAPHICS-NOV2025-C.pdf
7. Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women’s Health Initiative randomized clinical trials. JAMA. 2020;324(4):369–380. https://doi.org/10.1001/jama.2020.9482
8. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. The Lancet. 2019;394(10204):1159–1168. https://doi.org/10.1016/S0140-6736(19)31709-X
9. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810. https://doi.org/10.1136/bmj.k4810

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This article is general information only and is not a substitute for individual medical advice. Talk to your health practitioner about your own situation.