My options · Is it for me?
Am I a candidate? Who Menopausal Hormone Therapy is and isn’t for
Menopausal Hormone Therapy (MHT) helps a lot of women but not everyone, and not in every situation. Here’s how to tell where you might fall.
The safe starting window if you are having menopause symptoms
MHT is generally considered safe to start if you’re under 60, or within ten years of menopause, and you have no medical reasons to avoid it. In that window, for the right person, the benefits often outweigh the risks.
Who tends to benefit most
It’s the most effective treatment for hot flashes and night sweats which affect up to 80% of women during menopause and it meaningfully improves sleep, mood and quality of life. It also relieves the genitourinary symptoms of menopause, such as vaginal dryness, painful sex, and recurrent urinary tract infections. And systemic estrogen therapy helps prevent bone loss and fractures, which matters if you’re at higher risk of osteoporosis and have bothersome symptoms.
The safest time to start is before 60 or within ten years of your last period.
If you reached menopause early
If menopause came early (before 45) or prematurely (before 40), systemic MHT does something extra: it protects against the long-term effects of low estrogen cardiovascular disease, osteoporosis, and cognitive decline. In these cases it’s usually recommended until around age 51, the average age of natural menopause.
What the evidence is less sure about
MHT is sometimes prescribed off-label for symptoms like joint pain or brain fog. The evidence for those particular uses is less robust, so they call for an individualized conversation rather than a blanket recommendation.
When MHT isn’t recommended
Systemic MHT generally isn’t appropriate if you have a personal history of breast or other estrogen-sensitive cancers, unexplained vaginal bleeding, blood clots, stroke, heart disease, or active liver disease. And if you’re already on MHT and develop any of these, tell your provider right away they may adjust or change your treatment.
None of this replaces your own history. Think of it as the map; your provider helps you find where you are on it.
This article is general information, not medical advice. Menopausal hormone therapy is individualized any decision should be made with your own healthcare provider.
References
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. Menopause. 2022 Jul 1;29(7):767-794.
- Yuksel N, Evaniuk D, Huang L, et al. Guideline No. 422a: Menopause: Vasomotor Symptoms, Prescription Therapeutic Agents, Complementary and Alternative Medicine, Nutrition, and Lifestyle. J Obstet Gynaecol Can. 2021 Oct;43(10):1188-1204.
- 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):1353-68.
Effica’s clinical guides are prepared by our health team and reflect current Canadian and international menopause guidelines. They’re general information, not a substitute for personalized medical advice.