Pill, patch, gel, ring, insert, IUD the menu of menopausal hormone therapy can feel overwhelming. Here’s what’s actually available in Canada, and why the delivery method matters as much as the hormone itself.

The whole-body (systemic) options

If your symptoms are more than just vaginal such as hot flashes, night sweats, disrupted sleep systemic estrogen therapy is usually the route. In Canada, these come as oral products (estradiol, sold as Estrace; conjugated estrogen, Premarin), taken daily; transdermal gels (estradiol, sold as Estrogel or Divigel), applied daily; and transdermal patches (estradiol, sold as Estradot or Climara), applied once or twice weekly depending on the product. There are also combination estrogen-plus-progestogen products, including a patch (Estalis) and tablets (Activelle, Angeliq, and Bijuva).

Why the route matters

The delivery method isn’t just about convenience. Transdermal options patches and gels are often the safer choice for women with risk factors like high blood pressure, clotting risk, or migraines, because they do not go through the liver right away as oral tablets may, and may not affect clotting as much. Oral tablets have their own advantages: a familiar once-daily routine, reliable absorption, and coverage by most drug plans.

Same hormones, different doors in and the route can change the risk.

Two other options

A couple of medications deliver systemic hormone effects without the need for a separate progesterone prescription. Duavive is a tissue-selective estrogen complex (TSEC): each tablet pairs 0.45 mg conjugated estrogen with 20 mg bazedoxifene, which blocks estrogen’s effect on the breast and uterus while still helping to prevent bone loss. Tibolone (Tibella) is a synthetic steroid that contains no actual hormones; in the body it breaks down into substances that mimic estrogen, progesterone, and testosterone.

Around perimenopause

If you’re still having periods, two other options can pull double duty. Combined hormonal contraceptives the birth control pill can ease hot flashes, regulate cycles, reduce heavy or painful periods, and provide reliable contraception. The hormonal IUD (such as Mirena) releases a progestogen that controls heavy bleeding, provides contraception, and can also protect the uterine lining when you’re using estrogen therapy.

If your symptoms are only vaginal, there’s a whole separate set of low-risk local (vaginal) products covered in our guide to local (vaginal) estrogen.

The best choice depends on your symptoms, your risks, and how you’d actually like to take it. That’s worth mapping out with your provider.

This article is general information, not medical advice. Menopausal hormone therapy is individualized any decision should be made with your own healthcare provider.