If you’ve been handed the letters MHT and left to work out the rest on your own, here’s the plain-language version what it is, and how it actually works.

Menopausal hormone therapy (MHT) also called hormone replacement therapy (MHT), or simply hormone therapy is the most effective treatment we have for hot flashes, night sweats, and the vaginal and urinary symptoms of menopause. As you approach menopause, your natural estrogen levels begin to drop, and that decline is what triggers so many of the symptoms that disrupt daily life. MHT works by topping up some of the hormones estrogen, and usually progesterone that your body makes less of after menopause.

Why estrogen usually comes with progesterone

Estrogen is the part of MHT that relieves symptoms. On its own, though, it causes the lining of the uterus to thicken, which raises the risk of endometrial (uterine) cancer. That’s why women who still have a uterus also take a form of progesterone or another protective agent alongside estrogen, to keep that lining in check. If you’ve had a hysterectomy, you can safely take estrogen on its own.

Estrogen does the work. If you still have your uterus, progesterone keeps it safe.

Systemic vs. local: two different jobs

“Systemic” MHT treats your whole body. The hormones travel through your bloodstream, easing widespread symptoms like hot flashes and night sweats and helping protect against bone loss. Because your whole body is exposed, systemic therapy carries potential risks such as blood clots, stroke, or breast cancer in some women so your health history matters when you’re deciding whether it’s right for you.

“Local” MHT is different. These are vaginal products that act only in the vaginal, vulvar, and pelvic-floor tissues, easing dryness, irritation, painful sex, and urinary urgency. Because almost none of the hormone reaches the bloodstream, local therapy carries minimal systemic risk but it also won’t touch hot flashes or protect your bones. It’s generally considered safe for long-term use, even for many women who aren’t candidates for systemic therapy.

There’s no one-size-fits-all

The right type, dose, and duration of MHT depend on your age, how long it’s been since menopause, your symptoms, your personal and family history, your risk factors, and your own preferences. This is a decision to make with your healthcare provider the goal is the most benefit with the least risk for your particular situation.

Where to learn more

Trustworthy, patient-friendly information is also available from the Society of Obstetricians and Gynaecologists of Canada (menopauseandu.ca), the Canadian Menopause Society, the Menopause Foundation of Canada, and The Menopause Society.

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