HRT (Menopausal Hormone Therapy)

Overview

Menopausal hormone therapy replaces some of the hormones, mainly estrogen, that decline during menopause. Women who still have a uterus are usually given a progestogen together with estrogen to protect the lining of the uterus. It comes as pills, patches, gels, sprays, vaginal rings and vaginal creams, and the products differ in how they are absorbed and in their risks.

What the research has looked at

The largest randomized trials come from the Women's Health Initiative (WHI). Its estrogen-plus-progestin arm was stopped early in 2002 because of higher rates of breast cancer, heart disease, stroke and blood clots, while also showing fewer hip fractures and colorectal cancers. Later analyses and other research suggest that risk differs with age and time since menopause, with a more favorable balance for women who start earlier, for example under age 60 or within 10 years of menopause. This is still debated, and it does not remove risk. Systemic estrogen is the most effective treatment studied for hot flashes and night sweats, and low-dose vaginal estrogen is used for vaginal and urinary symptoms.

What we do not know

• A trial average cannot predict one woman's risk, which depends on age, health history, the type of hormone, the dose and how it is taken.
• Long-term effects of newer or "body-identical" formulations are less well studied, and compounded products are not reviewed by regulators.
• The size of the breast cancer risk with combined therapy, and the effects on memory and thinking, are still being debated.

Regulatory context

Many menopausal hormone products are FDA-approved for specific uses such as hot flashes, vaginal symptoms and prevention of osteoporosis. In November 2025 the FDA announced plans to remove boxed warnings about cardiovascular disease, breast cancer and probable dementia from many of these products, while keeping the endometrial cancer warning on systemic estrogen-alone products. Readers should check the current label of any product. Compounded hormone preparations are not FDA-approved.

Related pages

See also Testosterone Replacement Therapy (TRT) and the Peptide A-Z.

References & further reading

• Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333.
• The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.

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