Menopause Hormone Therapy in Perimenopause and Menopause
Menopausal hormone therapy, often called MHT, is one treatment option that may be considered for women experiencing symptoms during perimenopause and menopause. MHT can help manage some menopause-related symptoms, including hot flushes, night sweats, sleep disruption and vaginal symptoms. The decision to use MHT is individual and depends on a woman’s symptoms, medical history, risk factors and personal preferences.
What Is MHT?
MHT stands for menopausal hormone therapy. It involves using hormones to help manage symptoms related to changing or declining hormone levels during perimenopause and menopause.
MHT may include:
Oestrogen therapy
Progesterone or progestogen therapy
Combined oestrogen and progesterone therapy
Local vaginal oestrogen therapy for vaginal and urinary symptoms
The type of MHT that may be suitable depends on several factors, including whether a woman has a uterus, her symptoms, medical history and individual risk profile.
Why MHT May Be Considered
During perimenopause and menopause, hormone levels can fluctuate and gradually decline. These hormonal changes can affect many systems in the body, including temperature regulation, sleep, mood, vaginal tissue, bone health and metabolism.
MHT may be considered when symptoms are affecting quality of life, such as:
Hot flushes
Night sweats
Sleep disruption
Mood changes related to hormonal fluctuations
Vaginal dryness or discomfort
Urinary symptoms related to menopause
Reduced quality of life due to menopause symptoms
For some women, MHT may also have benefits for bone health when used in appropriate circumstances.
MHT During Perimenopause
MHT can sometimes be considered during perimenopause, not only after periods have stopped.
Perimenopause can be complex because hormone levels fluctuate from month to month. Women may still be having periods but experiencing symptoms such as sleep disruption, hot flushes, mood changes, heavy or irregular bleeding, brain fog or anxiety.
Management during perimenopause may also need to consider:
Irregular or heavy bleeding
Contraception needs
Migraine history
PMDD
Endometriosis
Adenomyosis
Other medical conditions
Medication tolerances and preferences
This is why individual assessment is important before deciding whether MHT or another approach may be appropriate.
MHT After Menopause
After menopause, oestrogen levels are generally lower and symptoms may continue for some women.
MHT may be considered after menopause for symptoms such as hot flushes, night sweats, sleep disruption or vaginal and urinary symptoms.
The most appropriate treatment approach depends on age, time since menopause, medical history, personal risk factors and symptom severity.
Different Types of MHT
There are different forms of MHT, and the most appropriate option varies between women.
MHT may come as:
Patches
Gels
Tablets
Vaginal creams
Vaginal pessaries
Some women require oestrogen alone, while others require both oestrogen and progesterone or a progestogen to protect the lining of the uterus.
A clinician experienced in menopause care can help explain which options may be relevant for your situation.
Local Vaginal Oestrogen
Local vaginal oestrogen is used specifically for vaginal and urinary symptoms related to menopause.
It may be considered for symptoms such as:
Vaginal dryness
Irritation or burning
Discomfort during sex
Urinary urgency or frequency
Recurrent urinary tract infections related to menopause changes
Local vaginal oestrogen works mainly on the vaginal and surrounding tissues and is different from systemic MHT used for symptoms such as hot flushes and night sweats.
Is MHT Suitable for Everyone?
MHT is not suitable for everyone.
Suitability depends on individual factors such as:
Personal medical history
Family history
Breast cancer history
Blood clot risk
Cardiovascular risk
Migraine history
Liver disease
Unexplained vaginal bleeding
Current medications
Individual preferences
For some women, non-hormonal options may be more appropriate.
This is why a personalised consultation is important before starting MHT.
Risks and Benefits of MHT
The benefits and risks of MHT vary depending on the individual woman, the type of MHT used, age, time since menopause and medical history.
Potential benefits may include improvement in symptoms such as hot flushes, night sweats and sleep disruption. MHT may also support bone health in some women.
Possible risks vary depending on the type of therapy and individual risk factors. These should be discussed carefully as part of a consultation so women can make informed choices.
At My Menopause, we aim to provide balanced information about MHT so women understand both the potential benefits and limitations of treatment.
Do Blood Tests Decide Whether You Need MHT?
Not always.
During perimenopause, hormone levels can fluctuate significantly. A single blood test may not reliably show what is happening across the whole month.
For many women, symptoms, menstrual cycle pattern, age and medical history are more useful than relying on hormone blood tests alone.
Blood tests may still be helpful in some situations, especially when checking for other causes of symptoms or when symptoms occur at an earlier age.
Other Treatment Options
MHT is one option, but it is not the only option.
Depending on symptoms and medical history, management may also include:
Lifestyle strategies
Sleep support
Non-hormonal medications for hot flushes or mood symptoms
Vaginal moisturisers or lubricants
Local vaginal oestrogen
Psychological support
Exercise and strength training
Nutrition and metabolic health support
The best approach is individual and should consider each woman’s symptoms, goals and preferences.
MHT Consultations at My Menopause
At My Menopause, we support women navigating perimenopause and menopause with clear information, individualised assessment and discussion of treatment options, including MHT where appropriate.
A consultation may include discussion of:
Your symptoms
Menstrual cycle changes
Medical and family history
Contraception needs
Current medications
Risk factors
Treatment preferences
Possible MHT and non-MHT options
Our approach is centred on knowledge, empowerment and choice, so women can make informed decisions about their health during perimenopause and menopause.
Local Menopause Care in Jamberoo
My Menopause is based in Jamberoo, NSW and supports women across Kiama, Shellharbour, the Illawarra and South Coast regions.
We currently consult two days per week.
Book a Consultation
If you are experiencing perimenopause or menopause symptoms and would like to understand whether MHT or another treatment option may be appropriate, you are welcome to book a consultation.
Related Menopause Resources
References
Australasian Menopause Society. Menopausal Hormone Therapy Information Sheet.
The Menopause Society. Hormone Therapy Position Statement.
National Institute for Health and Care Excellence. Menopause: Identification and Management.
International Menopause Society. Recommendations on Menopausal Hormone Therapy.
Disclaimer:This information is intended for general educational purposes only and should not be considered medical advice. MHT is not suitable for everyone and requires individual assessment of symptoms, medical history and risk factors. If you are experiencing symptoms or have concerns about your health, you should seek advice from a qualified healthcare professional.