Menopause hormone therapy: Is it right for me? 

Written by the Progyny Editorial Team. Reviewed by the Progyny Clinical Team – August 2026.

Menopause hormone therapy (MHT) is an effective treatment for peri/menopause (perimenopause and menopause) symptoms. This medicine used to be called hormone replacement therapy, or HRT.

MHT works by supplementing estrogen and sometimes a progestogen. These are hormones that decline in your body during peri/menopause.

If your healthcare provider recommends MHT, your treatment will be highly individualized. You and your provider will consider your health history, symptoms, age, and lifestyle. And, you’ll discuss what type and form to use, the dose, and how long you might take it. MHT is not recommended for everyone.

Let’s go over the basics to help you feel prepared for a discussion with your provider.

Why consider MHT?

MHT can improve many bothersome symptoms of peri/menopause, such as hot flashes, night sweats, and vaginal dryness. Like any medical therapy, it also has risks that are important for you and your provider to weigh.

Timing matters with MHT. For most people, the benefits outweigh the risks if you start:

• Before age 60, or
• Within 10 years of menopause

MHT may be used during perimenopause. In fact, during early perimenopause, combination hormonal contraceptives (containing both estrogen and progestogen) often provide a similar benefit in terms of controlling symptoms.

Types of MHT

There are two main ways MHT may be delivered: systemically or locally.

Systemic therapy is absorbed into your bloodstream and travels throughout the body.

• Combination therapy (estrogen with a progestogen) must be taken if you have a uterus. This is because estrogen alone causes an overgrowth of the lining of the uterus, raising the risk of endometrial cancer. Adding a progestogen helps reduce this risk. Progestogens include the natural hormone progesterone as well as progestins, a synthetic form.
• Estrogen-only therapy is an option if you do not have a uterus. Estrogen alone has fewer long-term risks.

Local vaginal estrogen therapy is inserted in your vagina in low doses and does not travel through the body.

• It’s OK to take estrogen-only local therapy whether or not you have a uterus.
• It’s common to use local vaginal estrogen therapy along with systemic therapy.

Comparing systemic and local therapy

The form of MHT, such as a pill taken by mouth or a patch on the skin, may affect the benefits and risks. Systemic therapy can also differ based on the hormones included (estrogen-only or combined therapy).

Ways to receive MHT

Different forms of MHT have different advantages and risks. With your provider, talk about what may be right for your treatment goals and lifestyle. You may need to try more than one type before finding what works best for you.

Systemic therapy	Local therapy
Gel Patch Pill taken by mouth Spray Vaginal ring	Cream Tablet Insert or suppository Vaginal ring

Benefits of MHT

Systemic therapy tends to help with a broader range of symptoms. Local vaginal estrogen therapy is a lower dose treatment targeting vaginal and urinary symptoms.

Systemic therapy	Local therapy
May help: Hot flashes and night sweats Sleep problems caused by symptoms Brain fog related to symptoms Vaginal symptoms Pain during sex Joint pain and stiffness Mood changes during perimenopause Bone density and reduced fracture risk Lower risk of colon cancer Lower risk of diabetes	May help: Vaginal symptoms, such as dryness Pain during sex Frequent or urgent urination Repeated urinary tract infections (UTIs)

Risks of MHT

Risks of MHT depend on the form (such as pill or cream), which hormones are used, the dose, and length of use. Risks are also influenced by your health, when you begin treatment, and other factors.

Systemic therapy

Local therapy

May increase the risk of Endometrial cancer (with long-term use of some forms of combined therapy) Blood clots in the deep veins (with pills taken by mouth) Stroke (with estrogen pills taken by mouth and high doses of estrogen absorbed through the skin) Breast cancer (a risk after taking estrogen therapy for 7 years or combined therapy for 3 to 5 years) Gallbladder disease (with estrogen pills taken by mouth) Urinary incontinence Dementia (if therapy is started after age 65)

No risks unless you are taking a certain type of medicine for breast cancer. Please speak with your provider.

Who should not take MHT?

Your provider will let you know if MHT is not an option for you. It’s typically not recommended if you’ve had:

• Breast cancer
• Endometrial cancer (advanced-stage or a hormone-sensitive cancer)
• Heart attack, stroke, or mini-stroke
• Liver disease (like severe cirrhosis or liver cancer)
• Blood clots in your deep veins (or if you’re at high risk)
• Unexplained vaginal bleeding

MHT is not safe if you become pregnant, and it will not prevent pregnancy.

Non-hormone treatment and lifestyle changes can be used on their own or layered with hormone therapy. Everyone’s care plan looks a little different.

Takeaway

For many, MHT is safe and effective. And you have support as you think through your decision. Your Progyny Care Advocate can explain your options, help you get ready for conversations with your provider, and answer questions after your visit.

When you meet with your provider, it’s OK to take your time as you explain your symptoms, goals, and concerns. Together, you can find a personalized care plan that’s right for you.

Explore related:

• Menopause hormone therapy: questions to ask your provider

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.