Menopause hormone therapy (MHT)
Menopause hormone therapy (MHT), also recorded as HRT, replaces declining estrogen and, where a uterus is present, progestogen across perimenopause and postmenopause. It is guideline-supported by NICE NG23 and The Menopause Society for most women under 60 or within ten years of menopause onset, with transdermal routes preferred for their lower thrombotic risk. In the Atlas it is the anchor term of the women's health pillar and is delivered by dedicated private menopause clinics, national telehealth platforms and hospital menopause programs across more than twenty countries. Evidence tier: well-evidenced.
What it is
Menopause hormone therapy (MHT) is systemic replacement of the estrogen, and where a uterus is present the progestogen, that falls away across the menopause transition. It is the anchor therapeutic term in women's midlife medicine and the term the rest of this branch hangs from. The naming is in active transition: the clinical register has been moving from HRT, hormone replacement therapy, toward MHT, on the argument that the therapy supplements rather than replaces a physiological state. Both names describe the same intervention and the Atlas records HRT as an alias rather than a separate value. Operators in this segment split on the register they use. Sir H. N. Reliance Foundation Hospital in Mumbai writes MHT and non-MHT; Menopause GP in Australia and South West Healthcare in Victoria write Menopause Hormone Therapy in full; KK Women's and Children's Hospital in Singapore writes hormone therapy and non-hormonal therapy. The modality has almost no discriminating power on its own, because nearly every qualifying operator in the pillar delivers it, and that is precisely why it is recorded: it is the baseline against which the more selective terms in this branch, bone densitometry and menopause-indexed cardiovascular risk assessment, separate symptom relief from healthspan delivery.
Who it is for
Women in perimenopause and postmenopause with vasomotor symptoms, sleep disruption, mood change, cognitive complaints, urogenital atrophy, or accelerated bone loss. Guidance from NICE and The Menopause Society supports use for most women under 60 or within ten years of menopause onset, where benefits generally outweigh risks. Women with premature ovarian insufficiency or surgical menopause are a distinct and higher-priority population, since they face decades of estrogen deficiency and hormone therapy is recommended at least until the average age of natural menopause. Contraindications include estrogen-sensitive cancers, active thromboembolic disease, and undiagnosed vaginal bleeding.
What to expect
Delivery begins with a symptom history and, in most operator models, a hormone and thyroid blood panel, though guidelines note that diagnosis in women over 45 is clinical and does not require blood tests. A prescribing clinician selects route and dose: transdermal patch, gel or spray, oral tablet, or vaginal preparation for local symptoms. Transdermal routes bypass first-pass hepatic metabolism and carry a lower thrombotic risk profile than oral estrogen, which is why most specialist operators in this Atlas default to them. A progestogen is added for endometrial protection where a uterus is present, commonly micronized progesterone or a levonorgestrel intrauterine system. Review at eight to twelve weeks assesses response and titrates dose, then annually thereafter. Across the Atlas the modality appears in three operator forms: dedicated private menopause clinics with published consultation pricing, national telehealth platforms billing through insurance or subscription, and hospital menopause programs where it sits inside a broader multidisciplinary pathway.
History and background
Estrogen therapy entered routine use in the 1940s using conjugated equine estrogens, and progestogen was added after the 1970s recognition that unopposed estrogen raised endometrial cancer risk. Prescribing peaked in the 1990s. The 2002 publication of the Women's Health Initiative reported elevated breast cancer risk in one arm of the combined trial and triggered a global collapse in prescribing within months. Re-analysis through the 2010s established that the trial population had been substantially older and further from menopause onset than typical clinical candidates, and that risk and benefit turn heavily on age at initiation, time since menopause, formulation and route. The 2022 Menopause Society position statement and the 2024 update to NICE NG23 restored hormone therapy to a guideline-supported position for eligible women. The shift in preferred nomenclature from HRT to MHT belongs to this same correction arc, and is one reason English-language search under the older term systematically under-recalls current clinical pages.
Worth knowing
The therapy is one of the few in medicine whose canonical name changed as a direct consequence of a trial misreading: MHT was promoted in part to separate current practice from the WHI-era understanding of HRT. Language, not just evidence, is a live variable in this segment. Local-language institutional terms find clinics that English-language search misses entirely: Wechseljahre Sprechstunde in German-speaking markets, Klimakteriemottagning in Sweden, Unidad de Climaterio across Spain and Latin America, and 更年期外来 in Japan. A menopause clinic that prescribes hormone therapy and nothing else is delivering symptom relief; the operators that also deliver bone densitometry or structured cardiovascular risk assessment are the ones making a healthspan claim, and they are a minority of the segment.
Offered across the Atlas 47
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