YOUR JOURNEY. YOUR CHOICE.
If You’ve Been Prescribed Hormone Therapy – Or Are Considering It – Understanding How To Use It Effectively Is Key.
What is Menopausal Hormone Therapy (MHT)?
Menopausal hormone therapy (MHT), also called hormone replacement therapy (HRT), is treatment that replaces the hormones estrogen and progesterone which fall during menopause.
Learn More about Perimenopause
Perimenopause is the stage leading up to menopause, and it can cause noticeable changes in how your body feels and functions. During this time, your ovaries gradually have fewer eggs, which affects how your hormones are produced and released.
Normally, your menstrual cycle follows a predictable pattern, with hormones rising and falling in a regular way. In perimenopause, this pattern becomes less stable. The signals between your brain and ovaries can become inconsistent, leading to hormone levels that may rise, fall, start, and stop unpredictably.
Because of these hormonal fluctuations, you may experience a wide range of symptoms. These can include changes in your menstrual cycle, mood swings, sleep disturbances, hot flushes, fatigue, and other physical or emotional changes. Symptoms can vary from person to person and may not follow a clear pattern.
One important thing to understand is that hormone levels during perimenopause can change significantly from day to day. This means that blood tests are often not reliable for diagnosing perimenopause or tracking hormone levels during this time. Instead, diagnosis is usually based on recognising changes in your body, tracking symptoms, and identifying patterns that differ from your usual cycle.
Learn More about Menopause
Menopause is defined as the time when you have not had a period for 12 consecutive months. The average age of menopause is 51 years, although anywhere between 45 and 55 years is considered normal. If menopause occurs between 40 and 45 years, it is referred to as early menopause. When it occurs before the age of 40, it is called premature ovarian insufficiency (POI). POI requires comprehensive assessment and support, so please do not delay seeking medical help if you suspect you may have POI.
In cases of suspected early menopause or POI, blood tests such as follicle-stimulating hormone (FSH) may be used to help confirm the diagnosis. While hormone blood tests are generally not helpful in perimenopause, other blood tests can still be important. These may include checks for iron levels, vitamin D, cholesterol, liver, kidney and thyroid function, and full blood counts, to rule out other causes of symptoms.
To better understand and manage your symptoms, health professionals often use a menopause symptom scale. This is a simple tool that helps track how you are feeling over time. By reviewing this at each appointment, they can assess how your symptoms are changing and how well treatments or lifestyle strategies are working.
Learn More about Post-Menopause
12 months after your final ovulation you are classified as being postmenopausal, and you remain so for the rest of your life. Generally hormones are more stable, leading to a more stable impact on the brain and mood.
Notice from the diagram however that oestrogen and progesterone levels remain persistently low from here on, which has significant health impacts:
- Decreased bone density. Bone loss speeds up temporarily at menopause, with a loss of up to 20% of bone mass in 5 years;
- Increased heart disease and dementia risk. Plaque begins to form in the arteries and brain due to inflammation. This effect may be reduced in women on oestrogen therapy.
- Genito-urinary sydrome of Menopause (GSM). Low oestrogen causes progressive thinning, drying and fragility of the labia, vaginal and urinary tract tissues, often resulting in discomfort, itching, urinary issues or pain. CLICK HERE TO LEARN MORE ABOUT GSM [Opens GSM page in another tab]
Downloadable Factsheets & Guides
The Simple Guide to MHT – a practical guide to Menopausal Hormone Therapy (MHT), providing clear, evidence-based information on how it works, the symptoms it can help with, and what to consider when exploring treatment options.
MHT Options – explore the different Menopausal Hormone Therapy options available, helping you understand what’s right for your symptoms, health needs, and stage of menopause.
Hormonal Treatments for Perimenopause & Menopause – a webinar exploring hormonal treatment options for perimenopause and menopause, including how they work, who they are suitable for, and key considerations for safe and effective use.
WellFemme Guides & Factsheets – providing clear, evidence-based information to help you better understand perimenopause, menopause, hormones, symptoms, and treatment options.
AMS Guide to Hormone Therapy – AMS Guide to MHT/HRT Doses – Australia | Information Sheet.
Evidence shows that MHT is the most effective treatment for the management of vasomotor symptoms of menopause such as hot flushes and night sweats. It can also help manage other symptoms such as sleep problems, low mood, joint aches, and vaginal dryness. There is also evidence to support the use of MHT for helping prevent bone loss associated with the menopausal transition and helping reduce the risk of heart disease if commenced within 10 years of menopause or before the age of 60. However, it has been recognised that this may be overly cautious and women may still benefit from symptom management. If starting after this time it is recommended that transdermal estrogen (eg. patch or gel) plus micronised progesterone (prometrium) be used as this is the safest combination MHT.
There is no increased risk of blood clots or stroke if estrogen is given transdermally (through the skin). This is very important if overweight, smoker, aged over 60 or having classic migraines.
Vaginal estrogen (cream or pessary) only has local effects, so very low risk. You can use it alone or with other MHT as needed.
Why are Women Scared of MHT?
In 2002, the largest women’s health study ever undertaken, the Women’s Health Initiative (WHI) study was widely reported as showing that hormone therapy caused breast cancer, heart attacks and strokes, which led many women and doctors to stop using MHT.
Later, experts showed that this headline was misleading for several reasons:
- The WHI used older, synthetic, higher-dose formulations (conjugated equine estrogen plus medroxyprogesterone acetate) that are not the same as many modern, body-identical, lower-dose, transdermal or micronised regimens used today.
- The average age of women in WHI was older (many in their 60s and 70s), often 10+ years after menopause, which is not the group for whom MHT is now usually recommended. When the results were prematurely announced, they had not been adequately analysed and they had not been adjusted to take the underlying risk factors for breast cancer into consideration.
- The media described the risk of developing breast cancer in terms of relative risk, instead of absolute risk. Here’s an example, relative risk might say, taking this medicine increases your risk of a side effect by 50%. That sounds scary, but if your original risk was 2 in 1,000, a 50% increase means it becomes 3 in 1,000, which is actually only 1 extra person in 1,000. Absolute risk would say: “This medicine increases your risk by 1 in 1,000″.
- When analysed in more detail, the absolute risks were small and many of the so-called “increased” risks were actually very rare events in absolute terms. In fact some risks were actually lower in MHT users.
- When results are re-analysed by age and time since menopause, younger women (under 60 or within 10 years of menopause) generally have a better benefit–risk balance, with more symptom relief and bone protection and relatively small risks.
A Simple Statement about MHT and Breast Cancer Safety
Menopausal hormone therapy (MHT) can slightly change breast cancer risk, but the size of that change depends on the type of MHT, the dose, how long it is used, and a woman’s age and personal risk.
- For estrogen-only MHT (used by women who have had a hysterectomy), large randomised trials show no increase in breast cancer risk and may even lower risk compared with no treatment.
- For combined estrogen + progestogen MHT, there is a small increase in breast cancer risk that mainly appears after at least 5 years of use, and the risk grows with longer use.
MHT Contraindications
Source: https://www1.racgp.org.au/ajgp/2026/april/demystifying-menopausal-hormone-therapy-prescribin
It is important to discuss your individual health risk profile with your doctor before commencing MHT.
Contraindications and precautions for MHT are listed in Box 2.
Box 2. Contraindications to menopausal hormone therapy |
Contraindications:
|
Conditions where caution is recommended and transdermal oestrogen is advised:3,15,42
|
Individual assessment and liaison with other specialists: Increased risk of breast cancer (eg women at moderate or high risk of breast cancer on risk calculators, and women with high breast density) |
Body Identical vs Bio Identical
Why TGA‑approved MHT, such as body-identical hormones are preferred over compounded “bio‑identical” therapy
1. Rigorous regulation and quality
TGA‑approved menopausal hormone therapy (MHT) has passed strict testing for:
Exact dose and strength in every tablet, patch, gel or cream
Consistency between batches so you get the same product each time
Purity and safety of ingredients, with no hidden contaminants
Proper packaging and labelling with clear instructions and expiry dates
In Australia, compounded “bio‑identical” hormones are prepared in private pharmacies and are not TGA‑approved. They are not subject to the same large‑scale quality testing, batch‑to‑batch checks, or mandatory safety reviews, so there is more uncertainty about exact dose and purity.
2. Proven safety and efficacy
TGA‑approved MHT products have been tested in clinical trials and real‑world use, with well‑documented benefits and risks. This includes clear data on:
Symptom relief (hot flushes, night sweats, vaginal dryness)
Bone protection and fracture risk reduction
Breast cancer, heart, stroke and blood clot risks for different formulations
Compounded hormones do not have the same level of independent clinical evidence showing they work the same way or are as safe long‑term.
3. Cost and PBS access
TGA‑approved MHT is often:
- Cheaper, especially when listed on the Pharmaceutical Benefits Scheme (PBS), which subsidises the cost for many patients
- Reimbursable for Medicare and some private health funds in standard ways
Compounded “bio‑identical” hormones are usually:
- Not PBS‑subsidised, so patients pay the full out‑of‑pocket cost
- More expensive because each batch is specially prepared rather than manufactured at scale
4. Prescribing and monitoring clarity
With TGA‑approved MHT:
- Doses are standardised and well‑known, making it easier for clinicians to prescribe, adjust and monitor
- Guidelines from the Australasian Menopause Society and other bodies are based on these approved products
- If side effects or problems occur, regulators and doctors can track them through established systems
With compounded hormones, dosing is more variable, guidelines are less clear, and there’s less infrastructure for monitoring safety signals.
General Guidelines for Using MHT
- Estrogen-only if you don’t have a uterus (eg. hysterectomy)
- Progestogen is the umbrella term for both progesterone and progestins. Progesterone is produced by the ovaries and is replaced using body-identical progesterone, known as Prometrium. Synthetic progestins have similar functionality to progesterone but may also have additional properties
- Combined MHT – estrogen + progestogen if you have a uterus
- Transdermal estrogen (patches or gel) is safer than oral estrogen because they bypass the liver and therefore don’t activate the liver to produce clotting factors
- Micronised progesterone (Prometrium) or the Mirena IUD (intra-uterine device) are considered low-risk progestagen replacement options
- Low- risk combined MHT might include an estrogen patch (changed twice a week), or estrogen gel applied daily, plus either oral micronised progesterone or a Mirena IUD
- If unusually young, sudden menopause (such as surgery/chemo) or severe symptoms, higher doses may be needed
- You can reduce dose or stop MHT later if symptoms abate BUT there are long term health benefits with ongoing MHT use.
- There is no absolute time limit of when you “have to stop” MHT
MHT - Click for Treatment Options
Disclaimer: This content is for informational purposes only and does not constitute medical advice or a clinical consultation. Always discuss your symptoms and treatment options with a qualified health professional for an individualised assessment and recommendations.
What it is:
Low‑dose vaginal hormones are applied inside or around the vagina to treat local symptoms such as dryness, itching, soreness and urinary symptoms without requiring systemic hormones
Typical preparations:
Common preparations in Australia include estriol creams or pessaries (Ovestin), oestradiol pessary tablet (Vagifem) and DHEA (dehydroepiandrosterone) pessary (Intrarosa)
Safety/notes:
Vaginal hormones are not systemic MHT and women with a uterus do not need to replace progesterone as they would with systemic MHT
What they do:
Transdermal estrogen patches deliver estradiol through the skin to relieve systemic menopausal symptoms such as hot flushes and night sweats.
Typical doses/preparations:
Patch doses are commonly described as low (25–37.5 mcg/24hrs), medium (50 mcg/24hrs and higher (75–100 mcg/24hr), usually applied twice per week.
Advantages/notes:
Transdermal therapy avoids first‑pass liver metabolism and is often used when there are concerns about clotting risk, liver function, absorption from the gut or blood triglyceride levels, but selection should be personalised by a clinician.
What they are:
Oral estrogen tablets (commonly 17β‑estradiol or estradiol valerate) treat systemic symptoms by raising circulating estradiol levels.
Typical doses:
Oral tablets are commonly grouped as low (e.g., 0.5–1 mg estradiol), medium (1–2 mg) and higher doses depending on preparation; the exact marketed product dosing varies by brand.
Considerations:
Oral estrogen undergoes first‑pass metabolism in the liver which can affect clotting factors and lipids; discuss personal risk factors with your clinician before choosing oral routes.
Purpose:
Progesterone (micronised oral progesterone) protects the uterus from estrogen‑induced endometrial hyperplasia (thickening) in women with an intact uterus.
Typical doses:
Common regimens include 100–200 mg micronised progesterone taken for part of the cycle (e.g., 12 days/month) or daily depending on whether therapy is cyclical or continuous; 100 mg daily is often used for continuous low–mid estrogen doses, whereas 200 mg for sequential or higher‑dose protection is used in some regimens.
Practical notes:
Micronised progesterone may be associated with sedation for some patients and is sometimes recommended at bedtime; discuss timing and dose with your clinician.
What they are:
Progestins are a synthetic progestogen. They are used as an alternative or sometimes alongside micronised progesterone to keep the lining of the uterus thin and stable in women using estrogen therapy (this is known as “endometrial protection”).
Typical preparations:
Examples used for endometrial protection include oral norethisterone (NETA) or medroxyprogesterone acetate (MPA), and levonorgestrel delivered via an intrauterine device (LNG‑IUD).
Choice considerations:
Some progestins have different side‑effect profiles (mood, bleeding, metabolic effects); selection should be individualised with discussion of risks and benefits.
What they are:
Combined preparations (where estrogen and progestogen are in one product) can be more convenient because you take just one medication instead of two separate ones. However, combined preparations may not allow you or your clinician to adjust the estrogen and progestogen doses separately, so you have less flexibility to tailor each hormone to your individual needs.
Typical regimens/options:
Combined therapy may be cyclical (estrogen with progestogen for part of each month, producing scheduled bleeding/used when still having cycle) or continuous (daily estrogen + daily progestogen, used when no longer having monthly bleed or after 12 months of cyclical MHT). Combined options include patches and oral preparations.
Practical points:
Progestogen type (micronised progesterone vs synthetic progestin), dose and schedule affect bleeding patterns and side effects; a shared decision with the prescriber will balance symptom control, bleeding preferences, and safety.
(Note — not covered in the AMS dosing guide)
When it is used:
Testosterone is licensed for use in post-menopausal women with hypoactive sexual desire disorder (HSDD) otherwise known as low libido. Off‑label use is common in perimenopausal women with low libido.
Typical dose/preparation:
AndroFeme (AndroFeme 1) is a 1% body-identical testosterone cream formulated specifically for women. Other preparations may be used.
Practical advice:
Discuss with a clinician experienced in women’s sexual health or menopause management before considering testosterone therapy; they can advise on formulation options, doses, expected benefits and monitoring. Potential side effects include acne, localised hair growth at application site and very rarely voice changes and clitoromegaly.
What it is:
Low‑dose vaginal hormones are applied inside or around the vagina to treat local symptoms such as dryness, itching, soreness and urinary symptoms without requiring systemic hormones
Typical preparations:
Common preparations include estriol creams or pessaries (Ovestin), oestradiol cream (Vagifem) and DHEA (dehydroepiandrosterone) pessary (Intrarosa)
Safety/notes:
Vaginal hormones are not systemic MHT and women with a uterus do not need to replace progesterone as they would with systemic MHT
What they do:
Transdermal estrogen patches deliver estradiol through the skin to relieve systemic menopausal symptoms such as hot flushes and night sweats.
Typical doses/preparations:
Patch doses are commonly described as low (25–37.5 mcg/24hrs), medium (50 mcg/24hrs and higher (75–100 mcg/24hr), applied once weekly or twice weekly depending on the product.
Advantages/notes:
Transdermal therapy avoids first‑pass liver metabolism and is often used when there are concerns about clotting risk or triglycerides, but selection should be personalised with a clinician.
What they are:
Oral estrogen tablets (commonly 17β‑estradiol or estradiol valerate) treat systemic symptoms by raising circulating estradiol levels.
Typical doses:
Oral tablets are commonly grouped as low (e.g., 0.5–1 mg estradiol), medium (1–2 mg) and higher doses depending on preparation; the exact marketed product dosing varies by brand.
Considerations:
Oral estrogen undergoes first‑pass metabolism in the liver which can affect clotting factors and lipids; discuss personal risk factors with your clinician before choosing oral routes.
Purpose:
Progesterone (micronised oral progesterone) protects the uterus from estrogen‑induced endometrial hyperplasia (thickening) in women with an intact uterus.
Typical doses:
Common regimens include 100–200 mg micronised progesterone taken for part of the cycle (e.g., 12 days/month) or daily depending on whether therapy is cyclical or continuous; 100 mg daily is often used for continuous low–mid estrogen doses, whereas 200 mg for sequential or higher‑dose protection is used in some regimens.
Practical notes:
Micronised progesterone may be associated with sedation for some patients and is sometimes recommended at bedtime; discuss timing and dose with your clinician.
What they are:
Progestins are a synthetic progestogen. They are used as an alternative or sometimes alongside micronised progesterone for endometrial protection.
Typical preparations/doses:
Examples used for endometrial protection include oral norethisterone (commonly 0.5–2.5 mg depending on regimen) and levonorgestrel delivered via an intrauterine device (LNG‑IUD releasing ~20 mcg/day).
Choice considerations:
Some progestins have different side‑effect profiles (mood, bleeding, metabolic effects); selection should be individualised with discussion of risks and benefits.
What they are:
Combined preparations (where estrogen and progestogen are in one product) can be more convenient because you take just one medication instead of two separate ones. However, combined preparations may not allow you or your clinician to adjust the estrogen and progestogen doses separately, so you have less flexibility to tailor each hormone to your individual needs.
Typical regimens/options:
Combined therapy may be cyclical (estrogen with progestogen for part of each month, producing scheduled bleeding/used when still having cycle) or continuous (daily estrogen + daily progestogen, used when no longer having monthly bleed or after 12 months of cyclical MHT). Combined options include patches and oral preparations.
Practical points:
Progestogen type (micronised progesterone vs synthetic progestin), dose and schedule affect bleeding patterns and side effects; a shared decision with the prescriber will balance symptom control, bleeding preferences, and safety.
(Note — not covered in the AMS dosing guide)
When it is used:
Testosterone is licensed for use in post-menopausal women with hypoactive sexual desire disorder (HSDD) otherwise known as low libido. Off‑label use is common in perimenopausal women with low libido.
Typical dose/preparation:
AndroFeme (AndroFeme 1) is a 1% body-identical testosterone cream formulated specifically for women. Other preparations may be used.
Practical advice:
Discuss with a clinician experienced in women’s sexual health or menopause management before considering testosterone therapy; they can advise on formulation options, doses, expected benefits and monitoring. Potential side effects include acne, localised hair growth at application site and very rarely voice changes and clitoromegaly.
Important reminder:
Tell your clinician if you have any unusual bleeding, breast symptoms, headaches, or side effects after starting treatment. MHT is not suitable for everyone, so treatment should be individualised. Your prescriber can help you choose the safest option for your symptoms and health history.
If you can’t find the professional help you need for your menopausal symptoms then book a Telehealth consultation today with an expert WellFemme menopause doctor.
If you are curious about vulvovaginal treatments, check out our detailed information and resources HERE, more signs & symptoms of menopause, and Peri & Menopause Symptoms: What Works?
