Menopausal Hormone Therapy
Estrogen with or without progesterone. Best evidence when started within 10 years of menopause.
Approved Verified 27 August 2026
What it does
Re-evaluated significantly since the original WHI findings overstated risk. Started within ~10 years of menopause, the evidence supports benefits for bone, cardiovascular risk, vasomotor symptoms, and quality of life — particularly with transdermal estrogen. A highly individual, timing-sensitive decision.
Replaces declining estrogen and progesterone. Estrogen supports bone, vascular, urogenital, and CNS function; progesterone protects the endometrium when the uterus is intact.
What the evidence shows
Overall evidence strength: Moderate certainty
Who it's for, who should skip
Women within roughly 10 years of menopause onset. Estrogen-only after hysterectomy; combined therapy when the uterus is intact. Transdermal estrogen has a more favorable risk profile than oral.
Running it
- Dose
- per physician protocol
- Titration
- transdermal estrogen preferred for cardiovascular and thrombotic safety; bioidentical progesterone with uterus intact; ongoing risk-benefit reassessment
Safety
- breast cancer risk (modest, varies by formulation and duration)
- thromboembolism (lower with transdermal), gallbladder disease
Access & cost
Prescription or clinician order — typically via gynecology or menopause specialist.
Last reviewed 27 August 2026. Regulatory status verified 27 August 2026.