Night sweats, sudden hot flashes, uncomfortable dryness down there—all signs point to menopause. 

As you age, your body produces less and less estrogen. Once estrogen production fully halts and you haven’t had a period for 12 months, you’ve officially entered menopause. For many, menopause manifests in a constellation of frustrating symptoms, including the hallmark night sweats and hot flashes. 

“It’s easy to downplay menopausal symptoms and think, ‘Just keep pushing through, it’ll be over soon,’” says Dr. Daiana Castleman, a naturopath and Menopause Society Certified Practitioner in Ontario. “That sort of approach can lead women to suffer unnecessarily.” 

Your healthcare provider may suggest a variety of treatments to help ease these effects. “Menopause hormone therapy is typically recommended as a first-line therapy for menopause symptoms,” says Dr. Castleman. 

Here’s how it works.

What is menopause hormone therapy?

Menopause hormone therapy (MHT) helps treat symptoms of menopause by reintroducing low doses of estrogen into your body. Replacing the lost hormone can help alleviate any uncomfortable symptoms that may arise.

“It’s not just about hot flashes and night sweats,” says Dr. Castleman.

Menopause has over 30 symptoms that can manifest in cognitive changes, low libido, brain fog, sleep disturbances, and more. MHT is considered the most effective treatment for hot flashes and night sweats, though it can also help treat genital and lower urinary tract symptoms associated with menopause such as dryness and pain during sex.

MHT is also often prescribed to prevent the development of chronic conditions such as osteoporosis and cardiovascular disease for those experiencing early or premature menopause.

You can receive MHT—previously called hormone replacement therapy (HRT)—orally through a pill, transdermally via patches and gels, or with vaginal products.

Do you need to be in menopause for MHT? 

Contrary to popular belief, you can receive MHT during perimenopause. 

“A lot of women can be very symptomatic during perimenopause,” says Dr. Castleman. Perimenopause is the transitional stage leading up to menopause, typically lasting anywhere from four to eight years. 

You also don’t need hormonal blood work done to confirm that you’re entering menopause to start treatment. “In perimenopause, your hormones change so often that blood work isn’t reliable,” says Dr. Castleman. Based on symptoms and discussions, your doctor can prescribe you MHT without tests and without you hitting any age threshold. 

Types of MHT

There are two main types of MHT: systemic and vaginal. They can be used independently or in tandem, depending on your symptoms. 

Systemic 

Systemic treatments—which contain synthetic or body-identical hormones—can be taken through an oral tablet or transdermally through patches and gels. Both types help treat classic menopause symptoms like hot flashes and night sweats, though they’re metabolized by your body differently. 

When you take oral estrogen, the drug is metabolized through your liver before it reaches your bloodstream. This is called first-pass metabolism. 

Transdermal estrogen avoids first-pass metabolism, resulting in more stable blood levels. While one treatment isn’t better than the other, your healthcare provider may recommend one based on pre-existing conditions or lifestyle, says Dr. Castleman. 

If you have a uterus and you’re taking systemic estrogen, you will also be prescribed progestogen. “Taking estrogen on its own can proliferate the uterine lining and put you at risk for endometrial cancer,” says Dr. Castleman. 

Progestogen, a synthetic or natural form of progesterone, can be administered via oral tablet, transdermal patch, or intrauterine system. 

Vaginal 

Vaginal estrogen products can be taken independently of systemic therapy. These include creams, rings, and vaginal tablets and inserts. 

“The key is being consistent with it,” says Dr. Castleman. One product might be more convenient for your lifestyle. You may also be prescribed a combination of vaginal products, such as a tablet to help with vaginal tissue and a cream for vulvar tissue. 

Unlike systemic treatments, you do not need to take progestogen alongside vaginal estrogens. 

Are there risks to MHT?

Overall, menopause hormone therapy is a well-regarded practice that’s been around for decades. Just like with any treatment, there can be side effects.

“Not everyone tolerates or responds to these medications the same way,” says Dr. Castleman.  

Oral estrogen, for example, may not be the best option for someone with migraines or experiencing active liver disease. Your treatment journey will ultimately come down to a risk-benefit assessment and plan with your healthcare provider. 

MHT is also more favourable for those younger than 60 years of age or within 10 years of menopause. There are more risks with starting treatment later, including coronary heart disease and stroke. 

“We keep a very close eye on our patients, especially in the first three months,” says Dr. Castleman. And if a treatment isn’t working, whether in terms of side effects or lifestyle, your healthcare provider can direct you to other hormonal or non-hormonal options. 

How long does it take to see the effects of MHT?

For night sweats and hot flashes, MHT can work relatively quickly to ease symptoms. The effects are typically seen within one month when using standard doses of estrogen.

If lower doses of estrogen are used, it may take two to three months to see any changes. That said, a lower dose can have the benefit of causing fewer side effects, such as breast tenderness and uterine bleeding. 

Most healthcare providers will check in with you around the three-month mark to see how you're progressing on the therapy.

Is MHT safe to use long-term?

If you’ve been using a systemic treatment and are responding well, you might be considering going off the pill or patch. While your MHT journey will ultimately depend on your individual health, there is no strict cut-off or age limit for the treatment. “There is no right time to stop hormone therapy,” says Dr. Castleman.  

Vaginal products are especially safe to take in the long run. “Many patients will say, ‘I’m taking this to my grave,’” says Dr. Castleman. 

No matter what treatment route you go, Dr. Castleman emphasizes the importance of advocating for yourself. “Don’t feel like you need to suffer through your symptoms,” she says. “Part of that treatment can be MHT, but if not, there are other supports in place.”
 

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