Menopause and Menopausal Hormone Therapy (MHT): Who It Suits, How Safe
Menopausal hormone therapy is not as frightening as it was once thought to be. For the right women, starting at the right time, the benefits usually outweigh the risks.
Key points
- For women under 60, or within 10 years of menopause, with no contraindications, the benefits for hot flushes and bone usually outweigh the risks.
- If you still have a womb, a progestogen must always be used with oestrogen to protect against endometrial cancer.
- There are non-hormonal options for women who cannot use hormones, and vaginal dryness can be treated with local treatment.
"Hot flushes wake me up in the middle of the night, my mood swings so much my family is afraid to talk to me, but I'm scared to take hormones because of cancer." Many menopausal women tell me something like this. That fear has its origins, but the evidence of the past ten years or so has changed the picture a great deal. This article will help you understand who hormones suit and what to watch out for.
What is menopause?
Menopause is when periods have stopped for 12 months in a row with no other cause. It usually happens between the ages of 45 and 55. The years before it are called perimenopause, when hormones fluctuate, periods become irregular, and symptoms often begin.
If periods stop before the age of 40, this is called premature ovarian insufficiency. It should be assessed, and hormone therapy is usually recommended until the average age of menopause to protect the bones and heart.
- Before age 40Premature ovarian failure
Needs assessment; hormones usually advised until the average menopause age
- Several years beforePerimenopause
Hormones fluctuate, periods irregular, symptoms begin
- Age 45-55Menopause
No period for 12 months in a row with no other cause
- AfterwardsPostmenopause
GSM often does not resolve alone; bone loss is fastest in the first years
Common symptoms
- Hot flushes and night sweats (vasomotor symptoms)
- Insomnia, tiredness
- Mood swings, irritability, low mood, poor concentration
- Vaginal dryness, pain during sex, passing urine often. Read vaginal dryness (GSM)
- Reduced sexual desire. Read low sexual desire (HSDD)
- Rapid bone loss in the first few years, increasing the risk of osteoporosis
How our understanding of hormones has changed
In 2002, the results of the WHI study made people around the world afraid of hormones. Later analyses found that the higher risks were in women who started at an older age and long after menopause, while women who started earlier had much lower risks.
The Menopause Society (2022) concluded that for women under 60, or within 10 years of menopause, with no contraindications, the benefits of hormone therapy for treating hot flushes and preventing osteoporosis usually outweigh the risks.
In November 2025, the US Food and Drug Administration (FDA) announced the removal of the boxed warnings about cardiovascular disease, breast cancer and dementia from menopausal hormone therapy labelling, and began approving the new labels in early 2026. This does not mean hormones carry no risk at all, but it reflects that risk depends on age, timing of starting, the type of medicine and each woman's health.
The Menopause Society (2022). Type, dose and duration as assessed by your doctor.
Types of menopausal hormone therapy
| Type | Used when | Points to know |
|---|---|---|
| Oestrogen alone | Women who have had a hysterectomy | Tablets, gel or patches |
| Oestrogen + progestogen | Women who still have a womb | The progestogen is essential to prevent endometrial cancer |
| Vaginal oestrogen | Mainly vaginal dryness symptoms | Low dose, little absorption |
- Transdermal (gel or patch) forms carry a lower risk of blood clots than tablets, so they are often chosen for women with risk factors such as being overweight or having migraine.
- Custom-compounded "bioidentical" hormones that have not been through standard approval are not recommended by The Menopause Society, because the dose and safety cannot be controlled.
- Low-dose testosterone is used only for low sexual desire that causes distress. Read testosterone in women.
The dose, type and duration of every form must be chosen as assessed and prescribed by a doctor.
Who should not use whole-body hormone therapy
- Women who have or have had breast cancer or another hormone-sensitive cancer
- Vaginal bleeding whose cause is not yet known
- A previous blood clot, stroke or heart attack
- Active severe liver disease
- Pregnancy
If you cannot or do not want to use hormones
- Non-hormonal medicines for hot flushes include certain SSRI/SNRI antidepressants, gabapentin, and newer medicines that act on the brain's temperature control centre, such as fezolinetant (approved in the US in 2023) and elinzanetant (approved in the US in late 2025). Some of the newer medicines may not yet be available in Thailand.
- CBT and sleep management have evidence for reducing the distress caused by hot flushes.
- Lifestyle changes: exercise, strength training for bone, less alcohol, no smoking and breathable clothing.
- Most supplements and herbal remedies are not clearly better than placebo. Talk to a doctor before using them.
Hormones and trans people
Oestrogen is also used in other contexts, such as gender affirmation for trans women, with different goals and doses from menopausal therapy. Read feminising hormone therapy (MTF).
Before starting and while using hormones
- Assess your heart, blood vessel, breast and bone risks.
- Have age-appropriate screening, such as mammograms as recommended, blood pressure, lipids and blood sugar. Read health check-ups for working-age adults.
- Review with your doctor every year whether you still need it and whether the dose is right. There is no fixed rule about the age at which you must stop.
When to see a doctor
- Menopausal symptoms are disturbing your sleep, work or relationships
- Your periods stopped before the age of 40
- Any vaginal bleeding after menopause always needs to be checked
- Chest pain, swelling of one leg, a sudden severe headache, or weakness of an arm or leg while on hormones: go to the emergency department straight away or call 1669 (Thailand's medical emergency number)
At Dr. Kris Clinic, I assess your symptoms, risks and goals, then explain the options with and without hormones so that you can decide with confidence. You do not have to live with these symptoms alone. English-speaking consultations are available in person or online.
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Frequently asked questions
Does menopausal hormone therapy cause breast cancer?
Oestrogen with a progestogen used for many years may increase the risk slightly. Oestrogen alone, in women who have had a hysterectomy, did not clearly increase the risk in WHI. The real risk depends on the individual, so discuss it with your doctor.
How long can I use hormone therapy?
There is no fixed limit. Current guidance recommends reviewing every year whether the benefits still outweigh the risks. Some women use it for a few years; others use it for longer when there is a clear reason.
Can I start after 60?
Blood vessel risks are higher when starting later, so it must be considered individually, usually with a low-dose transdermal form. For vaginal dryness, vaginal oestrogen can be used at almost any age.
My periods are still coming but irregularly. Can I use hormones?
In perimenopause it can be used in some cases, but you can still get pregnant, and menopausal hormone therapy is not contraception. Your doctor will choose a suitable approach.
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ภาวะพร่องฮอร์โมนในผู้หญิงและฮอร์โมนวัยทอง (MHT) ใครเหมาะ ปลอดภัยแค่ไหน →
References
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- U.S. Food and Drug Administration. HHS/FDA announcement on removal of boxed warnings from menopausal hormone therapy labeling. November 10, 2025; first labeling changes approved February 2026.
- Manson JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the WHI randomized trials. JAMA. 2017;318(10):927-938.
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- Panay N, et al. Premature ovarian insufficiency: an International Menopause Society White Paper. Climacteric. 2020;23(5):426-446.
This article is for education and does not replace diagnosis or treatment by a doctor. If you have symptoms or concerns, please see a doctor.
