The information provided here is for educational purposes only and is not a substitute for personalised medical advice. Menopausal hormone therapy and other treatments should always be discussed with a qualified healthcare professional who understands your medical history, symptoms, and individual risk factors. Every woman’s menopause journey is different. Decisions about menopausal hormone therapy should be made through informed discussion and shared decision making with your provider.

Menopausal Hormone Therapy (MHT) is the use of regulated hormonal treatments, most commonly estrogen with or without a progestogen, to relieve symptoms and address certain health risks that arise due to the decline in hormones during perimenopause and post menopause.

MHT is the preferred and more accurate term when referring to hormone therapy used during perimenopause and post-menopause. It recognises that hormones are being used to treat menopause-related symptoms and/or support the body during these phases, and not to “replace” hormones to pre-menopausal levels seen during younger years. HRT is an older term. It is more appropriately used when hormones are prescribed to replace hormones in situations of hormone deficiency, such as premature ovarian insufficiency. For clarity and accuracy, MHT is now the recommended term in medical guidelines and research when discussing hormone therapy for menopause

The hormones most commonly used in Menopausal Hormone Therapy are estrogens and progestogens. Estrogens are usually considered as the main hormones used in MHT. They are responsible for relieving a large proportion of menopause-related symptoms such as hot flashes, night sweats, sleep disturbance, mood changes, vaginal dryness, and bone loss. Progestogens are used in women who have a uterus to protect the lining of the uterus from the effects of estrogen. Some women without a uterus may also need a progestogen in specific situations, which is decided by their physician (discussed below) In some cases, testosterone may also be discussed. Testosterone is not routinely used as part of menopausal hormone therapy (MHT) and is considered only in specific situations, such as surgical menopause, when both ovaries are removed. This is because testosterone levels decline gradually with age, and this decline is not directly caused by menopause. An exception is surgical menopause, where removal of the ovaries leads to a sudden drop in testosterone levels. Testosterone may be discussed during your consultation when appropriate, recognising that midlife health and menopause are closely interconnected and should be considered together when making treatment decisions.

Systemic hormone therapy works by changing the blood levels of hormones. It therefore affects the whole body and is used to treat issues such as hot flashes, night sweats, sleep disturbance, mood changes, joint pains, bone loss, etc. It is taken in forms such as tablets, patches, gels, or sprays. Local hormone therapy is applied directly to the vagina and is used specifically to treat vaginal dryness, painful sex, recurrent urinary symptoms, and other features of genitourinary syndrome of menopause. It is not aimed at increasing blood levels of hormones or treating whole-body symptoms like hot flashes or sleep disturbances. The choice between systemic and local hormone therapy depends on symptoms, health history, and individual treatment goals.

Yes. Systemic and local hormone therapy can be used together when needed under the supervision of your provider

Low-dose vaginal estrogen is a form of estrogen treatment that is applied directly to the vagina to relieve local symptoms caused by estrogen deficiency during menopause. These symptoms may include vaginal dryness, burning, irritation, painful sex, and some urinary symptoms like frequency of urination, waking up at night to pass urine, recurrent urinary tract infections, etc. Unlike systemic menopausal hormone therapy (MHT), low-dose vaginal estrogen acts mainly on the vaginal and urinary tissues and has minimal absorption into the bloodstream. Because of this, it does not treat whole-body symptoms such as hot flashes or night sweats. Low-dose vaginal estrogen is available in forms such as creams, tablets, pessaries, or rings. In India, it is currently only available in the cream form. It is considered an effective and well-tolerated option for long-term management of vaginal and urinary symptoms related to menopause. You can also learn more about it on the MenopauseWize Podcast: Low-Dose Vaginal Estrogen for Vaginal Dryness https://youtu.be/88fUkSSbAhM

Regulated Bioidentical hormones These have the same chemical structure as hormones naturally produced by the body. In systemic MHT, this includes four forms of estrogen (estrone, estradiol, estriol and estetrol) and one form of progestogen (progesterone). Estradiol is the most commonly used bioidentical estrogen that is available in tablet, gel and spray forms in India. These are laboratory-made and FDA approved, with standardised dosing and safety data. Synthetic hormones These are also laboratory-made and FDA approved, but have a different chemical structure from the hormones naturally produced by the body. Examples include ethinyl estradiol and synthetic progestogens (progestins) such as norethisterone, medroxyprogesterone acetate, and dydrogesterone. Both types are regulated medications and both are factory made. The choice between them depends on individual symptoms, tolerance, medical history, and clinical judgement. Bioidentical does not mean natural. It simply refers to hormones that have the same chemical structure as those produced by the body, and their safety depends on regulation, dose, and how they are used.

Compounded bioidentical hormones are custom-made hormone preparations that are mixed in compounding pharmacies. They are often marketed as being personalised or more natural, but they are not regulated or standardised in the same way as approved menopause hormone therapies. Unlike regulated hormone therapies, compounded hormones: • Are not tested in large clinical trials for safety or effectiveness • May have variable dosing and absorption between batches • Do not undergo the same quality control or manufacturing standards A helpful way to understand this difference is to think of buying milk. Milk from a neighbour who owns a cow may be fresh and well intentioned, but the fat content, quality, and safety can vary from day to day. A carton of milk from a grocery store is processed, tested, labelled, and consistent, so you know exactly what you are getting each time. Regulated bioidentical hormones are like the grocery store milk. Products such as approved estradiol and micronised progesterone are manufactured under strict standards. Their dose, absorption, and safety profiles are well studied, consistent, and monitored by regulatory authorities. For these reasons, regulated hormone therapies are preferred when prescribing MHT, as they offer predictable dosing, proven effectiveness, better safety oversight, and are available at a fraction of the cost of compounded hormones.

There are a few simple ways to check whether your hormone therapy is a regulated product or a compounded preparation. • Check the packaging. Regulated hormone therapies are sold in proper packaging and clearly display a Maximum Retail Price (MRP) in India. Compounded hormones usually do not have an MRP on the label. • Look for the product online. Regulated hormone therapies are listed on reputable online pharmacy or chemist websites. If your product does not appear in web searches under established pharmacies, it is likely not regulated. • Check the label. Compounded hormones often list customised doses or combinations and may be labelled as “compounded,” “custom-made,” or “for individual use.” Regulated products have standardised names, doses, and manufacturer details. If you are unsure, bring your medication or prescription to your healthcare provider or pharmacist. They can help confirm whether your hormone therapy is regulated and appropriate for use

The main factor that determines whether estrogen is prescribed alone or together with progesterone is whether you have a uterus. If you have a uterus, estrogen must be combined with a progestogen (combined MHT). This is because estrogen on its own can cause the lining of the uterus to thicken, which may increase the risk of abnormal bleeding or endometrial cancer. Adding progesterone protects the uterine lining and keeps it stable. If you do not have a uterus, estrogen can usually be prescribed on its own. In some situations, such as a history of endometriosis, subtotal hysterectomy, etcetera, your doctor may still recommend adding progesterone. This decision is individualised and based on your medical history. Other factors your doctor considers include your symptoms, health risks, and treatment goals. Together, these help determine the most appropriate and safest menopausal hormone therapy plan for you.

The main types of estrogen used in hormone therapy are estradiol (bioidentical) and ethinyl estradiol (synthetic), but they are used in different clinical contexts. Estetrol, a newer bioidentical estrogen, is available in some countries, but currently estetrol preparations are not available in India. Estradiol or E2 is the estrogen that the body naturally produces during the reproductive years. It is therefore also considered as “Bioidentical”. Currently, it is the preferred estrogen used in MHT because it has the best safety and efficacy data for menopause care. Estradiol can be given in two main ways: • Oral estradiol, taken as a tablet • Transdermal estradiol, delivered through patches, gels, or sprays that are absorbed through the skin. Currently transdermal estradiol is only available as a gel in India. Both forms are effective, and the choice depends on symptoms, health profile, and individual risk factors. Some newer oral contraceptive pills also contain estradiol. Ethinyl estradiol is a synthetic estrogen. It is mainly used in oral contraceptive pills and may be appropriate for some women, particularly during perimenopause, when prescribed as a low-dose pill for symptom control, cycle regulation, and contraception.

Transdermal estradiol is estrogen that is absorbed through the skin using patches, gels, or sprays. This route offers several advantages for many women. • It avoids first-pass metabolism through the liver, which means estrogen enters the bloodstream directly and “spares” the liver in a simplistic way. • Transdermal estrogen does not increase a woman’s baseline risk of blood clots unlike oral estrogen. • Research demonstrates that transdermal estrogen in lower doses in contrast to oral estrogen, does not increase the risk of stroke in women.  • It is often preferred for women with migraine, high blood pressure, diabetes, obesity, high triglycerides, or higher cardiovascular risk • It is safer to use in women with gallbladder disease Because of these advantages, transdermal estradiol is commonly chosen as the first-line option in menopausal hormone therapy (MHT) for many women.

Progestogens used in MHT fall into two main categories: synthetic progestogens (progestins) and progesterone.  Progesterone Micronised progesterone prescribed in MHT has the same chemical structure as the progesterone naturally produced by the body. It is therefore, bioidentical. It is commonly used in menopause care and is available as a regulated and standardised product. It can be prescribed to you for oral, vagina, and sometimes for rectal use. Synthetic progestogens or Progestins Progestins These are laboratory-made hormones that act like progesterone but have a different chemical structure. Examples include norethisterone, medroxyprogesterone acetate, drosperinone, levnorgestrel, etc. These are also regulated and effective at protecting the uterus in different dosages, but they may differ in side effects and individual tolerance. The choice of progestogen depends on symptoms, bleeding patterns, medical history, and individual response. Your healthcare provider will help select the most appropriate option and dose for you.

There are two commonly used combined menopausal hormone therapy protocols: sequential and continuous combined. Sequential MHT Estrogen is taken every day, and a progestogen is added for part of the month, usually for 12 to 14 days. This regimen often results in a planned monthly bleed, similar to a light period. Sequential MHT is commonly used in perimenopause or early menopause when natural cycles may still be occurring. Continuous combined MHT Both estrogen and a progestogen are taken every day without a break. The goal of this regimen is to achieve no bleeding over time. Some spotting may occur in the first few months, but this usually settles. Continuous combined MHT is typically used in women who are postmenopausal. In many cases, women may start with sequential MHT and later transition to continuous combined MHT. Sequential therapy is generally not continued for more than about five years, and it is usually avoided in women over the age of 55. A switch to continuous combined therapy may also be recommended if there is no natural bleeding between progesterone phases or if a woman prefers the convenience of avoiding monthly bleeding. Your doctor chooses the protocol based on your menopause stage, bleeding pattern, symptoms, and personal preferences.

Currently there is evidence that MHT helps relieve symptoms that are directly caused by hormonal changes during perimenopause and post-menopause, including: • Hot flashes and night sweats (vasomotor symptoms) • New-onset sleep disturbance • New-onset mood changes • Vaginal dryness and painful sex • Urinary symptoms (frequent urination, recurrent UTI, etc) related to genitourinary syndrome of menopause • Joint pains and body aches related to hormonal decline In India, the Central Drugs Standard Control Organisation (CDSCO) is the regulatory body for medicines. Estrogen in gel form is approved by CDSCO (https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadApprovalMarketingFDC/website%20updation%20Approval%20Dec%202021.pdf)for the treatment of estrogen deficiency symptoms in postmenopausal women and for the prevention of osteoporosis in women at high risk of fractures when other treatments are not suitable.

Yes. Many women benefit from MHT during perimenopause, even if periods are still ongoing. The approach may differ slightly, and treatment is tailored based on symptoms, bleeding patterns, and individual risk factors.

Yes. Pregnancy is still possible during perimenopause because ovulation can occur unpredictably, even when periods become irregular. Menopausal hormone therapy (MHT) does not provide contraception. Contraception is recommended until menopause is confirmed. Menopause is defined as 12 consecutive months without a menstrual period if you are over the age of 45. Until then, contraception should be continued if pregnancy is not desired. Some hormonal contraceptive options may also help manage perimenopausal symptoms such as heavy or irregular bleeding, hot flashes, and cycle-related mood changes. Your healthcare provider can help choose an option that provides both symptom control and reliable contraception, or advise on how to combine contraception with MHT if needed.

Menopause Hormone Therapy is best understood in terms of balancing potential benefits and risks, rather than being labelled simply as safe or unsafe. For many women, particularly those who are healthy and in early menopause (< 60 years of age and within 10 years of menopause), the benefits can clearly outweigh the risks when therapy is appropriately chosen and monitored. The balance of risks and benefits depends on several factors, including: • The type and dose of hormones prescribed • The route of administration, such as oral or transdermal for estrogen • Individual medical history and risk factors These factors are carefully considered during a menopause consultation, and the potential benefits and risks are discussed and reviewed over time as needs change.

The potential benefits of Menopause Hormone Therapy depend on symptoms, menopause stage, and individual health factors. For many women, benefits may include: • Relief from hot flashes and night sweats • Improvement in menopause related sleep quality • Improvement in menopause related mood changes  • Relief from vaginal dryness, painful sex, and urinary symptoms • Preservation of bone density and reduced fracture risk • Reduced risk of developing type 2 diabetes • Improvement in overall quality of life • Reduction in endometrial cancer risk as compared to non-MHT users with continuous combined MHT • Reduction in colorectal cancer risk as compared to non-MHT users with the use of combined estrogen-progestogen MHT For women who start MHT earlier in the menopause transition, benefits are often greater and risks are generally lower.

Osteoporosis is a major and often underestimated health issue for women. Between one in two and one in three women will experience an osteoporotic fracture in their lifetime. These fractures can significantly affect mobility, independence, and quality of life, especially as we age. MHT is an effective tool for preventing bone loss and reducing fracture risk when started around the time of menopause. By replacing estrogen, MHT helps slow bone breakdown, maintain bone strength, and lower the risk of fractures during the critical years when bone loss is most rapid. For many women in early menopause, particularly those who also have menopausal symptoms, MHT offers the dual benefit of symptom relief and bone protection. It is an important option to consider as part of a proactive approach to long-term skeletal health. It is important to remember that MHT does not make bones unbreakable. Strong bones are built and maintained through a combination of hormone support, regular weight-bearing and resistance exercise, good nutrition including adequate protein, calcium and vitamin D, and safe movement patterns that support balance and core strength. When MHT is stopped, bone density gradually declines and often returns to pre-MHT levels within about two years. For this reason, having these lifestyle measures in place is essential both during and after MHT to support long-term bone health and reduce fracture risk. While other osteoporosis medications are available, they may have side effects and are often recommended for limited durations of use. Because bone health is a lifelong concern, it is important to have a long-term plan that looks beyond the next few years and considers bone protection over the coming decades. MHT can play a valuable role in this long-term strategy. When it is eventually stopped, bone health can be reassessed and additional measures introduced if needed. Planning early allows for smoother transitions and better protection against fractures later in life.

The relationship between menopausal hormone therapy (MHT) and breast cancer is often misunderstood and needs to be placed in proper context. Much of the concern stems from older studies and simplified headlines, whereas current evidence shows that any change in risk depends on the type of hormones used, how long they are used for, and a woman’s individual background risk. In the Women’s Health Initiative study, which has strongly influenced how menopausal hormone therapy is viewed, combined estrogen plus progestogen therapy was associated with an increase in breast cancer cases from 30 to 38 women per 10,000 women per year of use. This means 8 additional cases per 10,000 women per year, or 0.08 percent per year. For most women, this represents a small absolute increase in risk. More recent evidence suggests that this risk may be lower with certain progestogens, particularly micronised progesterone and dydrogesterone, compared to some older synthetic progestogens. Studies indicate that with up to five years of use, there may be no increase in breast cancer risk with these two progestogens, and that any increase seen with longer use appears to be smaller than that observed with older synthetic progestogens. This is why the type of progestogen used, along with individual risk factors and duration of therapy, is an important part of personalised menopausal hormone therapy decisions. Estrogen-only therapy is associated with a lower risk of breast cancer than combined estrogen and progestogen therapy and, in some studies, has shown no increase or even a slight reduction in risk. However, estrogen alone cannot be used in women who have a uterus, as it increases the risk of endometrial cancer. Estrogen-only therapy may be appropriate in women without a uterus or in specific clinical situations, which must be decided by a physician. Importantly, the breast cancer risk attributable to MHT is small and comparable to, or lower than, the increased risk associated with common lifestyle factors such as excess body weight, regular alcohol intake, or reduced physical inactivity. These factors often have a greater impact on overall breast cancer risk than MHT itself. At the same time, it is important not to consider breast cancer risk in isolation. MHT also reduces fracture risk and helps prevent osteoporosis, and osteoporotic fractures can be life changing in terms of mobility, independence, and overall health. A balanced discussion must consider both potential risks and meaningful benefits. For this reason, decisions about MHT should be based on an individual woman’s symptoms, background risk factors, and preferences, with a clear discussion of both absolute risks and benefits rather than fear-driven messaging. To learn more about Breast Cancer and MHT, you can also listen to these episodes of the MenopauseWize Podcast: Breast Cancer and Menopausal Hormone Therapy: Part 1 https://youtu.be/S64MOyPCh9U Breast Cancer and Menopausal Hormone Therapy: Part 2 https://youtu.be/rthpdfgoXLE here:

The effect of Menopausal Hormone Therapy on stroke risk depends on many factors including when it is started, the formulation and dosage. For women who begin MHT before the age of 60 or within 10 years of their final menstrual period, stroke risk appears to be similar to that of women who do not use MHT. Stroke risk becomes more relevant when MHT is started later, particularly after the age of 60 or more than 10 years after menopause, especially when oral estrogen is used. The way MHT is given also matters. Lower doses and estrogen delivered through the skin, such as patches, gels, or sprays, appear to be associated with a lower stroke risk compared to higher doses and oral forms. For this reason, timing, dose, and route of therapy are important considerations when choosing MHT, and are carefully discussed as part of individualised care.

The effect of menopausal hormone therapy on blood clot risk depends on the type of estrogen used and how it is given. Oral estrogen is associated with an increased risk of blood clots. This is because oral estrogen passes through the liver and can increase clotting factors in the blood. The risk is higher in women who are older or who already have risk factors such as obesity, smoking, a personal or family history of clots, or prolonged immobility. Transdermal estrogen, given through the skin as a patch, gel, or spray, does not appear to increase the risk of blood clots. This is because it bypasses the liver and has minimal effect on clotting proteins. For this reason, transdermal estrogen is often preferred for women who have concerns about clot risk or who have underlying risk factors. The type of progestogen used may also influence clot risk, and this is considered when choosing a treatment plan. Commonly used progestogens such as micronized progesterone and dydrogesterone do not increase the risk of blood clots.

The relationship between menopausal hormone therapy and dementia is complex, and research findings are mixed. What we know from current evidence is this: • Outside of premature ovarian insufficiency (characterized by menopause before the age of 40 years), menopausal hormone therapy is not recommended for the prevention of cognitive decline or dementia. Studies have not shown consistent cognitive benefits when MHT is started for this purpose. • When MHT is started around the time of menopause, there is no clear evidence that it either prevents or increases the risk of dementia. At present, the effects of MHT on long-term cognitive outcomes when started in perimenopausal women, or when used specifically to treat vasomotor symptoms, remain uncertain. • For women with premature ovarian insufficiency, hormone therapy is recommended until the average age of natural menopause, as early estrogen loss is associated with adverse brain and overall health outcomes. • Some research suggests that starting MHT later in life, particularly well after menopause, may be associated with an increased risk of dementia. This finding has been observed mainly in older women and does not support initiating MHT later in life for brain health. • Overall, MHT is prescribed mainly to treat menopausal symptoms and bone protection , not to prevent dementia. Decisions about MHT are made based on symptoms, health risks, and individual priorities, rather than expectations of cognitive protection. Cognitive function in midlife and later life depends on many factors, including lifestyle habits such as physical activity, sleep, nutrition, cardiovascular health, social connection, and mental stimulation, in addition to overall medical care.

Menopausal hormone therapy is not prescribed specifically to prevent heart attacks. What research shows is that the type of hormone therapy and the timing of when it is started matter. In women under the age of 60 who are close to the time of menopause and do not already have heart disease, estrogen-only therapy (for women without a uterus) has been associated with a lower risk of heart disease and lower overall mortality compared to women who do not use hormone therapy. This benefit has not been consistently seen with combined estrogen plus progesterone therapy. However, current evidence does not suggest that appropriately prescribed combined therapy in healthy women close to menopause causes cardiovascular harm. Menopausal hormone therapy is not used to treat or reverse existing heart disease. For this reason, currently MHT is prescribed primarily to treat menopausal symptoms and improve bone health. Heart health is best protected through a combination of healthy lifestyle habits and appropriate management of blood pressure, cholesterol, blood sugar, and other cardiovascular risk factors.

Before starting MHT it is important to ensure that there are no medical contraindications to using hormone therapy. This is done through a careful medical history, discussion of symptoms, and, when appropriate, targeted tests. Starting MHT is also an important opportunity for health screening. Your healthcare provider may review or recommend checks such as blood pressure, weight, blood sugar, cholesterol, breast screening, cervical screening, or bone health assessment based on your age and risk factors. This approach ensures that MHT is started safely and that your broader midlife health is addressed at the same time. Here (https://2cc1b1ad-aec5-4c2b-b75a-ab5e7aecbf4c.usrfiles.com/ugd/2cc1b1_45babad51f6b458c8344dabff2faeaf3.pdf)is a general list that you may find helpful

Yes. Finding the right Menopausal Hormone Therapy plan is often a gradual process. Your healthcare provider may start with a lower dose or a specific regimen and adjust it based on how your symptoms respond and how well you tolerate the treatment. As your body changes, your symptoms evolve, or new evidence and treatment options become available, your therapy can be reviewed and adjusted. Regular follow-up ensures that your treatment continues to meet your needs and that the balance of benefits and risks remains appropriate

After starting menopausal hormone therapy, an initial follow-up is usually recommended within 4 to 12 weeks. This allows your healthcare provider to review how well your symptoms are responding, assess any side effects, and adjust the dose or regimen if needed. Tracking your symptoms during this period is an important part of your MHT journey. There is ongoing discussion about measuring estradiol levels in women using MHT. While routine testing is not always necessary, there is evidence that absorption of transdermal estrogen can vary significantly between individuals. For this reason, your provider may occasionally check estradiol levels to help correlate blood levels with symptoms and guide dose adjustments when needed. It is also important to note that while symptoms such as hot flashes may improve at lower doses, the optimal dose for bone protection is higher and still not clearly defined. Once symptoms are well controlled and the treatment plan is stable, follow-up is typically recommended once a year, particularly for women who are postmenopausal. These visits focus on reviewing benefits and risks, confirming that the therapy remains appropriate, and ensuring routine health screening is up to date. For women in perimenopause, follow-up may be more frequent. This is because hormone production can fluctuate widely during this stage, symptoms may change, and dose adjustments may be needed as the body transitions toward menopause. Additional follow-up is advised if symptoms change, unexpected bleeding occurs, side effects develop, or there are changes in overall health or medications. Regular review helps ensure that menopausal hormone therapy continues to meet your needs safely and effectively over time.

There is no mandatory time limit for continuing MHT. MHT can be continued as long as: • Benefits outweigh risks • You are reviewed regularly • Treatment remains appropriate for your age and health profile For many women, this means several years—and for some, lifelong.

That is completely okay. You can choose to stop menopausal hormone therapy at any time. If MHT is stopped, some menopausal symptoms may return, and bone density may gradually decline toward pre-treatment levels. For this reason, it is helpful to think of MHT as part of a long-term health plan, rather than a fixed or permanent decision. Your healthcare provider can help you plan how and when to stop MHT, discuss alternative ways to manage symptoms or protect bone health, and ensure that you continue to feel supported as your needs change over time.

MHT is one option—not the only one. Lifestyle interventions, non-hormonal medications, vaginal therapies, and behavioural strategies may also be effective, depending on symptoms.

The best way is through a structured menopause consultation that explores your symptoms, health history, goals, and concerns—so you can make an informed decision.

Menopausal hormone therapy is not a weight loss treatment. However, it may help with factors that indirectly influence weight, such as improving sleep, reducing hot flashes, and supporting energy levels, which can make it easier to stay active. MHT may help some women to reduce the tendency for fat to redistribute toward the abdomen during menopause, but it does not lead to significant weight loss on its own. Sustainable weight management during midlife is best supported through nutrition, regular movement, strength training, sleep, and stress management, with MHT playing a supportive role when indicated.

No. Menopausal hormone therapy is not known to cause weight gain on its own. Weight changes commonly occur during midlife due to ageing, changes in metabolism, loss of muscle mass, sleep disruption, stress, changes in activity levels, and shifts in body composition that happen during the menopause transition. Some women may notice temporary bloating or fluid retention when starting MHT, but this is not the same as true weight gain and usually settles with time or dose adjustment.

Absolutely not. MHT is personalised medicine. The “right” therapy depends on: • Symptoms • Age and menopause stage • Medical history • Lifestyle and preferences There is no universal prescription because each one of us is unique!

Like any medication, menopausal hormone therapy can have side effects. Not everyone experiences these, and many settle within the first few months as the body adjusts. Side effects can vary depending on the type of hormone, dose, and route used. Possible side effects of estrogen may include: • Breast tenderness or fullness • Headaches • Nausea or feeling bloated • Mild fluid retention or swelling • Leg cramps • Changes in bowel habits • Skin irritation or rash, especially with patches or gels • Unexpected vaginal spotting or bleeding, particularly when starting treatment Possible side effects of progesterone or progestogens may include: • Changes in bleeding pattern • Breast tenderness • Headaches • Nausea • Feeling tired, dizzy, or sluggish • Mood changes in some women • Acne or skin changes Most side effects are dose related and often improve with time or after adjusting the dose, type, or route of hormones. If side effects persist or affect your quality of life, your healthcare provider can usually modify the regimen to improve tolerance. Regular follow-up helps ensure that menopausal hormone therapy remains both effective and comfortable for you.