Hormone therapy, sometimes called menopause hormone therapy (MHT) or hormone replacement therapy (HRT), is the most effective treatment we have for relieving many symptoms of perimenopause and menopause. Hormone therapy works by replacing the oestrogen – and sometimes progesterone – your body is no longer producing.
Some of the symptoms that respond well to hormone therapy are:
Hormone therapy isn't guaranteed to relieve all your symptoms, and it won’t stop you going through the stages of menopause, but the right treatment should support you to manage better. Hormone therapy also provides other health benefits, like reducing the risk of osteoporosis and heart disease.
For most people experiencing perimenopause, hormone therapy is the best option, but everyone is unique, and this treatment isn’t appropriate for everyone. Our menopause clinicians will consider your medical history and talk to you about the risks and benefits of using hormones to treat your symptoms before you decide on a treatment plan together.
These are tablets that are easy to take every day. Some pills are a combination of oestrogen and progesterone, and others are oestrogen-only. It’s easy to access these pills, because there are rarely shortages in pharmacies.
Oral hormone therapy is generally safe when prescribed within 10 years of your final menstrual period or when you're under 60 years old, provided you’re physically healthy. However, for some people, taking hormone therapy orally can increase the risk of blood clots and stroke. It might also lower your testosterone levels, which can affect your libido.
Oestrogen gels were approved for use in Aotearoa New Zealand by MedSafe in 2024.
If you use a gel, you’ll probably apply it to the back of your arm or your inner thigh every day. This is a discrete way to take hormone therapy, as the gel absorbs easily. It takes five minutes to dry and you’ll need to avoid showering and physical contact with others (especially males) for an hour. Using oestrogen gel makes it easy to alter your dose, which can be especially useful when your hormones are fluctuating a lot during perimenopause. If you're using a large dose, you might need to apply the gel to multiple areas of your body.
Oestrogen gels don’t increase your risks of blood clots, making this a safer option than tablets for some people. It’s also more suitable for people with focal migraines and liver problems.
Because gels are oestrogen-only, you might need to take progesterone in another form as well – for example, tablets or an IUD (Mirena).
Oestrogen patches are easy to use and are the most commonly prescribed form of oestrogen hormone therapy due to being safer than oestrogen tablets. However, recent patch shortages have meant gel has been prescribed in its place.
You apply patches twice a week to your lower abdomen (avoiding the waistline) and leave them on your skin. They don’t increase your risk of blood clots, and they deliver a steady dose of hormones. They are a safe option for people with focal migraines or liver problems. Patches can be used alone (oestrogen-only therapy) or with progesterone (as tablets or IUD).
Some people might have allergic reactions to the adhesive on the patches. They can also leave a sticky residue on your skin. If you sweat a lot or live somewhere very hot, it might be hard to keep them on. If this is the case a gel may be more suitable for you.
There is currently a shortage of oestrogen patches in Aotearoa New Zealand, so they might be more difficult for you to access than other forms of hormone therapy.
Combined (oestrogen and progesterone) patches also exist overseas, but these are not currently available in Aotearoa New Zealand.
An intrauterine device with hormone (Mirena) can be inserted into your uterus to release progesterone. It can be used as part of your hormone therapy, and as an effective form of contraception.
If using an IUD for hormone therapy, you’ll also need to use oestrogen patches, gel, or tablets. IUDs can be very helpful for managing perimenopausal bleeding issues, and last for five years when used for this purpose (compared with eight years when used for contraception).
Because these devices stop or reduce your periods, if you’re using this method of hormone therapy, it might be harder to tell when you reach menopause and postmenopause.
Some oestrogen treatments can be inserted directly into your vagina to reduce vaginal and bladder-related symptoms, which often last through postmenopause. These might be creams or pessaries (pills that are inserted into the vagina). When you put oestrogen directly into your vagina, your body only absorbs a tiny amount, so these vaginal oestrogen-only treatments don’t have the same risks as oestrogen-only hormone therapy.
The mental, emotional, and physical symptoms you experience during perimenopause are caused by hormone fluctuations. Hormone therapy replaces the oestrogen – and sometimes progesterone – that your ovaries are no longer producing (or producing at fluctuating levels), which helps keep your hormone levels stable and alleviates your symptoms.
Most hormone therapy treatments involve two hormones: oestrogen and progesterone. Oestrogen is the hormone most effective in relieving your symptoms, but when you use oestrogen without progesterone, your uterine lining can thicken and increase the risk of uterine cancer. Because of this, if you have a uterus, we’ll always prescribe you progesterone along with your oestrogen to protect your uterine lining. Progesterone (especially utrogestan, which is micronised progesterone) can help with sleep so we usually suggest women take it at night. If you don’t have a uterus, you will likely be given oestrogen alone.
There are a few different ways to take hormone therapy. Because everyone’s experience is different, there is no one-size-fits-all approach. Your hormone therapy will be tailored to you.
Treatment can be:
MHT and HRT are different names for the same treatment. The term MHT tends to be used more these days when referring to menopause treatment, and has largely replaced HRT. However, to avoid confusion, we talk about “hormone therapy”.
Some transgender and non-binary people also use hormone therapy to support physical changes that align with their gender identity.
We’ll send your prescription to the pharmacy of your choice. Learn more about appointments with us.
There is an ongoing international shortage of oestradiol patches. However, as Dr Beth Messenger, Sexual Wellbeing Aotearoa medical director, explains, work is underway to address this issue,
“PHARMAC has been working hard to reduce the difficulties of accessing transdermal oestrogen by funding oestrogen gel and an alternative brand of oestrogen patches that expects to be able to meet the demands of supply in New Zealand. Most people have had no issues with the different brand, but a few people may notice a difference.”
