HRT or MHT? Hormone therapy for menopause
HRT (hormone replacement therapy) and MHT (menopausal hormone therapy) are the same treatment. MHT is the newer name, and the one the Australasian Menopause Society uses, because the aim is to treat menopause symptoms rather than “replace” hormones to younger levels. You’ll see both names on prescriptions, websites and in your GP’s notes.
MHT usually means oestrogen, as a patch, gel or tablet, plus a progestogen if you still have your uterus, to protect the lining of the womb. Some women also benefit from testosterone for low libido. Below are the options available in New Zealand.
If you've had breast cancer or DCIS, or your breast cancer risk is high, read about menopause care after breast cancer.
Common questions, such as how long you can stay on HRT or whether it causes breast cancer, are answered on Your menopause questions, answered.
Hormone Replacement Therapy (HRT) and Menopausal Hormone Therapy (MHT) are interchangeable terms used to describe the medical approach of administering hormones to alleviate symptoms associated with menopause.
This treatment strategy aims to replenish the declining levels of hormones that occur naturally during the menopausal transition.
Body-identical hormone therapy uses hormones with the same chemical structure as the ones your ovaries make. These are regulated medicines, such as oestradiol patches and gel and micronised progesterone (Utrogestan), and in New Zealand they are funded by Pharmac.
Body-identical is not the same as the "bioidentical" hormones some clinics sell. Those are custom-compounded creams or lozenges, often dosed from saliva tests, and they are not tested for quality or safety. The Australasian Menopause Society does not recommend them, and I don't prescribe them.
The spectrum of body-identical hormones encompasses several key components:
Oestradiol:
This primary form of oestrogen is available in various formulations to suit individual preferences and medical requirements. Options include transdermal patches for consistent hormone delivery through the skin, gels for topical application, and tablets for oral administration. It’s made in a laboratory from plant sources, such as yams or soy, so it is chemically identical to the oestrogen your ovaries make.
Micronised progesterone:
Marketed under the brand name Utrogestan, these capsules contain micronised progesterone, also made in a laboratory from plant sources. They offer flexibility in administration, as they can be taken orally or used vaginally, depending on the specific treatment plan.
Testosterone:
While not as commonly prescribed as oestrogen and progesterone, testosterone therapy may be considered for some women experiencing low libido. AndroFeme Cream is a female-specific topical formulation of testosterone, though it's important to note that this particular product is not subsidised, which may affect its accessibility for some patients.
Body-identical hormones are accessible through two primary channels: as prescription medicines or as compounded formulations. Understanding the distinction between these two sources is crucial for both healthcare providers and patients:
Prescription medicines:
These undergo rigorous regulatory oversight and standardised manufacturing processes. This stringent approach ensures consistent hormone dosages and preparation methods across batches, resulting in predictable and uniform therapeutic effects. The reliability of prescription medicines provides confidence in treatment outcomes and facilitates more precise management of menopausal symptoms.
Compounded medicines:
In contrast, compounded hormones are prepared in specialised pharmacies, often tailored to individual patient needs. While this customisation can be beneficial in certain cases, the production process for compounded medicines is subject to less stringent regulatory controls. Consequently, there's a potential for more significant dose variations between batches, which may impact treatment consistency and efficacy.
It's important to acknowledge that not all hormone therapies fall under the category of body-identical treatments. Several oral non-body-identical options remain available and widely used in menopausal hormone therapy:
Ovestin:
This preparation contains oestriol, a form of oestrogen that is generally considered weaker than oestradiol.
Premarin:
Derived from a pregnant mare's urine, this medication contains conjugated equine oestrogens. While effective, its non-human source distinguishes it from body-identical options.
Kliogest and Kliovance:
These combination products contain oestradiol paired with norethisterone, a synthetic progestogen. They offer the convenience of combined hormone therapy in a single preparation.
Trisequens:
This cyclical regimen mimics the natural hormonal fluctuations of the menstrual cycle by providing oestradiol and a cyclical progestogen component.
Oral contraceptive tablets:
In some cases, particularly for women in the perimenopausal phase, oral contraceptives may be prescribed to manage symptoms and provide contraception.
Mirena coil:
While primarily used for contraception, this intrauterine device releases a local progestogen and can be beneficial in managing certain menopausal symptoms, particularly heavy menstrual bleeding during the perimenopausal transition.
It's crucial to exercise caution regarding over-the-counter products marketed for menopausal symptom relief. These preparations often lack the rigorous regulatory oversight applied to prescription medications. Consequently, their precise composition, potency, and mechanisms of action may be unclear or inconsistent.