Perimenopause and menopause is a time of profound change for women; marked by the gradual decline in estrogen and progesterone, eventually leading to the end of menstrual cycles. This hormonal transition can cause a wide range of symptoms, from hot flashes and mood swings to vaginal dryness and bone loss. Since every midlife journey is different, support should be personalized, thoughtful, and informed by your unique health profile. 

Menopausal hormone therapy (MHT), formerly hormone replacement therapy (HRT), is a common option for symptom relief; however, it’s important to weigh both its benefits and limitations. This article explores how menopausal hormone therapy can play a meaningful role in symptom management, especially when combined with a holistic lifestyle-centred approach to relief.

What MHT/HRT can do 

Menopausal hormone therapy (MHT), often referred to as HRT, is an effective treatment option for many women whose peri- or postmenopausal symptoms interfere with their daily lives. Simply put, MHT/HRT is a medical treatment that replenishes hormones, typically estrogen (for women without a uterus) and a progestogen (for women with a uterus), that naturally decline during the menopause transition.

When tailored to your needs and started at the right time, MHT/HRT can:

• Soothe menopause-related symptoms, such as hot flashes and night sweats, while potentially improving related issues like poor sleep, brain fog, and irritability. The Menopause Society considers hormone therapy the “gold standard” for relief of vasomotor symptoms.
• Relieve symptoms of genitourinary syndrome of menopause (GSM), including vaginal dryness, vaginal irritation, and pain during intercourse. Low-dose vaginal estrogen therapy is considered effective and generally safe. It may also help manage urinary symptoms such as recurrent urinary tract infections (UTIs), overactive bladder, and urge incontinence.
• Support sexual function by increasing lubrication, blood flow, and sensation in vaginal tissues. Low-dose vaginal estrogen therapy is associated with improved sexual function in postmenopausal women experiencing GSM.
• Potentially help sustain skin health by helping maintain skin thickness and elasticity, especially when estrogen therapy is started around menopause.
• Protect against bone loss and reduce fracture risk in healthy postmenopausal women. Estrogen in topical gel or patch, alone or combined with progestogens (for women with a uterus), have government approval for the prevention of osteoporosis. It should be considered for osteoporosis prevention in women over the age of 60 who continue to benefit from MHT in terms of menopause symptom relief.
• Potentially reduce joint pain and stiffness, although research on this effect is ongoing. One study published in The Lancet found that women randomized to receive estrogen alone reported significantly less joint pain compared to those given a placebo. In addition, estrogen has anti-inflammatory effects, which can help alleviate the inflammation contributing to joint pain. 
• May lower the risk of developing new cases of type 2 diabetes mellitus, but hormone therapy has not yet been approved specifically for this purpose. One study found MHT/HRT may improve insulin secretion and sensitivity as well as glucose effectiveness.

While MHT/HRT isn’t a one-size-fits-all solution, it can offer meaningful relief and health support for many women navigating the most bothersome symptoms of menopause. 

What MHT/HRT can’t do

MHT/HRT is not a cure-all, it works best in conjunction with a healthy lifestyle.

1. MHT/HRT can’t stop your aging

• While it can ease menopause symptoms, it’s not a fountain of youth. For example, it won’t reverse aging or replace healthy habits that support long-term wellness.
• Be mindful not to smoke, stay mentally and physically active, eat a balanced diet, and keep a healthy weight to maintain optimal health and longevity.

2. MHT/HRT can’t lift weights for you

• It can help protect against bone loss, especially when started early in the menopause transition, but it works best alongside regular physical activity.
• Strength training is essential for maintaining bone density, muscle mass, and mobility as you age. Research shows that about 30% of adults over 70 experience difficulty walking, climbing stairs, or rising from a chair—common mobility challenges linked to higher risks of falls and chronic disease. The good news? Many of these limitations are preventable.
• Whether it’s lifting weights, practicing yoga, or walking briskly uphill, regular movement makes a meaningful difference.

3. MHT/HRT can’t cook you a balanced meal

• Nourishing your body well is one of the most powerful things you can do for your long-term health. Start by making sure you’re eating enough to fuel your day and getting the protein your muscles need to stay strong. Choose foods that are as close to their natural state as possible—simple, wholesome, and minimally processed. No matter what specific diet you follow, including more fruits, vegetables, whole grains, healthy fats, nuts, legumes, and low-fat dairy can support a vibrant, healthy life. These foods don’t just fuel your body, they help protect your mind, lift your mood, and build resilience for the years ahead.

4. MHT/HRT can’t manage your stress 

• Stress is a complex part of life, and while MHT/HRT may help with emotional regulation for some women, it won’t lower your workload, set boundaries, or breathe deeply for you. 
• Mind-body tools like mindfulness, physical activity, social connection, and saying “no” when needed are still powerful (and necessary) ways to protect your emotional health. In essence, seek activities that bring you joy, and this will help lower your chronic stress levels.

5. MHT/HRT can’t fix your poor sleep habits

• If hot flashes or night sweats are interfering with sleep, MHT/HRT can help reduce those symptoms. But sleep hygiene still matters. Hormones won’t dim your screen, keep you off email late at night, or calm a racing mind. 
• Simple routines like going to bed at the same time, keeping your room cool and dark, and limiting caffeine or alcohol can go a long way in supporting restful sleep. Even when you wake up, ask yourself: Do I have enough energy for my day? Do I need to adjust my schedule and activities to respect my body and mental state?

6. MHT/HRT can’t eliminate the need for regular health check-ups

• Even if MHT/HRT is working well for you, regular check-ins with your healthcare provider are still important. 
• Ongoing care helps ensure that the benefits continue to outweigh any potential risks, and that your treatment is still aligned with your evolving health needs. It’s also a good time to monitor blood pressure, screen for breast and cervical cancer, and stay on top of any other midlife health priorities. 

The “Four Horsemen” of chronic disease—cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease—are responsible for nearly 80% of all deaths. By proactively working to prevent these conditions, we significantly improve our chances of living a longer, healthier, and more fulfilling life.

Longevity isn’t just about adding years to life, it’s about adding life to those years.

MHT/HRT considerations

Hormone therapy carries different levels of risk depending on factors such as the type and dose of hormones used, how long the therapy is continued, the method of delivery (e.g., oral or transdermal), the timing of when treatment begins, and whether a progestogen is required. Decisions around treatment should be tailored to the individual, drawing on the best available evidence to enhance benefits and minimize risks, with regular reassessment over time.

MHT/HRT is a nuanced treatment, not an all-or-nothing choice. Like any medical treatment, menopausal hormone therapy (MHT) comes with both risks and benefits. Understanding these will help you decide if it’s the right choice for you. Remember: you are the main decision-maker in your health journey. Don’t hesitate to ask your healthcare provider for all the information you need to make a clear, informed, and confident decision.

At Coral, we believe MHT/HRT can offer powerful symptom relief for many women.

But it works best alongside healthy habits: movement, nourishing food, chronic stress care, quality sleep, and proactive health monitoring. These habits are concrete ways to prevent any of the Four Horseman diseases. 

We are transitioning from traditional medicine to a lifestyle-focused, holistic approach that considers the whole person. We aim to understand what matters most to you and empower you to create the best quality of life at every stage. This way, you can not only live but also thrive, experiencing joy and autonomy for as long as possible.

Disclaimer: The information provided here is for informational purposes only. It is not intended as medical advice. Always consult with your doctor or healthcare provider to determine what is best for your individual health needs.

References:

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5. ‌National Institute on Aging. How can strength training build healthier bodies as we age? National Institute on Aging. Published June 30, 2022. https://www.nia.nih.gov/news/how-can-strength-training-build-healthier-bodies-we-age
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