"HRT," "MHT," "hormone therapy" — the terms get used interchangeably and often anxiously. This article does one thing: explain, in plain language, what menopause hormone therapy actually is — the types, what it treats, and how it's delivered. The next two articles cover benefits and risks, and how to talk it through with a doctor.

What it's for

Menopause hormone therapy (MHT) is the most effective treatment for the classic vasomotor symptoms — hot flashes and night sweats — and for the genitourinary syndrome of menopause (GSM: vaginal dryness, irritation, painful sex, and some urinary symptoms). It has also been shown to prevent bone loss and reduce fractures.¹ It replaces some of the estrogen your body is no longer making.

The two main forms

• Estrogen alone. Generally used for women who have had a hysterectomy (no uterus).²
• Estrogen plus a progestogen. For women who still have a uterus. The progestogen is essential here: unopposed estrogen thickens the uterine lining and raises the risk of endometrial (uterine) cancer, and the progestogen protects against that.²

Which one is appropriate is determined by a simple fact of anatomy — whether you still have a uterus — not by preference.

Systemic vs. local

This distinction matters a lot for both effect and risk:

• Systemic therapy (pills, skin patches, gels, sprays) circulates through the bloodstream and treats whole-body symptoms like hot flashes and night sweats. It also relieves vaginal symptoms and helps protect bone.³
• Local (vaginal) therapy — low-dose creams, tablets, or a ring — acts mainly on the genital and urinary tissues, at much lower doses. For bothersome dryness or painful sex in women who don't need whole-body treatment, low-dose vaginal estrogen (or vaginal DHEA, or oral ospemifene) is typically recommended instead of systemic MHT.¹

Delivery routes — and why they're not interchangeable

Systemic estrogen can be taken as an oral pill or absorbed through the skin via a patch, gel, or spray.³ Route isn't just convenience: how the hormone enters the body changes its risk profile — a point the next article develops. That's why "should I take a pill or use a patch?" is a genuinely medical question worth asking, not a coin flip.

This article is general educational information, not medical advice. Hormone therapy is not right for everyone, and the right type, dose, and route depend on your individual health history. Discuss any decision with a qualified clinician.