Menopausal Hormone Therapy (MHT)

What is Menopausal Hormone Therapy (MHT)?

Note: The terminology “Menopausal Hormone Therapy (MHT)” has replaced “Hormone Replacement Therapy (HRT)”

Menopausal Hormone Therapy (MHT) are preparations that contains female hormone estrogen or a combination of estrogen and progestogen. MHT replaces the loss of estrogen that occurs with menopause and helps women cope with their symptoms better.

Who should take MHT?

MHT is recommended to women who experience menopausal symptoms that affect their quality of life. It is also advised for women to prevent or manage chronic conditions that may occur with menopause, such as genitourinary symptoms and osteoporosis.

General recommendations advice that MHT use is safe in healthy women with symptoms, who are less than 60 years old or within 10 years of menopause, who have no contraindications for MHT.

How should I take MHT?

Women who have had their uterus taken out for various reasons, need only take estrogen hormones.

Women who still have their uterus need to take a combination of 2 hormones i.e. estrogen and progestogen. This is called combined hormone therapy (HT). In such women, taking estrogen alone can increase the thickness of the lining of her uterus and cause bleeding problems, hyperplasia (over activity of the uterine lining) or even cancer of the uterus in the future.

There are two types of combined HT available:

 

Cyclical HT: 

• This type of HT is for perimenopausal women who are still having menstrual bleeding either regularly or irregularly
• Estrogen is given daily and progestogens are added for at least 10-12 days. 
• She will experience regular monthly bleeding.

 

Continuous combined HT: 

• This type of HT is for women who are officially menopaused or had their last period one year ago. 
• Estrogen and progestogens are taken daily. 
• The woman may experience some bleeding during the initial 4 months. After which, if correctly taken without any missed tablets, she will not experience any more bleeding.

 

What are the different types of MHT available?

MHT may be delivered via oral, transdermal and intrauterine routes.

Estrogen

Estrogen is replaced either in the form of tablets, patches, creams or spray.

There are different types of estrogen preparations available.

1. Oral route as tablets to swallow. This is the most common route in Malaysia.
2. Non oral routes such as:

• Estrogen gel or spray: women can apply a prescribed amount over the upper shoulder or thigh daily.
• Patches are not available in Malaysia.

1. c) Low dose vaginal estrogen:

• Available as cream or tablet (which is in combination with probiotics) and is suited for women with genitourinary syndrome of menopause (GSM)

 

Progestogens

Progestogens are available as oral, vaginal tablets or the intrauterine system (IUS)

Why are there different types of MHT and different routes of delivery (oral/non-oral)?

Different preparations available allow you and your doctor to choose a treatment that suits your needs and lifestyle.

The advantage of the non-oral route is that it avoids the liver and very suited for women with liver problems, high cholesterol levels, high risk of clotting problems, obesity or chronic migraine. 

Using a non oral route of HT lowers the risk of deep vein thrombosis (blood clots), stroke and heart attack.

How do I know which type of MHT would be the most suitable for me?

Before prescribing MHT, your doctor would probably take a good history and carry out a gynaecological examination. 

It would be good to provide a detailed family history of cardiovascular disease, migraines, deep vein thrombosis, cancers and osteoporosis. 

Blood pressure values, height and weight measurements and BMI would be tabulated.

A pap smear (where relevant), a pelvic ultrasound and mammography is ideal as baseline investigations and again at regular intervals. 

Bone mineral density tests is encouraged for women with a high risk of fracture.

Your doctor would then carry out a risk / benefit assessment based on your symptoms, your health and  existing medical and family history.