Delivery of Menopausal Hormone Therapy (MHT)

Menopausal hormone therapy restores or supplements hormones that naturally decline during menopause or due to certain medical conditions. When prescribed appropriately, MHT can be highly effective in easing symptoms, maintaining bone health, and supporting overall wellbeing.

Several delivery routes are available, each influencing how the body absorbs and responds to hormones. Understanding these options helps tailor therapy to each woman’s needs, health profile, and preferences.

Systemic MHT delivers hormones into the bloodstream, allowing them to act throughout the body.

Local vaginal therapy delivers low doses of hormone directly to vaginal tissues, with very little entering the bloodstream.

Common forms: Vaginal creams, tablets, or rings.

Custom-compounded MHT may include estradiol, progesterone, and testosterone, tailored to individual needs. These formulations are often marketed as “natural” or “bioidentical,” but it's important to note:

• Not FDA-approved: Compounded hormones are not subject to the same rigorous testing and oversight as commercially manufactured products.

• Lack of standardization: Potency and purity can vary between batches, which may affect safety and effectiveness.

Common forms:  Creams, troches (lozenges), pellets (implanted under the skin), or capsules

While some women report symptom relief with compounded therapies, most experts recommend FDA-approved options when available, due to their consistency and proven safety profiles. 

The type of hormone (estrogen alone or combined with a progestogen), dosage, and route of delivery all affect safety and effectiveness.

Most experts recommend using the lowest effective dose for the shortest duration necessary to manage symptoms.