Menopausal Hormone Therapy
FDA Updates Hormone Therapy Guidance (November 2025)
In November 2025, the FDA announced significant changes to labeling for menopause hormone therapy (MHT), including the removal of several long-standing boxed warnings related to cardiovascular disease, breast cancer, and probable dementia associated with certain products. These changes reflect a more individualized understanding of the benefits and risks of different types of hormone therapy, including bioidentical hormone therapy, and estrogen and progesterone therapy. The updated guidelines emphasize the importance of factors such as a woman’s age, symptoms, health history, type of therapy, and timing of treatment when considering MHT benefits and risks.
What is Menopausal Hormone Therapy?
Menopausal hormone therapy (MHT), often referred to as hormone replacement therapy (HRT), involves the use of hormones—primarily estrogen and progesterone therapy—to alleviate symptoms associated with menopause. Bioidentical hormone therapy can be particularly beneficial for managing symptoms like hot flashes and night sweats, and it can also aid in the prevention of bone loss. For those experiencing vaginal and urinary issues linked to genitourinary syndrome of menopause (GSM), local vaginal estrogen may be recommended as a targeted approach. The type of hormone therapy suggested, whether systemic MHT or localized treatment, is determined by your specific symptoms, the presence of a uterus, your health history, and your individual risks and preferences. It’s crucial to understand the MHT benefits and risks before starting any form of treatment.
How Menopausal Hormone Therapy Works
Types of Menopausal Hormone Therapy
Estrogen Alone
Combined Estrogen + Progestogen
Combined Estrogen + Progestogen
Bioidentical hormone therapy may involve the use of estrogen alone for women without a uterus, which is a crucial consideration in menopause hormone therapy. It's important to weigh the MHT benefits and risks, especially when discussing the types of hormone therapy available, including estrogen and progesterone therapy.
Combined Estrogen + Progestogen
Combined Estrogen + Progestogen
Combined Estrogen + Progestogen
Women with a uterus who undergo bioidentical hormone therapy using systemic estrogen typically require additional estrogen and progesterone therapy, specifically a progestogen, to protect the uterine lining during menopause hormone therapy. This is an important consideration when evaluating the benefits and risks of various types of hormone therapy.
Local Vaginal Estrogen
Combined Estrogen + Progestogen
Other Hormone Treatments
Low-dose vaginal estrogen, a type of hormone therapy, can effectively target vaginal and urinary symptoms with minimal systemic absorption, making it a valuable option in the broader context of menopause hormone therapy and bioidentical hormone therapy.
Other Hormone Treatments
Combined Estrogen + Progestogen
Other Hormone Treatments
Other types of hormone therapy, including bioidentical hormone therapy and estrogen and progesterone therapy, may be considered for specific symptoms and circumstances, particularly in the context of menopause hormone therapy, where understanding the MHT benefits and risks is essential.
Bioidentical Hormone Therapy
"Bioidentical hormone therapy" refers to hormones that are chemically identical to those produced by the human body. FDA-approved bioidentical hormone therapies include specific forms of estradiol and micronized progesterone, which are often used in "estrogen and progesterone therapy".
It's important to note that the term "bioidentical" does not imply that a product is necessarily compounded. There are standardized formulations of FDA-approved bioidentical hormone therapies available, while compounded bioidentical hormones are customized by compounding pharmacies and follow different regulations. These therapies are often utilized in "menopause hormone therapy" (MHT), which comes with its own set of "MHT benefits and risks". Understanding the different "types of hormone therapy" can help individuals make informed decisions about their treatment options.
Benefits & Considerations
Potential Benefits
Depending on the type of hormone therapy, including bioidentical hormone therapy, menopause hormone therapy may: reduce hot flashes and night sweats, improve sleep when disrupted by vasomotor symptoms, relieve vaginal and urinary symptoms, and help prevent bone loss while reducing fracture risk. Understanding the benefits and risks of MHT, particularly estrogen and progesterone therapy, is essential for making informed decisions.
Risks and Considerations
The risks of menopause hormone therapy (MHT) vary according to the type of hormones used, such as estrogen and progesterone therapy, as well as factors like dose, route of administration, age, health history, and timing of treatment. When considering the benefits and risks of MHT, especially with bioidentical hormone therapy, important health considerations can include:
- Blood clots
- Stroke
- Gallbladder disease
- Increased breast cancer risk associated with certain forms and durations of combined therapy
- Endometrial cancer risk when systemic estrogen is used without adequate uterine protection in women with a uterus.
For many healthy women younger than 60 or within 10 years of menopause onset who experience bothersome symptoms, the benefit-risk profile of menopause hormone therapy (MHT) may be favorable. When considering bioidentical hormone therapy, including estrogen and progesterone therapy, treatment decisions should always be individualized to align with the specific types of hormone therapy that best suit each woman's needs.
Personalized Treatment
Finding the Right Treatment
There is no single menopause hormone therapy (MHT) regimen that is right for everyone. Your healthcare provider can help you consider the most bothersome symptoms you experience, your age and stage of menopause, whether you have a uterus, and your personal and family medical history. Additionally, they can guide you on whether to pursue systemic or local treatment, and discuss the most suitable types of hormone therapy, such as bioidentical hormone therapy or estrogen and progesterone therapy. They will also help you determine the hormone, dose, and delivery method that best fits your needs and how your treatment should be reviewed over time, especially regarding the MHT benefits and risks.
Healthy Lifestyle
Healthy habits can complement medical treatments like bioidentical hormone therapy and support long-term health during menopause. Incorporating a balanced diet rich in calcium, vitamin D, protein, fruits, and vegetables is essential. Additionally, regular weight-bearing and strength-training exercises can enhance the benefits of menopause hormone therapy. It's also crucial to prioritize good sleep and effective stress management. Avoiding smoking and limiting alcohol intake can further support your health during this stage. Maintaining a healthy weight is vital, especially when considering the types of hormone therapy available, such as estrogen and progesterone therapy. To better understand the benefits and risks of MHT, as well as learn more about nutrition, exercise, sleep, and other healthy habits, visit our Healthy Lifestyle page.
Final Thoughts
Menopause hormone therapy (MHT), which includes various options like bioidentical hormone therapy and estrogen and progesterone therapy, can be an effective approach for managing symptoms and supporting certain aspects of long-term health. By understanding the different types of hormone therapy, along with the MHT benefits and risks, you can have a more informed conversation with your healthcare provider to determine if this treatment is appropriate for you.
Understanding your options can help you make informed choices about menopause treatment.
Want a More Comprehensive Guide?
Looking for a complete guide to every stage of menopause? Explore Menopause Spotlight: Your Essential Guide to Perimenopause, Menopause, and Beyond, which covers important topics such as bioidentical hormone therapy, estrogen and progesterone therapy, and various types of hormone therapy. Understand the MHT benefits and risks to make informed decisions during this pivotal time in your life. Available in paperback, hardcover, and eBook.
Medical Disclaimer
The information on this page is provided for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. The benefits and risks of menopause hormone therapy, including bioidentical hormone therapy and estrogen and progesterone therapy, can vary from person to person. It is crucial to consult your healthcare provider before starting, stopping, or changing any type of hormone therapy or other treatments. Always seek prompt medical attention for severe or unusual symptoms or any medical emergency.