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Treatments · hormone therapy options

The hormone therapy menu, from patches to vaginal to non-hormonal

A plain-English map of the options you'll actually be offered — or should know to ask about. Not dosing, not prescribing, just the shape of each choice so the appointment makes sense.

Eleven options, sorted by hormone family and delivery method. Click any row to see what it is, who it suits, and the practical tips that usually don't fit on a prescription label. Already prescribed something? Decode the doses and brand names →

Two quick things before the menu

  • MHT and HRT usually mean the same thing. Menopausal hormone therapy / hormone replacement therapy = estrogen, with a progestogen added if you have a uterus.
  • Route matters as much as molecule. Transdermal estrogen (patch/gel) carries a lower clot risk than oral estrogen — this is reflected in current menopause guidelines.
  • Every option carries an evidence badge. Open a row to see its sources and what the badge means — the scale is explained on how we grade evidence.

The options

How to narrow it down

A few decision forks that usually matter

Hormone options lead the menu because that's the order most people encounter them — not because they're the right answer for everyone. The non-hormonal prescriptions below are first-line for some people, including anyone who can't or doesn't want to take estrogen.

  • If hot flashes are the main problem: When estrogen is suitable for you, systemic estrogen (patch/gel first) is the most effective. If it isn't suitable or you'd prefer not to take hormones, NK3 antagonists, SSRIs/SNRIs, or gabapentin are the usual alternatives.
  • If vaginal/urinary symptoms are the main problem: Start with vaginal estrogen or vaginal DHEA. These don't replace systemic estrogen for hot flashes, but they're the most effective treatment for GSM — whether you use them depends on your history and preferences.
  • If you still have a uterus and take systemic estrogen: You need a progestogen. Oral micronized progesterone at night, or a levonorgestrel IUD, are the two common choices.
  • If low libido is the main concern: Estrogen first; if that doesn't fix it, low-dose testosterone may be worth discussing off-label.
  • If you've had a hormone-sensitive cancer: The conversation is more careful but not closed. Non-hormonal options and local vaginal therapies (with oncology input) are often still on the table.

The most useful appointment question: "Given my symptoms, my history, and what I want to treat first, what are my options — and why would you start with one over the other?"

Where to next

Upstream

The hormones, plainly

What estrogen, progesterone, testosterone, FSH and LH actually do before you talk about replacing them.

Read hormones

Vocabulary

Natural, body-identical, synthetic, compounded

What the labels mean, which are regulated, and which distinction actually changes risk.

Read labels guide

Myth-busting

Common HRT myths, sorted

WHI in context, the timing window, vaginal estrogen, and the five-year rule that never existed.

Read myths

Back to menu

Treatments overview

Symptom-by-symptum: hot flashes, vaginal, bone, mood, heart, and the misunderstood options.

Treatments

The numbers

MHT and cancer risk

The real risk picture, in absolute numbers, and why the route and progestogen matter.

Read risk guide

Pathway

Menopause after cancer

When systemic MHT is off the table, what options remain for symptoms, bone, and quality of life.

Read pathway

References & further reading

Where this page's claims come from

The framing follows mainstream menopause guidance. If you want to read the source documents or check the evidence grades, start here.

Guidelines

NICE NG23 — Menopause: diagnosis and management

NICE (UK)

Recommends transdermal estradiol as first-line systemic MHT and explains when oral routes are less suitable.

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The 2022 Hormone Therapy Position Statement

The Menopause Society (NAMS)

North American reference on benefits, risks, and the difference between progestins and micronized progesterone.

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Bioidentical HRT — Tools for Clinicians

British Menopause Society

Why regulated body-identical HRT is supported and why compounded BHRT is not.

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Use of hormone replacement therapy and risk of venous thromboembolism

Vinogradova et al, BMJ 2019

Large UK primary-care study showing transdermal estradiol does not raise VTE risk; oral estrogen modestly does.

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The 2023 Nonhormone Therapy Position Statement

The Menopause Society (NAMS)

Evidence review behind the non-hormonal prescriptions on this page: SSRIs/SNRIs, gabapentin, and NK3 antagonists.

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Global Consensus Position Statement on the Use of Testosterone Therapy for Women

Multi-society consensus, 2019

The reference point for female testosterone: supported for low sexual desire after menopause, not for other indications.

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