Menopausal hormone therapy · What is approved, and what changed after 2002

Menopausal hormone therapy (MHT/HRT) uses oestrogen — with progesterone or a progestogen when a uterus is present — to treat menopausal symptoms. Many products are FDA-approved: patches, gels, sprays, oral tablets, vaginal preparations. Compounded "bioidentical" versions are also marketed, without the same regulatory review.

Fear of HRT dates from the 2002 Women's Health Initiative headlines; later analysis showed risk depends strongly on age at starting, time since menopause, dose and route. Professional societies now describe it as the most effective treatment for vasomotor symptoms in appropriately selected women.

Oestrogen relieves hot flushes, night sweats and genitourinary symptoms and protects bone; progestogen protects the uterine lining. Transdermal routes carry lower clot risk than oral. Contraindications include certain cancers, unexplained bleeding and clotting history — which is why a history and, often, imaging come first.

FDA-approved HRT products carry labels and boxed warnings. Compounded bioidentical hormones are not FDA-approved and are the subject of an FDA/NASEM safety review. This is a general note, not medical advice.