Menopausal Hormone Therapy (MHT)—also commonly referred to as hormone replacement therapy (HRT)—is the most effective treatment for common menopausal symptoms, including hot flashes, night sweats, sleep disruption, mood changes, and vaginal or urinary discomfort. At Tilla Virtual Care, we provide evidence-based menopause treatment, including prescription bioidentical hormone therapy using regulated medications that are molecularly identical to hormones naturally produced by the body. Care is guided by established clinical guidelines and individualized risk assessment, with a focus on safety, appropriate dosing, and informed decision-making through virtual menopause care.
Approximately 50-75% of women experience hot flashes and night sweats during menopause, and more than half experience vaginal dryness and discomfort. For many women, these symptoms last more than 7 years, with some experiencing moderate to severe symptoms for over a decade. Despite this widespread impact, only about 25% of women with symptoms seek help, and recent data shows that hormone therapy use has declined dramatically - from about 38% in 1999 to just 5-6% by 2020, leaving many women suffering unnecessarily. There are also significant disparities in who receives treatment, with Black and Hispanic women having less access to care despite often experiencing more severe symptoms.
If you're struggling with menopausal symptoms, effective treatment options are available, and we can help.
Menopausal hormone therapy (MHT) uses estrogen, with or without progesterone, to relieve symptoms of menopause. It is the most effective treatment available, reducing hot flashes and night sweats by approximately 75% compared to placebo.
You may be a good candidate for hormone therapy if you:
- Are experiencing moderate to severe hot flashes or night sweats that interfere with your daily life or sleep
- Are under age 60 or within 10 years of menopause
- Do not have certain medical conditions that make hormone therapy unsafe
Estrogen-only therapy is used for women who have had a hysterectomy (uterus removed).
Combined estrogen and progesterone therapy is used for women who still have their uterus. The progesterone is essential to protect the lining of the uterus from overgrowth and reduce the risk of endometrial cancer.
Hormone therapy comes in several forms including pills, patches, gels, and creams. Transdermal (patch or gel) forms may have some safety advantages over oral forms.
Reduces hot flashes and night sweats by approximately 75%, which is significantly more effective than non-hormonal options.
Relieves vaginal dryness, painful intercourse, and urinary symptoms. Low-dose vaginal estrogen can be used safely for these symptoms alone.
Helps prevent bone loss and reduces fracture risk.
May improve sleep quality, mood, and overall well-being.
For women with a uterus, progesterone is a critical component of hormone therapy. Beyond protecting the uterine lining, progesterone offers additional benefits:
- Symptom relief: Progesterone itself can help reduce hot flashes and night sweats, with some studies showing up to 55% improvement in symptoms.
- Sleep improvement: Progesterone taken at bedtime can improve deep sleep quality without causing depression.
- Breast safety: Natural progesterone (micronized progesterone) appears to have a more favorable breast cancer risk profile compared to synthetic progestins, with large observational studies suggesting it may not increase breast cancer risk when combined with estrogen.
- Cardiovascular benefits: Progesterone does not appear to have the negative cardiovascular effects seen with some synthetic progestins.
Natural progesterone can be taken continuously to avoid monthly bleeding, making it a convenient option for many women.
Like all medications, hormone therapy has potential risks that vary based on your age, health history, and the type of therapy used:
- Small increased risk of blood clots and stroke (approximately 1 extra event per 1,000 women per year)
- Possible increased risk of breast cancer with long-term combined therapy using synthetic progestins
- Increased risk of gallbladder disease
The absolute risks are generally small, especially in younger, recently menopausal women. The type of progesterone used matters - natural progesterone appears safer than synthetic progestins for breast health.
Timing matters: Starting hormone therapy soon after menopause (within 10 years) appears safer than starting it many years later.
Individualized treatment: We prescribe the lowest effective dose for the shortest time needed to control your symptoms.
Not for disease prevention: Hormone therapy should not be used solely to prevent heart disease, dementia, or other chronic conditions.
Regular monitoring: You should have periodic check-ups to reassess whether you still need hormone therapy and to monitor for any side effects.
Hormone therapy may not be safe if you have:
- History of breast cancer or certain other cancers
- History of blood clots or stroke
- Active liver disease
- Unexplained vaginal bleeding
- Known or suspected pregnancy
If hormone therapy is not right for you, or if you prefer non-hormonal approaches, several effective alternatives are available:
- SSRIs and SNRIs (such as paroxetine, venlafaxine, escitalopram, citalopram, desvenlafaxine): Reduce hot flashes by 40-65%. These can also help with mood symptoms and sleep disturbances. Paroxetine is FDA-approved specifically for menopausal hot flashes.
- Fezolinetant (Veozah): A newer medication that reduces moderate to severe hot flashes by 20-25%. Requires liver function monitoring.
- Gabapentin or pregabalin: Reduce hot flashes by 10-25% and can particularly help with sleep disturbances and nighttime symptoms.
- Oxybutynin: Can reduce hot flashes by 30-50% but may cause dry mouth and drowsiness.
- Cognitive Behavioral Therapy (CBT): Reduces hot flashes, night sweats, sleep disturbance, depression, anxiety, and fatigue with small to moderate effects (15-25% improvement). Can be delivered through group sessions, self-help books, or online programs.
- Clinical Hypnosis: Reduces hot flashes by 45-55% in some studies and improves sleep quality. Can be delivered by a trained provider or through smartphone apps.
- Low-dose vaginal estrogen (creams, tablets, or rings)
- Vaginal DHEA (prasterone)
- Oral ospemifene
These local treatments are very safe and effective for vaginal dryness and discomfort.
While not as effective as medications, addressing modifiable factors can help:
- Reducing alcohol and caffeine intake
- Quitting smoking
- Maintaining a healthy weight
- Managing stress
- Improving sleep hygiene
Research shows that acupuncture, most herbal supplements (including black cohosh), phytoestrogens, and exercise are not significantly better than placebo for hot flashes. We don't recommend these as primary treatments.
The decision to use hormone therapy or other treatments is personal and should be based on your symptoms, medical history, personal preferences, and individual risk factors. Many women are suffering unnecessarily because they don't know that safe, effective treatments are available.
Whether you're experiencing debilitating hot flashes, struggling with sleep disruption, dealing with vaginal discomfort, or simply want to understand your options better, we can help you find the right treatment approach for your unique situation. You don't have to suffer through menopause - effective relief is available, and we're here to support you every step of the way.
Menopausal hormone therapy (also known as hormone replacement therapy or HRT) involves the use of estrogen, with or without progesterone, to relieve symptoms of menopause such as hot flashes, night sweats, sleep disruption, and vaginal dryness. It is the most effective treatment available for moderate to severe menopausal symptoms.
Yes. MHT and HRT refer to the same treatment.
The term menopausal hormone therapy (MHT) is increasingly used in medical guidelines, while hormone replacement therapy (HRT) remains commonly used by patients.
“Bioidentical” refers to hormones that are chemically identical to those produced by the human body. Many commonly prescribed estrogen and progesterone products used in conventional medical practice fall into this category.
At Tilla Virtual Care Clinic, hormone therapy is prescribed based on safety, evidence, and individual risk, not marketing labels.
You may be a good candidate if you:
Hormone therapy may not be appropriate if you have:
If MHT is not suitable, non-hormonal treatment options can be discussed.
Hormone therapy may be prescribed as:
Progesterone is required if you still have a uterus, as it protects the uterine lining from overgrowth.
Micronized (natural) progesterone is commonly used due to its favorable safety and tolerability profile.
There is no single “correct” duration for hormone therapy. Treatment is individualized and regularly reviewed, with the goal of using the lowest effective dose for symptom control.
Yes. Non-hormonal prescription options, including certain antidepressants and newer therapies, can reduce hot flashes and improve sleep. Vaginal symptoms can often be treated safely with local therapies alone.
Visits at Tilla Virtual Care Clinic are not covered by Alberta Health Care Insurance Plan (AHCIP) and are self-pay.
If you have an Alberta Health Care Number, most lab tests ordered are covered. Medications are not included and depend on your pharmacy coverage.
Yes. Many women can safely begin or continue hormone therapy through a virtual consultation, depending on their history, symptoms, and previous investigations. Additional testing may be required in some cases.
Yes. Patients can book follow-up visits to reassess symptoms, adjust treatment, and monitor safety over time.