Menopause Hormone Therapy (MHT): an evidence‑based guide for women in perimenopause and menopause 

For many women, untreated symptoms can feel debilitating, affecting their ability to perform at work, maintain relationships and feel like themselves. With appropriate hormone therapy and integrated care, that experience can change dramatically.  

What types of hormones are used in MHT? 

Hormones commonly used in MHT are: 

1. Estrogen – used to relieve most menopause symptoms. 
2. Progesterone – used if a woman still has a uterus where estrogen must be paired with a form of progesterone to protect the uterine lining and reduce the risk of endometrial cancer. 
3. Testosterone – not routinely prescribed but may be considered in select cases. 

They are delivered through the skin – via creams, sprays, gels, patches – by mouth – via pills – or locally to vaginal tissue or the vagina –  with rings, tablets, IUDs or creams. Each method is chosen for the symptoms being treated individually to balance effectiveness and safety with patient preference. 

There are two main types of hormones used in hormone therapy: bio‑identical and synthetic. 

Bio-identical hormones are chemically identical to the hormones the body naturally produces. They are made using plant sterols – commonly derived from soy or yams – and then modified through pharmaceutical processes to create hormones, such as estradiol or progesterone that have the same molecular structure as those produced in the human body. 

Synthetic hormones are not structurally identical to human hormones and may act slightly differently in the body, sometimes producing stronger or longer‑lasting effects or interacting with tissues in distinct ways.  

Many women are misled to believe that bio‑identical means ‘natural’ and therefore, synthetic must be less effective. However, Dr. Zelovitzky clarifies that both bio‑identical and synthetic hormones are made in laboratories. The critical distinction is whether the hormone is Health‑Canada / FDA‑approved (tested for safety, consistency, and dose accuracy) or compounded (custom‑mixed formulations that may lack rigorous oversight). 

She cautions against claims that compounded bio-identical hormones are safer, noting that this is not supported by evidence. “MHT should be prescribed based on what’s safest and most effective for the individual woman, and today’s evidence‑based options,” Dr. Zelovitzky explains. 

Who is MHT for? 

MHT is not a one-size-fits-all solution. Generally, it is recommended for women going through the menopause transition (including some women in perimenopause) who experience: 

1. Moderate to severe hot flashes or night sweats 
2. Low bone mass or a high risk of fractures 
3. Significant vaginal or urinary symptoms 
4. Struggles with mood, cognitive function, and/or mental wellbeing  
5. Premenstrual symptoms that have become more intense or are affecting quality of life 

It is also used for women who experience early menopause before age 45, either naturally or following surgery, such as removal of the ovaries or uterus.  

Women who fit these profiles are often clear candidates for MHT. For instance, MHT therapy is used for women who have had a total hysterectomy, which is surgery to remove the uterus and ovaries. These women typically need estrogen because estrogen production will stop if ovaries are removed. Yet, the woman will still require estrogen to maintain systems in the body and protect bone health. 

For women in premature menopause, MHT is strongly recommended until the natural age of menopause, around 50–51, to help prevent complications such as osteoporosis, hip fracture and cardiovascular disease. For these women, hormone therapy is not only about symptom relief. It plays a role in protecting long-term health during years when the body would normally still be exposed to estrogen. It can even reduce cardiovascular disease and dementia risk. 

MHT is not for everyone. There are medical situations, known as contraindications, where hormone therapy is not appropriate. For instance, women with hormone-responsive cancers should not automatically use systemic estrogen. It is imperative to discuss your options with a trained physician and make a decision that is suitable for your health history, symptoms, and goals. 

When MHT is not appropriate, non-hormonal options are available. They include prescription medications that act on the nervous system – such certain antidepressants, or Gabapentin or Clonidine, which help with nighttime hot flashes and sleep disruption – and/or cognitive behavioural therapies (CBT), sleep‑focused treatments, lifestyle strategies, and targeted therapies for vaginal and urinary symptoms.  

More recently, a newer class of non‑hormonal medications call KNDY receptor blockers have been made available in Canada. KNDY neurons are specialized nerve cells located in the hypothalamus that co‑produce three signaling molecules – Kisspeptin, Neurokinin B (NKB) and Dynorphin. They are designed to reduce menopausal hot flashes and night sweats by targeting a specific temperature‑control pathway in the brain. 

A thorough health review and up-to-date screening can help determine whether hormone therapy is right for you. It is also important to assess your overall health to ensure that there are no other health concerns which could be causing or contributing to your symptoms. At Medcan, we suggest women complete an Annual Health Assessment before starting our Menopause and Perimenopause program. This assessment reviews 100+ biomarkers through blood and urine analysis, ultrasounds, fitness testing, bone density scans, and more to provide a comprehensive picture of your health.  

If you suspect you are experiencing symptoms of perimenopause, Dr. Zelovitzky recommends completing important analysis including iron and nutrient levels to rule out other underlying conditions.

Is MHT safe? 

Currently, fears still exist around MHT, and much of this anxiety can be attributed to a study by the Women’s Health Initiative that was published about 20 years ago. Dr. Zelovitzky explains that “Headlines at the time, suggested that MHT caused cancer and heart disease. However, those early conclusions were not nuanced.” 

The study focused on disease prevention, not on relieving symptoms. It also included women aged 50 to 79, with an average participant of age 63. Given that the study obtained data from women decades past menopause, it was found that older women were more likely to have established plaque buildup in arteries. That matters because estrogen’s effects on blood vessels differ depending on vascular health at the time therapy is started. 

Later analyses of the same data showed a different picture. For women aged 50 to 59 or within 10 years of menopause, hormone therapy was shown to be safe and, in some cases, beneficial. It’s now been acknowledged that women who start MHT within 10 years of menopause may experience long-term health benefits, not just symptom relief.  

Potential benefits of MHT include: 

• Lower risk of coronary artery calcification  
• Vascular flexibility, healthy lipid profiles, and endothelial function 
• Slower bone loss  
• Reduced risk of osteoporosis 
• Lower fracture risk  
• Improved insulin sensitivity 
• Reduced risk of type 2 diabetes 
• Helping to limit menopause related shifts in fat distribution (particularly visceral fat) 
• Better sleep quality 
• Improved mood and anxiety 
• Maintenance of sexual and urogenital health 
• Reduced chronic inflammation linked to estrogen loss  

“Research shows that there is a critical ‘window of opportunity’ where if MHT is started closer to menopause, it has a different benefit‑risk profile than therapy started later in life,” explains Dr. Zelovitzky. 

This more detailed understanding has reshaped how medical communities use hormone therapy today. The change has been reflected in the FDA’s decision to remove broad black box warnings from estrogen-containing menopause hormone therapies, and rewrite labels to include age- and timing-specific guidance. 

While many wonder how these changes impact Canadian health providers, FDA decisions in the United States do not immediately change Canadian drug labels or approvals because Health Canada regulates medications independently. However, FDA decisions like this matter because they are based on large expert panel reviews and decades of data.  

“Canadian guidelines and specialist practice often evolve in response to major FDA evidence reviews. Many Canadian menopause experts already practice in alignment with this updated science,” says Dr. Zelovitzky. 

According to Dr. Zelovitzky, the biggest takeaway from modern research is timing: starting hormone therapy closer to menopause, versus later in life, carries much lower risk. 

How is MHT used in treatment? 

At Medcan, MHT is never prescribed without a thorough and individualized assessment. Before treatment is considered, your physician conducts a detailed review of your health history, symptoms, and personal risk factors. They will also confirm that all recommended screenings are up to date, and your overall health is optimal. 

This comprehensive evaluation helps ensure that menopause is truly the cause of your symptoms and that other possible contributors have been ruled out. For example, persistent fatigue may be related to thyroid dysfunction rather than hormonal changes, while sleep disturbances could be caused by untreated sleep apnea.  

If MHT is appropriate, treatment often begins with a three‑month trial at the lowest effective dose – the smallest amount needed to provide meaningful symptom relief. 

It’s also important to recognize that no two women experience menopause the same way, and treatment is never one‑size‑fits‑all. Where a woman is in the menopause transition plays a critical role in shaping her care plan. 

For instance, a 47‑year‑old in early perimenopause with irregular cycles and sleep disruption may benefit from a more conservative, symptom targeted approach with flexible dosing. By contrast, a 55‑year‑old who is postmenopausal and experiencing persistent hot flashes and bone loss may require steadier systemic estrogen, with longer‑term goals such as bone protection in mind. 

Ongoing follow-up and reassessment are essential to safe and effective hormone therapy. That’s why Medcan’s Menopause & Perimenopause Program is a six‑month program, with the option to continue at annual intervals for sustained support. This is because it can take four to six weeks to feel the full benefits of treatment. This timeline allows for realistic expectations, careful monitoring, and thoughtful dose adjustments over time. It also allows for comprehensive integration with other therapies, such as nutrition support or osteotherapy, one of the hallmarks of our program. 

How long is MHT needed? 

Women should be assessed annually and may continue indefinitely if benefits continue to outweigh the risk. The dose may also be reduced after 5-10 years, depending on her current dose.  

One client’s story serves as a powerful glimpse into how hormone therapy, when used appropriately, can be truly transformative. Jen, an active triathlete and health enthusiast, was 51 when she sought treatment. “I felt like I was 75 years old,” she recalls. “I had no energy, I was bloated, and it really impacted my confidence.” 

Over time, her symptoms began affecting more than just her physical wellbeing. Jen became genuinely concerned about her ability to perform at work. “I honestly thought I might not be able to keep up," she said. “Mentally, I just wasn’t there.” 

Through Medcan’s Perimenopause and Menopause Program, Jen began MHT alongside comprehensive support from an osteopath and dietitian. Within months, the change was profound. “I feel like an even better version of myself,” she says. 

After six to eight months, Jen felt like herself again, and in many ways, even better. She lost the weight she had gained, her energy returned, and she was back to working out five days a week. The brain fog lifted, allowing her to focus clearly at work, and with her cognitive clarity restored, her confidence returned as well. Read the full story here.

The role of comprehensive perimenopause and menopause care 

Dr. Zelovitzky stresses that, “MHT should always be seen as only one part of effective menopause care.” 

Medcan’s approach is based on exactly that. Our Menopause and Perimenopause Program is an integrated, multidisciplinary experience with evidence-based support provided by our Medcan’s team of clinical experts. It is highly personalized to deliver tailored care to each woman. As part of the program, women receive: 

• Six months of physician‑led care: A structured, evidence‑based program medically supervised by a women’s health physician certified by The Menopause Society (TMS).  
• Personalized treatment plan: Care is tailored to your symptoms, health history, and goals, with hormone therapy recommended when appropriate alongside nonhormonal options.  
• Initial nurse consultation: The program begins with a 30‑minute nurse appointment and detailed health questionnaire to understand symptoms and overall health.  
• Comprehensive physician visit: Clients have a 60‑minute consultation with a women’s health physician specializing in hormone treatment to develop and initiate their care plan. 
• Diagnostic testing and assessments: The program includes hormone and blood testing, a wellness assessment, and consultations related to nutrition, skin health, and physical health, as needed.  
• Multidisciplinary team support: Clients may work with specialists in nutrition, physiotherapy, osteopathy, nursing, and dermatology for whole person care.  
• Mid‑program check‑in: A three‑month follow‑up with a women’s health physician assesses symptom progress and adjusts treatment if required. 
• Program completion review: At six months, clients meet with a nurse to review outcomes, results, and next steps. 
• 24/7 nurse access: Throughout the program, clients can contact an on‑call nurse at any time for questions or urgent concerns.  
• Option for continued support: After completing the program, clients can continue care with ongoing medical guidance, prescription renewals, referrals, and nurse access. 

Many women who go through the program describe feeling seen and supported after years of feeling dismissed. Validation that what they’re experiencing is common – and temporary – can be powerful.  

The path to MHT 

If you are wondering whether hormone therapy might be right for you, do a quick self-audit, ask yourself the following questions.  

Are you ... 

• Noticing moderate to severe hot flashes, night sweats or sleep disruption? 
• Experiencing significant vaginal or urinary symptoms affecting daily life? 
• Aware that you have low bone mass or high fracture risk? 
• Experiencing menopause before age 45 or had a hysterectomy? 
• Feeling your symptoms affecting work, relationships or quality of life? 

If several of these statements apply to you, hormone therapy may be worth discussing with your physician. A comprehensive review of your health, including up-to-date screening, can help determine whether you are a fit.  

At Medcan, we recommend completing our Annual Health Assessment as a first step for a comprehensive review of over 100 biomarkers that can identify various health issues, and risks and provide comprehensives insights for our menopause physicians.

Take Action 

Delivering a high-touch comprehensive level of service, our Menopause and Perimenopause Program is for women aged 45 to 60 dealing with issues related to menopause or perimenopause.  

This customized, 6-month long, evidence-based program is medically supervised by a physician who is TMS (The Menopause Society) certified to improve symptoms and overall wellness. It includes blood tests, a wellness assessment, nutrition and fitness analysis, and a review of diagnostic imaging results for breast health and bone density. Hormone treatments can be a part of this program and are closely monitored. A variety of other options, including non-hormonal treatment, are also available to help manage menopause and perimenopause symptoms. 

From pregnancy to menopause, Medcan also offers additional Women’s Health programs provide personalized support through life’s transitions. Led by experienced professionals, these programs combine advanced assessments with evidence-based care across hormone health, nutrition, genetics, and fitness. 

Note: This information is intended for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. 

This article was written by Medcan’s editorial team with review and contribution from Medcan Clinical Director of Women's Health and Menopause Specialist Physician, Dr. Jennifer Zelovitzky.