Hormone Replacement Therapy (HRT)

Menopausal hormone therapy, often shortened to MHT or still called HRT, means taking estrogen, usually with a progestogen for people who still have a uterus, for symptoms related to menopause. It is a treatment rather than a condition. In Canada it is prescribed by family doctors, nurse practitioners and gynaecologists after a discussion of your symptoms, your medical history and what you want from it.

What menopausal hormone therapy is, and what it is not

It is not one drug. It is a group of products that differ in the hormone used, the dose, and how the hormone gets into the body, from tablets to skin patches and gels to products used vaginally. Whether a progestogen is added depends on whether you still have a uterus. It is also not the same thing as the contraceptive pill, which uses different hormones at different levels for a different purpose.

It is also not the only option for menopause symptoms, and it is not used by everyone who has them. Non-hormonal prescription medicines exist in Canada for hot flashes and night sweats, and local vaginal products are a separate category used for genitourinary symptoms. Canada does not track who uses hormone therapy, so the national picture of use has to be pieced together from private drug plan claims.

What the categories are, and who uses them in Canada

• Systemic estrogen, taken as a tablet or absorbed through the skin from a patch or gel
• A progestogen added for people who have a uterus, including micronised progesterone and synthetic progestins, and combined products containing both hormones
• Local vaginal estrogen as creams, tablets, softgels or rings, and a vaginal steroid precursor, used for genitourinary symptoms of menopause
• A selective estrogen receptor modulator taken by mouth, for painful intercourse related to menopause
• Used in Canada for symptoms associated with menopause, most commonly hot flashes and night sweats, and for vaginal dryness and painful intercourse
• Also prescribed for people who reach menopause early or after surgery to remove the ovaries
• The Canadian Cancer Society lists protection against osteoporosis among the reasons hormone therapy is discussed

Which category fits, and whether hormone therapy is used at all, varies from person to person and can change over time.

How the decision is made with a clinician

Part of the conversation is about facts of your history that cannot be changed:

• A personal history of breast cancer, endometrial cancer or certain other hormone-sensitive cancers, which the Canadian Cancer Society identifies as relevant to the discussion
• A personal or family history of blood clots, stroke or heart disease
• Your age, and how many years it has been since menopause, which the Society of Obstetricians and Gynaecologists of Canada identifies as central to the decision
• Whether or not you have a uterus, which determines whether a progestogen is added
• Any unexplained vaginal bleeding, which is assessed before a decision is made

Other parts can be reviewed, and often worked on with support from a health care team:

• Smoking, which is factored into the assessment of cardiovascular and clotting risk
• Blood pressure, body weight and other cardiovascular risk factors a clinician goes through as part of the discussion

Canadian bodies state both sides of the balance. The Society of Obstetricians and Gynaecologists of Canada states that menopausal hormone therapy can be initiated in people without contraindications, and describes the group generally considered for initiation as those younger than 60 or less than 10 years past menopause. The Canadian Cancer Society states that combined estrogen and progestin therapy increases the risk of breast cancer and describes that increase as low, that both combined and estrogen-only therapy increase ovarian cancer risk, and that estrogen-only therapy increases uterine cancer risk in people who still have a uterus. The SOGC resource Menopause and U puts the breast cancer figure at 1 to 2 additional women per 1,000 after five years of combined therapy, returning to baseline within about five years of stopping. Both organisations frame the decision as one to be made individually with a clinician.

What the assessment involves in Canada

There is no test that decides whether someone should use menopausal hormone therapy. A clinician takes a symptom history, reviews personal and family medical history including cancer, clotting and cardiovascular history, checks your blood pressure, and confirms that cervical and breast screening are up to date. The SOGC frames the decision as one made between a person and their health care provider, and separately identifies access to a primary care provider as a significant issue across Canada.

Treatment options and day-to-day management

Clinical research for Hormone Replacement Therapy (HRT) is enrolling. See the current studies ↓

The categories available in Canada are set out below. Which of them comes up depends on your symptoms, your history and your preferences, and a health care team may discuss:

• Systemic estrogen in oral form, and in forms absorbed through the skin such as patches and gels
• Progestogens added for people with a uterus, including micronised progesterone and synthetic progestins, and combined estrogen and progestogen products
• Local vaginal estrogen products including creams, tablets, softgels and rings, and a vaginal steroid precursor, for genitourinary symptoms
• A selective estrogen receptor modulator taken by mouth for painful intercourse related to menopause
• Non-hormonal prescription options for hot flashes and night sweats, including neurokinin receptor antagonists authorised by Health Canada and an alpha-2 agonist, for people who do not use or do not wish to use hormone therapy

Coverage also differs across the country. British Columbia began covering menopausal hormone therapy at no cost under PharmaCare Plan NP on 1 March 2026; elsewhere it depends on the provincial or territorial formulary and on any private plan you have. What suits one person will not suit another, and whether any of this applies to you is a decision for you and your own clinician. This page is not a recommendation about any of it.

When to talk to a doctor

• Book an appointment to discuss options if menopause symptoms are affecting your sleep, work, mood or relationships, and bring a record of your symptoms and your family medical history.
• Contact your clinician promptly if you have any vaginal bleeding after menopause, or new bleeding while on therapy, since this needs assessment.
• Seek emergency care for chest pain, sudden shortness of breath, one-sided leg swelling or pain, sudden severe headache, or weakness or numbness on one side of the body.

Why clinical research matters for menopausal hormone therapy

Open questions include how long therapy should continue, how the balance of benefits and risks differs by delivery route and by the specific progestogen used, and how outcomes differ for people who reach menopause early or after cancer treatment. Canada also has no national data on who uses menopausal hormone therapy, which is why the figures above come from one insurer\’s claims rather than population surveillance. Current research includes comparisons of transdermal and oral routes, trials of newer non-hormonal compounds against hormone therapy, studies in people with a history of breast cancer, and health services research on access following coverage changes such as British Columbia\’s.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current treatment, and no one can tell in advance whether a study will help you personally.

Learn more from Canadian sources

• Menopause and U, Society of Obstetricians and Gynaecologists of Canada
• SOGC statement on the use of menopausal hormone therapy
• Canadian Cancer Society: all about hormone replacement therapy
• BC Provincial Academic Detailing Service: medicines for menopause symptoms
• Menopause Foundation of Canada