HRT, Without the Fear: A Quick Guide to Your Options

If hormone therapy is on your “I should look into that” list but the word still makes you nervous, you’re in good company. Here’s the short, reassuring version.

By Kristy Vardanega · Reviewed by Dr Kelly Needham, Women’s Health Doctor · Updated 14 July 2026

What it actually is

During your reproductive years, your ovaries make oestrogen and progesterone — hormones that do far more than manage periods. They support your bones, regulate temperature, keep vaginal and bladder tissue healthy, and influence mood, sleep and concentration. As your ovaries wind down in perimenopause, the drop in these hormones drives the symptoms so many women know: hot flushes, broken sleep, brain fog, mood changes and dryness.

Menopause hormone therapy (MHT, the term that’s replaced “HRT”) simply tops those hormones back up.

It isn’t adding something foreign — it’s replacing something you’ve had your whole adult life.

Isn’t it more natural to just let them decline?

It is natural — but natural doesn’t always mean “best left alone.” We comfortably treat plenty of natural changes, like short-sightedness or rising blood pressure, to protect quality of life. The drop in oestrogen also speeds up bone loss in the years right after menopause, so for many women this is about protecting the years ahead, not just easing today’s symptoms.

Your main options

1. Oestrogen — as a skin patch, gel or spray, or tablet. Through-the-skin options avoid the small clot risk linked to tablets, so they’re often the starting point.
2. Progesterone — added if you still have your uterus (as a capsule or a hormonal IUD) to keep the uterine lining healthy.
3. Vaginal oestrogen — a pessary, cream or ring for dryness and bladder symptoms, acting locally with very little absorbed systemically.
4. Testosterone — the often-forgotten female hormone. It can help with libido, mood, brain fog, memory, energy and maintaining muscle mass.

A note on “bioidentical” compounded creams: these custom-mixed products aren’t regulated for dose or safety and aren’t recommended. The good news is genuine body-identical hormones are available as approved, regulated products.

“But didn’t it cause cancer?”

That fear traces back to one 2002 study — on women whose average age was 63, many starting hormones over a decade after menopause. It was misread, and the headlines outlived the facts. When researchers looked again, a clearer picture emerged: for most women who start under 60, or within 10 years of their final period, and who don’t have specific reasons to avoid it, the benefits generally outweigh the risks. That’s now the consensus of menopause experts, in Australia and internationally.

There are real risks to weigh, and it isn’t right for everyone — but it’s a genuine, reasonable choice, not something to be afraid of. For most women those risks are small, and the bigger risk can be the long-term toll on your health of going without hormones. It’s worth weighing up both sides — the risks of treating, and the risks of not.

Where to start

You don’t need all the answers before you book a GP visit. You just need enough to ask good questions — and to know that wanting relief, and wanting to protect your future health, is a completely reasonable place to start.

General information only, not a substitute for personalised medical advice. Please talk to your GP or a menopause-experienced doctor about what’s right for you.