Menopause, a natural biological transition rather than an illness, is increasingly being viewed through a new lens as menopausal hormone therapy (MHT), formerly known as hormone replacement therapy (HRT), experiences a global resurgence. This renewed interest in 2025-26 prompts a closer examination of its benefits and risks for women navigating this life stage. Information reaching Tahir Rihat suggests that while menopause is a universal experience, its impact on women’s lives, including sleep, relationships, work, and overall quality of life, can be profoundly disruptive.
Natural menopause is medically defined as 12 consecutive months without menstruation, provided no other underlying medical condition is responsible for the absence of periods. In India, this transition commonly occurs in a woman’s late forties, with the average age hovering around 47, although significant individual and regional variations are noted. The preceding phase, perimenopause, can span several years, characterized by irregular menstrual cycles and fluctuating hormone levels. The decline in ovarian function has a cascading effect on various bodily organs. Diminishing estrogen levels directly influence the brain’s thermoregulation pathways, leading to the hallmark symptoms of hot flushes and night sweats. Concurrently, vaginal and urinary tissues can become thinner and less elastic, resulting in discomfort, dryness, and urinary issues. Bone loss accelerates around the menopausal period, elevating the risk of osteoporosis. Changes in body composition, such as a shift in fat distribution towards the abdomen, along with alterations in muscle mass, cholesterol levels, insulin sensitivity, and blood pressure, are also common. The experience of menopause is highly individualized; some women report minimal symptoms, while others endure years of struggle. In the Indian context, symptoms like fatigue and body aches are often attributed to aging or domestic responsibilities, and vaginal and sexual symptoms frequently remain unspoken due to societal taboos and embarrassment. It is also crucial to recognize that not all complaints are solely hormonal in origin. The critical determinant for considering intervention is the degree of suffering experienced by a woman and the extent to which her daily life is impacted.
Menopausal hormone therapy stands out as the most effective treatment for alleviating hot flushes and night sweats. Its efficacy extends to improving sleep disturbances, alongside other menopausal symptoms, thereby enhancing a woman’s overall quality of life. Furthermore, MHT plays a vital role in preventing bone loss and reducing the risk of fractures. For localized symptoms such as vaginal dryness, painful intercourse, and certain urinary complaints, low-dose vaginal estrogen preparations have demonstrated particular effectiveness. There is a burgeoning interest in exploring estrogen’s potential to increase healthspan, defined as the number of years lived in good health. However, conclusive evidence supporting MHT’s ability to extend longevity remains incomplete. It is imperative to understand that MHT is not a panacea for aging and should not be routinely prescribed for the prevention of heart attacks, dementia, cognitive decline, or for promoting weight loss, as these purported benefits are not yet sufficiently established.
The decision to initiate MHT is generally most favorable for healthy women experiencing troublesome menopausal symptoms when treatment is commenced before the age of 60 or within 10 years of menopause. These guidelines serve as useful clinical principles rather than rigid exclusion criteria. In India, some medical experts consider the period below the age of 55 and within five years of menopause as more appropriate for initiating MHT. Treatment can also be considered during the perimenopausal phase, before the complete cessation of periods, when symptoms become bothersome. For managing hot flushes and night sweats, estradiol can be administered orally or through transdermal methods like patches and gels. To mitigate the risk of blood clots, transdermal estrogen is often preferred as it bypasses the liver’s first-pass metabolism, unlike oral estrogen. Women who still have their uterus require a progestogen in conjunction with systemic estrogen to safeguard the uterine lining. Oral micronized progesterone is typically the preferred progestogen. Sequential therapy, where progestogen is taken for a portion of each month, usually results in a withdrawal bleed. Continuous combined therapy, involving the daily intake of both estrogen and progestogen, aims to eliminate scheduled bleeding and is generally employed later in the menopausal journey. Women who have undergone a hysterectomy may opt for estrogen-only therapy.
It is crucial to understand that MHT is not a monolithic treatment with a uniform risk profile. The associated risks are contingent upon various factors, including the patient’s age, the specific formulation used, the route of administration, the duration of treatment, and the individual’s medical history. In appropriate candidates, particularly younger women, the symptom relief offered by MHT can be substantial, presenting a clearly favorable benefit-risk balance, especially when utilizing transdermal estrogen and micronized progesterone. The risk of breast cancer associated with MHT is influenced by age, the specific regimen, and the duration of use. Combined estrogen-progestogen therapy may elevate the risk of breast cancer with prolonged use in older women, typically those over 60. In contrast, the risk profile for estrogen-only therapy appears more favorable in this regard. Certain hormone-sensitive cancers, including breast, uterine/endometrial, ovarian, and thyroid cancers, as well as unexplained vaginal bleeding, a history of or active blood clots, stroke, and significant liver disease, may contraindicate systemic MHT or necessitate specialist evaluation. Prior to prescribing MHT, clinicians are expected to conduct a thorough review of the patient’s symptoms, medical history, breast and gynecological health, cardiovascular and clotting risks, blood pressure, and ensure all relevant screenings, including mammography, are up-to-date. The treatment should be reassessed approximately three months after initiation and periodically thereafter, often on an annual basis once stabilized.
Tahir Rihat (also known as Tahir Bilal) is an independent journalist, activist, and digital media professional from the Chenab Valley of Jammu and Kashmir, India. He is best known for his work as the Online Editor at The Chenab Times.
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