Menopausal Hormone Therapy (MHT): Understanding the Risks, Benefits, and Science 

At Oura, we believe aging isn’t something to fear. Most of all, we’re committed to providing information and data that empowers people with knowledge about their bodies—which is why we want to change the conversation around menopausal hormone therapy (MHT).  

It’s time to replace the silence, stigma, and misunderstanding around this natural life stage with more informed choices. As Dr. Neta Gotlieb, PhD, Staff Product Manager, Women’s Health at Oura, says:

“We understand that every woman’s body and experience with menopause is unique. Our commitment is to empower women with tools to truly grasp their own unique patterns and responses, helping them discover the personalized approaches that are right for them. Our goal is to transform moments of confusion into opportunities for informed action and greater peace during the perimenopause transition.”

Below, learn about common MHT myths as well as what the latest research shows, so you can feel more empowered in making decisions for your health.  

READ MORE: How Oura Can Help You Manage Perimenopause

What Is Menopausal Hormone Therapy?

For the vast majority of women (around 85%), menopause symptoms like hot flashes, night sweats, sleep disturbances, vaginal dryness, mood changes, and cognitive shifts aren’t just a minor inconvenience—they can profoundly disrupt daily life, relationships, and overall well-being. 

Menopausal hormone therapy (MHT), formerly referred to as hormone replacement therapy (HRT), addresses these by supplementing estrogen and progesterone—the hormones that your body may no longer produce in sufficient amounts. This can help to alleviate menopause symptoms, restore hormonal balance, and significantly improve quality of life. 

8 Common Myths Surrounding Menopausal Hormone Therapy

“Navigating menopause often feels like stepping into a labyrinth of conflicting information, where scientific facts are frequently overshadowed by widespread myths, misconceptions, and even outright misinformation,” says Dr. Gotlieb.

Below, we debunk common MHT myths, empowering you with evidence-based information to help you make an informed decision alongside your doctor. Always consult your healthcare provider before starting any new medical treatment. 

Misunderstanding #1: MHT Causes Breast Cancer

Many women avoid menopausal hormone therapy (MHT) primarily due to concerns about breast cancer. This apprehension stems from the 2002 Women’s Health Initiative (WHI) study, which indicated a 26% heightened risk of breast cancer in women using a combination of estrogen and progestin. This finding triggered widespread alarm, leading millions of women to discontinue their therapy suddenly.

But that relative risk isn’t the full story. It’s crucial to understand the absolute risk implications. 

• A woman’s baseline risk of developing breast cancer between the ages of 50–60 is about 2.4%. Increasing that risk by 26% would raise it to approximately 3.02%—an increase of just 0.62 percentage points.
• In other words, for every 10,000 women taking combined MHT, about 8 additional cases of breast cancer may occur.
• Importantly, estrogen-only therapy (typically prescribed to women who’ve had a hysterectomy) was not linked to increased breast cancer risk in the WHI study. In fact, later follow-ups showed a reduced risk in this group.

While there is a small increase in risk with certain forms of MHT, it’s comparable to the risks associated with many common medications, including insulin therapy, oral contraceptives, and antidepressants. 

At the same time, research suggests that MHT may reduce the risk of other conditions. Ultimately, one’s decision to use MHT should weigh the potential benefits against individual risk factors.

Misunderstanding #2: You Should Start MHT Only If Your Symptoms Are Severe

Many women downplay their menopause symptoms or report feeling dismissed by doctors when (or if) they discuss them. As a result, some believe—or are told—that they should wait until their symptoms become more severe before considering hormone therapy.

However, a growing body of research indicates that initiating MHT earlier, ideally closer to the onset of menopause (generally before age 60 or within 10 years of your last menstrual period), may offer greater benefits and lower risks. This “window of opportunity” approach can be particularly impactful for mitigating severe symptoms and supporting long-term bone health. 

Misunderstanding #3: MHT Increases the Risk of Heart Attack and Stroke

Contrary to increasing the risk, some studies suggest that starting MHT near the onset of menopause (typically before age 60 or within 10 years of the last menstrual period) may reduce the risk of cardiovascular disease and even lower all-cause mortality. 

This misconception comes from early interpretations of the 2002 WHI study, which reported a higher risk of cardiovascular events in women taking hormone therapy. 

However, the average age of participants in that original WHI study was 63—significantly older than the typical onset of menopause, and a critical factor often overlooked.

In long-term observational studies, women who used MHT early after menopause experienced approximately a 40% reduction in the risk of myocardial infarction and all-cause mortality. Analyses of certain randomized trials outside the WHI also suggest an approximately 30% cardioprotective effect in recently menopausal women.

This may be due to estrogen’s effects on vascular health, including improved vasodilation, lower blood pressure, and protection against atherosclerosis. However, estrogen can also increase the risk of acute cardiac events if atherosclerotic plaques are already present—which may explain why older participants in earlier studies didn’t experience the same benefits.

Finally, it’s important to note that oral (tablet) forms of MHT can slightly increase the risk of stroke and blood clots. However, this risk is generally very low and can often be minimized by opting for transdermal options like patches, gels, or sprays, which bypass the liver. 

Misunderstanding #4: Most Doctors Know How to Treat Menopause

Menopause research is globally underfunded, limiting the medical and scientific understanding of this phase. Plus, most medical professionals receive little to no training on menopause. In fact, results from a 2017 survey found that 20% of U.S. medical residents had zero lectures on menopause, and a third said they would not prescribe hormone therapy to a symptomatic patient, even when no risks were present.

This lack of education has lasting consequences. Many women are told their symptoms are “normal” or not serious enough to treat. Others are offered unproven supplements or dismissed altogether. This systemic lack of education and subsequent dismissive approach can take a serious toll on women’s mental and physical well-being.

While MHT may not be right for everyone, every woman deserves a well-informed conversation and access to evidence-based care.

Misunderstanding #5: MHT Should Only Be Used for the Shortest Time Possible

The “lowest dose for the shortest duration” mantra came directly from WHI-era caution. It stemmed from early concerns about long-term safety, combined with the outdated assumption that menopausal symptoms are a benign nuisance that resolves within a few years. However, this approach was more speculative than evidence-based.

Emerging research suggests that for some women, longer-term use of MHT may offer continued benefits without significantly increasing risk. Large-scale studies in Finland found that continued MHT use was associated with a lower risk of cardiovascular death compared to stopping therapy. In fact, women who discontinued MHT—even after more than 5 years—had an increased risk of death from heart-related causes. This is due to the heart-protective benefits of estrogen.

The International Menopause Society now advises that there should be no arbitrary time limit for MHT use. Instead, treatment should be personalized based on an individual’s symptoms, health status, and preferences, with regular reevaluation over time.

Misunderstanding #6: MHT is Right for Everyone

“At Oura, we see how the profound hormonal shifts during perimenopause can impact individual sleep patterns, daily readiness, and overall well-being,” explains Dr. Gotlieb. That said, “We understand that every woman’s body and experience with menopause is unique—so the treatments should be too.”

Menopause hormone therapy can be transformative for many, but it’s not a universal solution. 

MHT may not be appropriate for women with a history of certain conditions, such as hormone-receptor-positive breast cancer, endometrial cancer, ovarian cancer, unexplained vaginal bleeding, or severe liver disease. In these cases, MHT may require specialized medical guidance. Finally, some women may simply prefer non-hormonal approaches or may not experience noticeable symptoms that require medical intervention.

READ MORE: How Does Menopause Affect Sleep?

Misunderstanding #7: It’s Safer to Be Hormone-Free

Some women are cautious about using artificial hormones, believing they are harmful. But this view overlooks the fact that menopause itself increases the risk of long-term health issues like heart disease, osteoporosis, cognitive decline, and type 2 diabetes. When started near the onset of menopause, some evidence suggests that MHT may actually help reduce the risk of these conditions.

Choosing to remain hormone-free isn’t inherently safer, because going without estrogen after menopause means losing a key protective factor for your heart, bones, brain, and metabolism. For many women, the risks of untreated estrogen deficiency can outweigh the risks of appropriately prescribed MHT.

Ultimately, the decision should weigh the individual’s symptoms, personal and family medical history, and preferences, ideally in consultation with a healthcare provider.

Misunderstanding #8: All Hormone Therapy Carries the Same Risk

Many people still believe that MHT only comes in pill form, or that all versions carry the same level of risk—neither of these assumptions holds true today.

The WHI only studied one formulation: Prempro, a synthetic combination of conjugated equine estrogens and medroxyprogesterone acetate. Since then, newer options have emerged with potentially better safety profiles, particularly for cardiovascular and thrombotic risk.

For example, transdermal estradiol (delivered through a patch, gel, or spray) bypasses the liver and doesn’t increase clotting factors the way oral estrogen can. This makes transdermal options a potentially safer choice for many women, particularly those with a higher risk of blood clots or stroke. 

Similarly, micronized progesterone—a bioidentical form of progesterone—appears to have a more favorable impact on breast tissue and cardiovascular markers compared to older synthetic progestins like MPA.

Today, MHT is available in a wide range of formulations, including transdermal options, oral tablets, localized creams, and injections. It’s always best to discuss your options with your medical provider to find out what is best for you.

Misunderstanding #9: MHT Is a Fountain of Youth

Hormone therapy isn’t meant to reverse aging—it’s meant to support you through it. While MHT can ease symptoms, it’s not a cure-all or a way to turn back the clock. Menopause is a natural transition, and the sole goal of MHT is to make that transition smoother.

Using Oura during the perimenopause transition can help you feel supported and empowered. Whether it’s tagging your sleep habits to see what leads to more deep sleep, or tracking your cycle to monitor the effects of MHT—Oura is here to guide you through each stage with insight and care.