Menopause treatment, Johannesburg
Hormone replacement therapy for menopause.
A doctor-led assessment of whether menopausal hormone therapy is appropriate for you, which route and combination makes sense, and how treatment should be reviewed over time.
In short
Menopausal hormone therapy, often called HRT, is an effective treatment for vasomotor symptoms such as hot flushes and night sweats and can also be used as part of broader menopause care. Treatment is individualised according to symptoms, age, time since menopause, medical history, whether the uterus is present, clotting and breast-cancer risk, and patient preference. HRT should not be prescribed as a universal anti-ageing treatment or solely to prevent chronic disease.
Medically reviewed by Dr Arnav Kapur, MBBCh Cum Laude
The approach
Understand first. Then treat.
Many people approach HRT after hearing either that it is dangerous or that everyone should be taking it. Neither is a useful starting point. The balance of benefit and risk depends on the individual, the symptom being treated and the formulation used.
At MLI, the discussion starts with what you are trying to improve, whether HRT is appropriate, which route and combination makes sense, and what monitoring or follow-up is actually required.
What an HRT assessment considers
- Menopause and perimenopause symptoms
- Cycle and bleeding history
- Age and time since the final menstrual period
- Whether the uterus is present
- Personal breast-cancer history and relevant family history
- Venous thromboembolism and cardiovascular risk
- Migraine and other conditions affected by hormone route
- Bone health and fracture risk
- Genitourinary symptoms
- Current medicines and previous hormone therapy
HRT is mainly used to treat symptoms
Current NICE guidance recommends HRT for vasomotor symptoms associated with menopause. The decision is based on symptom burden and individual benefit-risk assessment. HRT is not prescribed simply because someone has reached a certain age, and it should not be marketed as a guaranteed anti-ageing intervention.
The route and components matter
People with a uterus generally need progestogen alongside systemic oestrogen to protect the endometrium, while oestrogen-only treatment is used after total hysterectomy. Oral and transdermal routes have different risk considerations; transdermal treatment is often considered when venous-thromboembolism risk is higher. Treatment should use the lowest effective dose appropriate to the person.
Vaginal symptoms are treated differently
Genitourinary symptoms such as dryness, discomfort and urinary symptoms may respond to local vaginal oestrogen, which has minimal systemic absorption compared with systemic HRT. It can be used alone or alongside systemic treatment where appropriate, with individual discussion in people with a breast-cancer history.
HRT needs review, not autopilot
Symptoms, bleeding, side effects, medical history and treatment goals change over time. Treatment should be reviewed after starting and periodically thereafter. Unscheduled bleeding outside the expected early treatment or dose-change window needs appropriate assessment.
Common questions
Answers before you book.
Is HRT safe?
For many symptomatic people without contraindications, HRT is a reasonable treatment after an individual benefit-risk discussion. Risk varies with age, time since menopause, route, formulation and medical history, so there is no single answer that applies to everyone.
Do I need blood tests before starting HRT?
Not always. Menopause is often diagnosed clinically in people over 45 with typical symptoms and cycle change. Blood tests are selected when another diagnosis needs to be excluded or when they are relevant to broader metabolic, thyroid or bone-health assessment.
Is transdermal HRT safer than oral HRT?
The route matters, particularly for venous-thromboembolism risk. NICE advises considering transdermal rather than oral HRT when VTE risk is increased. The best route still depends on the individual clinical picture.
How long can I stay on HRT?
There is no single fixed duration for everyone. Benefits and risks should be reviewed periodically, and treatment can continue while it remains appropriate for the person's symptoms, preferences and risk profile.
This page provides general health information and does not replace an individual menopause assessment. Hormone therapy is prescription treatment and should be selected after reviewing benefits, risks and contraindications.
Clinical references
Ready to start properly?
- Menopause & Perimenopause Care
- Women's Hormone Consultation
- Hot Flushes & Night Sweats
- Brain Fog
- Longevity & Preventative Medicine
Centre of Advanced Medicine · 13 Scott Street, Waverley, Johannesburg
Monday to Friday, 07:40 to 17:00
011 440 8721