MHT or HRT? Why the name changed. Does it matter?

HRT is what we used to call it.

Hormone replacement therapy was the name for fifty years. It is what your mother probably called it. It is what most current Australian GPs were taught. It is what you almost certainly grew up hearing, if menopause was mentioned at all in your house.

In Australia, the term has now shifted to MHT, menopausal hormone therapy.

However, internationally the picture is currently mixed. The United Kingdom has largely stayed with HRT. Australian and international menopause societies have moved to MHT.

Same hormones. Same treatment. Different name.

If you ask your GP about HRT, they will know exactly what you mean. The technical term in current Australian practice is MHT. What actually matters is what is being prescribed, not which set of three letters you use to ask for it.

It is a bit like the oestrogen-versus-estrogen mismatch you see between Australian and American writing. The spelling is different, but everyone is talking about the same hormone.

Still, the reason behind the change in name is worth understanding, because it tells you something important about how the conversation around menopause is shifting. It reflects a real shift in how menopause is understood. This shift is important because it can change how women are treated and how they understand their own bodies.

What HRT meant, and where it came from

HRT stands for hormone replacement therapy. The word replacement matters here, because it tells you what doctors originally thought they were doing.

The first oestrogen treatment for menopause was approved by the United States Food and Drug Administration in 1942 [1]. It was a product called Premarin, derived from pregnant horses urine.

By the mid-1960s, hormone therapy was being marketed not so much to women as to their husbands. The era was defined by Robert Wilson's 1966 book Feminine Forever, which framed menopause as a deficiency disease and positioned oestrogen as the cure that would keep wives sexually attractive, agreeable and "feminine." Wilson promised oestrogen would preserve "the strength of her bones, the glow of her skin, the gloss of her hair" [2]. What was not disclosed at the time, and only became public years later, was that Wilson was being secretly paid by Wyeth, the manufacturer of Premarin, to write the book [3]. It was not independent medical advice. It was paid promotion of a product, framed for a male readership of husbands tolerating their troublesome or unhappy wives, and of doctors who would prescribe a treatment that made the household easier.

That marketing has consequences that menopause medicine is still untangling sixty years later, and it is one of the reasons the language is now shifting.

There were two specific issues with that framing.

The first issue is the word replacement. It implies that menopause is a state of deficiency, that something has been taken away that needs to be put back. But menopause is not a disease. It is a stage of life that every woman who lives long enough will go through. The word replacement made a normal life stage sound like a medical condition. That is not a small distinction. It changes how women feel about their own bodies, and it changes how clinicians treat them.

The second issue is the implicit promise that hormone therapy returns women to who they were before. It does not. Modern hormone therapy supports women through the transition by easing symptoms and reducing some long-term health risks, but the doses used are well below pre-menopausal levels, and the treatment does not aim to recreate the hormonal state of a thirty-year-old. The women I work with sometimes find this clarification a relief. The point of MHT is not to turn back the clock. It is to make this stage of life liveable.

Why did the name change to MHT?

The shift from HRT to MHT was led by the International Menopause Society, with the Australasian Menopause Society leading the change in Australia [4,5].

The change matters because language shapes how we think.

Calling something therapy rather than replacement moves the conversation away from fixing what is broken and toward supporting a transition. It steps back from the deficiency-disease framing that was used for decades to sell hormones as anti-ageing products to husbands.

Why is HRT still everywhere, especially in the UK?

In Australia, MHT is now the standard term used by AMS, Jean Hailes, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and most published clinical guidance [6,7]. But you will still hear HRT everywhere. Two reasons.

The first is simple inertia. HRT has been the dominant term for fifty years. Women, GPs, journalists, and even pharmaceutical companies have used it for so long that switching takes time.

The second is the United Kingdom. UK menopause specialists, including high-profile voices like Dr Louise Newson, have continued to use HRT because it is what UK women search for, talk about, and recognise. The UK National Institute for Health and Care Excellence guidelines still use HRT in their published documents [8]. So when Australian women consume UK podcasts, books and Instagram accounts, they hear HRT.

HRT vs MHT. What is the difference?

HRT (hormone replacement therapy) and MHT (menopausal hormone therapy) refer to the same treatment. There is no difference in the hormones used. Oestrogen, with progesterone where needed, sometimes with testosterone.

The term MHT is preferred in Australia today because it more accurately reflects how hormone therapy is actually used. Not to "replace" something that is missing, but to support women through a normal life transition.

That is the whole change. Same hormones, same treatment, different framing.

The substance of what is actually being prescribed comes down to three hormones, each with a different role.

Oestrogen is the foundation of MHT.

Oestrogen is given to ease the symptoms most women associate with menopause, including hot flushes, night sweats, broken sleep, joint pain and mood changes, and to support longer-term bone, brain and cardiovascular health. For most women in Australia, body-identical oestradiol is now the preferred form. It is the same molecule the ovary produces during the reproductive years.

Progesterone is added when needed.

Progesterone is added when a woman still has a uterus, to protect the lining of the uterus from the effect of oestrogen. The body-identical option in Australia is micronised progesterone (sold as Prometrium).

There is also a growing conversation in some specialist menopause practice about whether progesterone has roles beyond protecting the uterus, particularly around sleep and mood. The standard Australian position has not yet shifted, but the question is being raised and the evidence base is developing. There is more on this in a later blog in the series.

Testosterone is sometimes part of the picture.

Testosterone has roles in libido, energy, mood and muscle in women, not only in men. Australia is unusual internationally in having a TGA-approved testosterone product specifically licensed for women, AndroFeme cream. In the United Kingdom and the United States, women who are prescribed testosterone are generally prescribed it off-label, often in male-formulated products at much smaller doses.

There is also a growing conversation in specialist menopause practice about the wider roles of testosterone in midlife women. As with progesterone, knowledge is developing and clinical opinion is shifting. There is more on this in a later blog in the series.

I encountered this terminology mismatch directly during my own training. My Postgraduate Certificate in Menopause Medicine was a UK-based course, and almost everything I read and discussed used HRT. Back here in Australia, the term had shifted to MHT. Two terms. Same conversation.

This is not wrong. It is just different terminology for the same thing.

There is no clinical difference between HRT and MHT. The hormones are the same. The treatment is the same. The risks are the same. The benefits are the same. The only thing that has changed is the language we use to describe it.

When women work with me, the terminology comes up almost every time, usually in the first ten minutes. I always say the same thing.

Your GP will know what you mean whether you call it HRT or MHT.

What matters more is what is being prescribed. The form of oestrogen. Whether progesterone is added. How it is taken. Whether testosterone is part of the picture for you.

That is the conversation worth having.

In simple terms

- HRT and MHT mean the same thing. Same hormones, same treatment.

- In Australia today, MHT for most women means body-identical oestradiol through the skin (a patch, gel or spray), with micronised progesterone added orally if a uterus is present.

- Australia is unusual in having a TGA-approved testosterone product, AndroFeme, specifically licensed for women.

- The name changed to move away from the "deficiency disease" framing of the past. Menopause is not a disease. It is a normal life stage.

- If your GP says HRT and you say MHT, you are still talking about the same prescription.

Want the complete picture?

There are three free resources to take this further.

[PLACEHOLDER] Audio guide on MHT. A 10-minute audio overview of MHT in plain language. menopausehub.com.au/mht-audio (URL to be confirmed).

[PLACEHOLDER] MHT Key Fact Sheet. A one-page reference you can keep or take to your GP. menopausehub.com.au/links (when published).

[PLACEHOLDER] MHT Complete Guide. The full plain-language guide. menopausehub.com.au/links (when published).

Next in the series

The next blog goes into the WHI study, the 2002 American research that ended a generation of MHT prescriptions and is still shaping how women and GPs talk about hormone therapy today. If your mother stopped MHT in 2002, or you have been refused it because of WHI, the next post is for you.

[Link to Blog 2: The Study That Scared a Generation. What WHI Got Wrong. To be added when blog 2 is published.]

This information is educational only and does not constitute personal medical advice. Always consult a qualified health professional about your individual circumstances.

© 2026 Menopause Hub | Anna Pattison | Former Registered Nurse, Clinical Myotherapist, Menopause Mentor | menopausehub.com.au

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CITATIONS

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[1] U.S. Food and Drug Administration. Premarin (conjugated estrogens) approval history (1942). fda.gov

[2] Wilson, R.A. (1966). Feminine Forever. M. Evans and Company. Direct quote from the original text.

[3] Encyclopaedia entry citing primary medical history sources on the Wyeth-Wilson paid relationship. The manufacturer of Premarin (Wyeth) secretly paid gynaecologist Robert A. Wilson to promote oestrogen use by menopausal women in his 1966 book Feminine Forever. The financial relationship was not publicly disclosed at the time.

[4] International Menopause Society. (2016). Global Consensus Recommendations on Menopausal Hormone Therapy. IMS Position Statement.

[5] Australasian Menopause Society. Information Sheets. MHT/HRT and Health Risks. menopause.org.au

[6] Jean Hailes for Women's Health. Menopausal Hormone Therapy (MHT). jeanhailes.org.au

[7] Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Guidelines on Hormone Therapy. ranzcog.edu.au

[8] National Institute for Health and Care Excellence (NICE). (2024). Menopause: Identification and Management. NICE Guideline NG23.

[9] Davis, S.R., Magraith, K. (2023). Practitioner's Toolkit for the Management of the Menopause. Medical Journal of Australia.