HRT vs MHT: Terminology Clarification
HRT (Hormone Replacement Therapy) and MHT (Menopausal Hormone Therapy) are the same treatment—the terminology simply evolved to reflect a shift in clinical philosophy and indication. 1, 2
The Terminology Evolution
"Hormone Replacement Therapy" (HRT) was the original term used when these medications were prescribed primarily to "replace" hormones and prevent chronic diseases like osteoporosis and cardiovascular disease in postmenopausal women 1, 3
"Menopausal Hormone Therapy" (MHT) became the preferred term after major trials (particularly the Women's Health Initiative) demonstrated that hormone therapy should NOT be used for chronic disease prevention, but rather specifically for managing menopausal symptoms 1, 4
The name change from HRT to MHT reflects a fundamental shift: from viewing hormones as something to routinely "replace" for prevention, to using them as targeted symptom management therapy 1, 2
Why the Name Changed
The USPSTF explicitly clarified that hormone therapy recommendations apply only to treatment of menopausal symptoms (hot flashes, vaginal atrophy), NOT to primary prevention of chronic diseases like coronary heart disease or fractures 1
The Grade D recommendation against using hormone therapy for chronic disease prevention made it inappropriate to continue calling it "replacement" therapy, as this implied routine use for all postmenopausal women 1, 2
Modern guidelines from the American College of Obstetricians and Gynecologists and North American Menopause Society consistently use "MHT" to emphasize symptom-directed treatment rather than blanket hormone "replacement" 2, 4
Clinical Implications: Same Medications, Different Philosophy
Both terms refer to identical medications: estrogen alone (for women without a uterus) or estrogen plus progestin (for women with an intact uterus) 2, 5
The formulations haven't changed—transdermal estradiol 50 μg twice weekly plus micronized progesterone 200 mg nightly remains first-line regardless of whether you call it HRT or MHT 2, 5
What changed is the indication: MHT should be initiated for bothersome vasomotor or genitourinary symptoms in women under 60 or within 10 years of menopause, using the lowest effective dose for the shortest duration 2, 5, 6
Common Pitfall to Avoid
Never initiate hormone therapy (whether called HRT or MHT) solely for osteoporosis prevention, cardiovascular protection, or dementia prevention in asymptomatic women—this is explicitly contraindicated with a Grade D recommendation 1, 2, 6
The terminology matters because "replacement" implies all postmenopausal women need it, while "menopausal hormone therapy" correctly frames it as symptom-directed treatment for women with bothersome vasomotor or genitourinary symptoms 1, 4