Menopause Hormone Therapy (MHT) and Hormone Therapy (HT) are the Terms Women Deserve

HRT Is Outdated, Misleading, and Long Overdue for Retirement

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Menopause hormone therapy (MHT) or simply hormone therapy (HT) are the accepted terms from the Menopause Society, the Australasian Menopause Society, the International Menopause Society, and the Endocrine Society for the practice of prescribing hormones (typically estrogen and/or or a progestogen) for menopause. Estrogen therapy (ET) or estrogen and progestogen (EPT) therapy are also acceptable terms, although they tend to be used more often in scientific literature. More recently, MHT has been emphasized as hormone therapy is less specific, but either MHT or HT is perfectly acceptable.

Despite the long-standing use of MHT, HT, ET, and EPT in the scientific literature (the latter three for decades), there are still many healthcare professionals and menopause influencers, many of whom are doctors, who still use the outdated, unscientific, and misogynistic term hormone replacement therapy, or HRT.

I recently shared an Instagram post from Dr. Karl Nadolsky, an endocrinologist, that was a plea to use the correct terminology, and the blowback from some menopause influencers was surprising. Given that people are pushing the old terminology or clinging to it (come on, British Menopause Society), I want to review why the language matters and poke holes in the fatuous arguments used to defend the old terminology.

Hormone Replacement Therapy or HRT Implies that Menopausal Women Have a Disease

A disease is an abnormal condition that affects the structure or function of part or all of the body.

Endocrine (hormone) diseases are usually defined into one of three categories: excess, deficiency, or resistance, and when someone has a deficiency, they are given a replacement therapy (assuming one exists). For example, people with growth hormone deficiency are given growth hormone to replace what should have been there.

The menopause transition (perimenopause) and menopause that happen at the expected time are not diseases. This doesn't mean people don’t have symptoms that might need to be treated, but menopause is not a medical condition because we expect the ovaries to decrease estradiol production. If menopause is a disease, then puberty must be one as well, and of course, it isn't (more on the similarities between the two here in this post).

The term hormone replacement therapy, or HRT, supports a disease model of menopause, which is a major reason why it has been replaced with menopause hormone therapy (MHT) or hormone therapy (HT).

Does Changing Terminology Really Matter?

We want to be accurate, so yes, it does. As we learn more terminology often changes.

But it’s also important to remember that words can shape our thoughts. A great example is gendered nouns. For example, bridge is female in German and is male in Spanish. Native German speakers are more likely to use a stereotypical feminine word, such as “beautiful” to describe a bridge, and native Spanish speakers are more likely to use a stereotypical male word, like “strong.”

We have quite a few words in medicine for female anatomy with awful latin roots, and there is a movement to change them. There is also a movement to change eponymous terms, for example instead of Fallopian tubes to use oviducts, which I did in my book Blood and I do here in The Vajenda.

I expect doctors who are experts to lead the charge for up to date terminology, so it’s disappointing when they don’t.

What About Women with Primary Ovarian Insufficiency or Early Surgical or Medical Menopause?

When ovulation stops before age 40 in these situations, it is the result of a medical condition, so it is not the same as menopause. It is widely accepted that estrogen therapy for these women reduces their risk of cardiovascular disease and osteoporosis as well as treats bothersome symptoms, so the term hormone replacement therapy would not be inappropriate here; hormone therapy works just fine as well, and is the preferred term in the 2022 Menopause Society Guidelines.

The Recommended Terminology from the Menopause Society

I fell down a seemingly bottomless rabbit hole looking for just how long the term menopause hormone therapy (MHT) or hormone therapy (HT) has been used by the Menopause Society. I pulled every Position Statement back to 2003 (the first one post WHI, I believe), and the preferred terminology even back then was estrogen or estrogen-progestogen therapy, not replacement. Here is a screenshot from the paper:

The Origins of Hormone Replacement Therapy

The first use of the term ”hormone replacement therapy” appears to be in JAMA, 1936. I was actually able to find it, and it is used in this context for someone who had had their ovaries removed, presumably before menopause, so not typical menopause.

A variety of terms seem to have been used over the following years, but estrogen therapy appears to have been the most popular in the medical literature (the importance of a progestogen was not known before the 1970s). Once the drug company Wyeth was able to produce Premarin in large enough quantities that estrogen became a viable business (the 1940s-50s), the use of the term “estrogen replacement therapy” gradually entered the mainstream, undoubtedly pushed in large part by lots of direct-to-consumer advertisements, like this one:

Looking at medical articles from the 1960s and 1970s, a mix of terminology was used interchangeably, including hormone replacement therapy, estrogen replacement therapy, estrogen, hormone therapy, and estrogen therapy. For example, the original articles in the 1970s describing the risk of endometrial cancer from estrogen do not use the term HRT; it’s just estrogen therapy in menopause.

It seems HRT became the dominant term in the 1980s and 1990s via advertising and ghostwriting, a practice where a drug company writes a biased article and gets doctors to claim authorship. Wyeth had a company write many positive articles about Premarin and “HRT,” downplaying the risks and upselling the benefits, and medical experts would put their names to these articles. This helps the language that Wyeth wants, language that affects how doctors practice and talk with patients, seep into the literature.

This practice was in full swing in the 1990s, which is also when the term “natural hormone replacement” hit the mainstream. Premarin, you see, was unnatural, and the self-styled natural experts saw the massive hold that Wyeth had on the market. So they countered with a supposedly “natural” option, compounded bioidentical concoctions advertised (for more on what bioidentical means and doesn’t mean, read this post). According to the natural claim, Wyeth had synthetic hormone therapy (never mind that Premarin isn’t synthetic, only the progestogen was, and synthetic does not mean bad), and wouldn't you rather take a “natural hormone replacement”?

The term “replacement” was gradually introduced into the lexicon and then cemented by a combined effort of Big Pharma and Big Natural, using a disease model that each twisted to their own design.

Here are some of the “arguments” (in bold) people have made in support of using the term from the last century:

Shouldn't we stick with HRT and meet people where they are? After all, that’s what they know.

We, as healthcare professionals, are supposed to be up to date on modern medical technology as well as terminology. When patients are confused because Google gave them incorrect information, it’s our responsibility to correct them. In this case, it is incredibly easy to simply say, “I prescribe MHT or HT, which you might have heard of as HRT. MHT or HT are the preferred terms, as HRT implies that menopause is a disease. Also, the term HRT was essentially a push from Big Pharma and people selling untested compounded hormones, so it’s a marketing term, not a medical term.”

In my experience, zero people have found this explanation confusing. Most thank me and are typically very happy that their doctor is up to date. At one point, menopause was referred to as Women’s Winter. Should we have just met women where they were, and left it at that? Medical terms evolve, and it’s good to bring everyone along with the change. That is part of the job. Again, MHT and HT have been the preferred terms since at least 2003. This isn’t new.

I know that some doctors depend on Google search terms and advertisements to attract new patients to their private practices. It’s not that hard to use the correct term, MHT or HT, alongside the old (incorrect) term on their websites. It might reduce some of their hits, but honestly, marginally more website traffic is a gross excuse for not doing the right thing. You are supposed to be a professional physician after all.

I also suspect that the disease model is financially profitable for people who tell women that everyone should be on MHT because it’s “natural,” (the old, “we are just replacing what you body used to make,” gambit) so “not meeting people where they are” really means, “I need people to believe in the disease model as it’s personally profitable.” Someone left this brilliant comment on my Instagram making that same point:

“Replacement is probably more lucrative when it comes to marketing…”We've been trying to reach you concerning your ovaries extended warranty.” 🤣⁣.”

Do we not have bigger fish to fry, like ensuring women have access to treatment?

I can do more than one thing at a time, and I believe women are wise and want to use the most up-to-date, non-misogynistic terminology. This is a strawperson argument, and not even a good one at that.

Menopausal hormone therapy makes it sound inaccessible to women in perimenopause or even post menopause.

I am struggling to understand how someone is okay with using the words periMENOPAUSE and post MENOPAUSE and not MENOPAUSE hormone therapy.

How can something be more descriptive than menopause hormone therapy?

Menopause hormone therapy is worse than the term “geriatric pregnancy.”

Objectively, it is not. But if this bothers someone, the acceptable term hormone therapy is right there!

Botox is a brand name that stuck, and HRT is similar to that, so it’s okay to use it.

Botox is like Kleenex or Hoover in the United Kingdom. With Botox, people know they are getting a neuromodulator; with Kleenex, they know they are getting a facial tissue; with Hoover, they know it’s a vacuum. If we were all using the term PremPro (the most common MHT of the 1980s and 1990s), then the analogy of Botox would hold.

It’s pretty easy to use language like this on a website: “I prescribe MHT, which you may know as HRT.” I’m not sure how doing the right thing alienates people.

The term hormone replacement therapy (HRT) is outdated, misleading, and rooted in a disease model of menopause. While some influencers cling to HRT for familiarity or marketing, most medical societies recommend updated terminology and have been doing so for decades. The push to use the more medically appropriate terms menopause hormone therapy or hormone therapy, is not new. Some prominent menopause influencers love to criticize the Menopause Society for not being up to date (while using low-quality studies to support their points), but are somehow unable to keep up with terms that changed 20 years ago? You have to wonder who is really not up to date.

Using the right terms isn’t just semantics; it's about respecting women's health, rejecting misogynistic legacies, and using science-based language that empowers rather than confuses.

Let’s call it what it is—and leave "replacement" where it belongs: in the past.

References

The 2022 Hormone Therapy Position Statement from the North American Menopause Society. Menopause, 2022;29:767-794.

North American Menopause Society. Estrogen and progestogen use in peri- and postmenopausal women: September 2003 position statement of The North American Menopause Society. Menopause. 2003 Nov-Dec;10(6):497-506. doi: 10.1097/01.gme.0000102909.93629.8b. PMID: 14627857.

Recommendations for estrogen and progestogen use in peri and postmenopausal women: October 2004 The North American Menopause Society Position Statement. Menopause; 2004:11:89-600.

Antunes CMF, Stolley PD, Rosenshein, NB, et. al. Endometrial Cancer and Estrogen Use. N ENg J Med 1979;300:9-13.

Letter, JAMA 1936, July 11:150.