Prescribing MHT: evidence base, tricks, tips, practice pearls

Professor Rodney Baber AM

The University of Sydney

The menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity and is said to have occurred when 12 months have passed since the final menstrual period (FMP).

The menopause is associated with a number of signs and symptoms the best known of which are vasomotor symptoms including hot flushes and night sweats. National and International guidelines and a global consensus statement have set out guidelines for the safe use of MHT in women in midlife, remembering that MHT should be part of an overall strategy aimed at improving the overall health of each woman.

MHT should be initiated within 10 years of the FMP.

For women with an intact uterus a progestogen in an appropriate dose and for an appropriate duration must be used to provide endometrial protection. The dose of estradiol used should be the lowest effective dose. For perimenopausal women MHT should be prescribed in a sequential regimen whilst for most postmenopausal women continuous combined MHT is preferred. RCTs and Observational studies have shown that the use of a body identical estrogen, preferably transdermal, together with a neutral body identical progestogen offers the safest outcome with minimal risk. Treatment should always be individualised, and this presentation will discuss different regimens to be used in different circumstances.


Rod Baber is Clinical Professor of Obstetrics and Gynaecology at The University of Sydney and is Head of the Menopause and Menstrual disorders clinic at Royal North Shore Hospital.He is a Past President of The International Menopause Society and The Australasian Menopause Society and currently Editor in Chief of Climacteric, the journal of The International Menopause Society and an associate editor of The Australian and New Zealand Journal of Obstetrics and Gynaecology.

His awards include membership of The Order of Australia for services to Obstetrics and Gynaecology in clinical medicine and research and The RANZCOG Distinguished Service medal.