Menopause replacement therapy: the four approved indications and how to recognise them
November 25, 2025 2025-12-27 23:09Menopause replacement therapy: the four approved indications and how to recognise them
Introduction
This guide explains the four approved indications for menopause replacement therapy and how to recognise each one.
Many women are unsure whether they “qualify” for hormone replacement therapy (HRT).
They may have symptoms, but they do not know if these symptoms are part of perimenopause, stress, sleep problems, thyroid changes or simply ageing.
According to NICE, BMS, IMS and NAMS, there are four clear, evidence-based indications for HRT.
When these are present, HRT is considered appropriate, safe and often life-changing.
This guide explains each indication in simple language so women can recognise themselves and make informed decisions.
What this article covers
Vasomotor symptoms (moderate or severe)
Genitourinary syndrome of menopause (GSM)
Prevention of bone loss and osteoporosis
Primary ovarian insufficiency (POI)
1. Vasomotor symptoms (moderate or severe)
These are the most common indication for MRT. (Menopause hormone Therapy)
What they are
Vasomotor symptoms include:
hot flushes
night sweats
broken or fragmented sleep caused by sudden heat
waking drenched and needing to change clothes or bedsheets
These symptoms are NOT “just being warm”.
They come from sudden changes in the brain’s temperature-control centre as oestrogen fluctuates.
When they are “moderate” or “severe”
Moderate: noticeable symptoms that disturb daily life or concentration, or interrupt sleep.
Severe: repeated night-time awakenings, needing to change pyjamas or bedclothes, exhaustion the next day, avoidance of social or professional activities.
Many women do not realise they have vasomotor symptoms because they deny or normalise them.
Why HRT helps
Oestrogen stabilises the brain’s temperature-control system.
HRT is the first-line treatment for vasomotor symptoms in all major menopause guidelines.
2. Genitourinary syndrome of menopause (GSM)
This is extremely common but often hidden because women feel embarrassed or think it is “normal”.
What GSM includes
vaginal dryness
pain with intimacy
burning or irritation
recurrent urinary infections
low lubrication
pain inserting tampons
discomfort when sitting, cycling or wearing tight clothing
Many women say “my sex life is fine”, yet admit they use lubricants or vaginal moisturisers every time.
This is already GSM.
Why HRT helps
Local oestrogen restores the vaginal tissues, improves lubrication, reduces urinary infections and improves comfort.
It is safe, long-term, and recommended by every guideline.
3. HRT to prevent bone loss and osteoporosis
Bone loss accelerates dramatically during the menopause transition.
What happens without treatment
Rapid reduction in bone mineral density
Loss of micro-architecture (internal bone strength)
Higher risk of fractures later in life
This bone loss starts before the final period — during perimenopause — when oestrogen levels become unstable.
Who benefits
HRT is recommended when:
a woman has early menopause
a woman has significant bone-loss risk
a woman has menopausal symptoms plus risk factors (family history, low BMI, early menopause, smoking, steroid use)
HRT is not cosmetic: it is a proven medical treatment that prevents future fragility.
4. Primary ovarian insufficiency (POI)
POI occurs when the ovaries stop functioning before the age of 40.
What this means
irregular or absent periods
low oestrogen and progesterone
elevated FSH and LH
symptoms similar to early menopause
Why HRT is essential
Women with POI require HRT until at least age 51 (the average natural menopause).
Without treatment, they face higher risks of:
bone loss
cardiovascular disease
urogenital symptoms
reduced quality of life
Why early diagnosis matters
Many cases are idiopathic (meaning the exact cause is unknown).
Others may involve genetic factors or previous medical treatments — but the management is the same: restore physiological hormones.
Closing sentence
Understanding these four indications helps women recognise their symptoms early and seek appropriate, evidence-based support.
If one of these applies to you, MRT is medically recommended and can significantly improve long-term health.
Reference
The North American Menopause Society. “2022 Hormone Therapy Position Statement of The North American Menopause Society.” Menopause. 2022
Download the full document here
British Menopause Society (2020). Hormone replacement therapy recommendations.
