Menopause Hormone Therapy (MHT) Dosing Explained: Cyclical vs Continuous Hormone Therapy for Menopause

When women ask about menopausal hormone therapy (MHT) also known formerly as hormone replacement therapy (HRT), one of the most common questions is whether cyclical or continuous dosing is the better fit.

The answer depends on where you are in the menopause transition, whether you are still bleeding, and what feels most manageable for your body and lifestyle.

"HRT is a treatment designed to restore declining levels of endogenous hormones (estrogen, progesterone, and, in certain instances, androgens). The NAMS Position Statement and the NICE guidelines recommend hormone replacement therapy for moderate to severe vasomotor symptoms, genitourinary syndrome of menopause, prevention or treatment of osteoporosis in high-risk women, premature ovarian insufficiency or early menopause (under 45 years), and induced menopause (post-oophorectomy)." (Yanakanov, 2025)

What is cyclical (sequential) MHT?

In cyclical (also referred to as sequential) therapy, MHT usually means taking estrogen every day and progesterone for 10 to 14 days each month. When progesterone is stopped, it often leads to a predictable, period-like bleed. This approach is often used in perimenopause or within 12 months of a final period.

A common cyclic regimen includes daily transdermal 17β-estradiol (gel, patch, etc) plus oral micronized progesterone 200 mg for 12–14 days per calendar month. (e.g. oral micronized progesterone 200mg day 12-27 in a 28 day cycle or days 10-25 in a 26 day cycle)

What is continuous combined MHT?

Continuous combined MHT means taking both hormones every day, with the goal of gradually stopping monthly bleeding after an adjustment period. It is usually preferred after menopause, when it has been 12 months or more since a period.

Many women transition from cyclical to continuous MHT as they move further into postmenopause and when the period stops for 12 months or when cycles get further apart and dosing of progesterone cyclical becomes unpredictable, continuous is the option for many.

A typical continuous regimen might include daily 17β-estradiol (gel, patch, or oral) plus micronized progesterone 100–200 mg daily.

Endometrial Protection

Both approaches are designed to protect the uterine lining when progesterone is used properly. Continuous combined MHT can offer steadier hormone levels and is often a good fit for women who want to avoid bleeding, especially if hot flashes, sleep disruption, or mood changes are a concern.

Because up to 75% of women experience hot flashes during the menopause transition, choosing a regimen that matches your stage of life can make a meaningful difference. In practice, the best option is usually the one that fits your symptoms, bleeding pattern, and health history, while also supporting bone health, cardiovascular health, blood sugar balance, and overall hormone health.

Work with your primary healthcare provider to determine the regemine based your symptoms, risk profile, and lifestyle.

To your best health,

Dr. Amy J. Tung, ND, MSCP

Naturopathic Doctor | Menopause Society Certified Practitioner

References:

Mukherjee, A., & Davis, S. (2025). Update on Menopause Hormone Therapy; Current Indications and Unanswered Questions.. Clinical endocrinology. https://doi.org/10.1111/cen.15211

Ruan, X., & Mueck, A. (2024). Criteria for the choice and monitoring of Menopausal Hormone Therapy. Current Medicine, 3. https://doi.org/10.1007/s44194-024-00038-5

Yanachkova V, Vasileva-Slaveva M, Kostov S, Yordanov A. Reconsidering Hormone Replacement Therapy: Current Insights on Utilisation in Premenopausal and Menopausal Women: An Overview. J Clin Med. 2025 Oct 10;14(20):7156. doi: 10.3390/jcm14207156. PMID: 41156026; PMCID: PMC12565178.