First, the name

Menopausal hormone therapy (MHT) is the term most often used in current Canadian guidance. You may also see menopausal hormone replacement therapy (MHRT) or the older term hormone replacement therapy (HRT). They refer to the use of hormone medicines to treat menopausal symptoms and, in selected circumstances, help prevent bone loss. Maple Menopause uses MHT.

Three hormones, three different jobs

“Topical” does not always mean “local”

A patch or gel is applied to the skin, but the estrogen enters the bloodstream and works throughout the body. It is therefore systemic. Low-dose vaginal estrogen is local: it is placed in or around the vagina and has minimal systemic absorption.

Form	Where it works	Usually used for	Is uterine protection needed?
Oral estrogen	Systemic: throughout the body	Hot flashes, night sweats and other appropriate systemic symptoms	Yes, if you have a uterus
Skin patch or gel	Systemic: absorbed through skin into the bloodstream	The same systemic symptoms; transdermal estrogen generally has a lower blood-clot risk than oral estrogen	Yes, if you have a uterus
Low-dose vaginal cream, tablet, insert or ring	Primarily local vaginal and urinary tissues	Dryness, burning, painful sex and some urinary symptoms of genitourinary syndrome of menopause (GSM)	Generally no at standard low doses; any postmenopausal bleeding still needs assessment

Two useful reminders: MHT is not contraception. If pregnancy is still possible, ask about contraception. If you have had a total hysterectomy, progesterone is usually not needed solely to protect the uterine lining.

Who may consider systemic MHT?

For a generally healthy person younger than 60 or within 10 years of the final menstrual period, systemic MHT is the most effective treatment for bothersome hot flashes and night sweats when there is no contraindication. The decision is individualized. A clinician should review your personal and family history, bleeding pattern, cardiovascular and clotting risks, breast health, liver health, medications and treatment goals.

• Systemic MHT is not automatically required simply because menopause has occurred.
• Local vaginal estrogen may be appropriate without systemic MHT when the concern is limited to vaginal or urinary symptoms.
• Route matters. Transdermal estrogen is often considered when clot, stroke or metabolic risk makes oral estrogen less attractive.
• There is no universal stop date. Benefits, risks and preferences should be reviewed periodically.

Estrogen products commonly prescribed in Canada

The table lists common examples, not every strength or generic manufacturer. Availability and coverage can change. “Source/type” describes the hormone molecule and pharmaceutical source—not where the prescription is dispensed.

Route and common products	What it does	Source/type	Public coverage snapshot
Oral estradiol Estrace and estradiol generics	Systemic treatment for hot flashes and night sweats; helps prevent bone loss while taken	Regulated 17β-estradiol, molecularly identical to human estradiol; manufactured from pharmaceutical plant-derived starting materials	Product- and plan-specific. BC Plan NP lists selected oral estradiol; Manitoba MEPP covers most eligible MHT
Estradiol patches Estradot, Climara, Sandoz Estradiol Derm	Systemic treatment delivered steadily through skin; bypasses first-pass liver metabolism	Regulated 17β-estradiol, molecularly identical to human estradiol	Selected products are BC Plan NP benefits; elsewhere check the provincial formulary and your eligibility
Estradiol gels EstroGel, Divigel	Systemic treatment absorbed through skin; dose and application instructions vary by product	Regulated 17β-estradiol, molecularly identical to human estradiol	Selected products are BC Plan NP benefits; Manitoba MEPP and other public plans depend on current listing and eligibility
Oral conjugated estrogens Premarin	Systemic treatment for vasomotor symptoms and other approved indications	A mixture of conjugated estrogens derived from pregnant mares’ urine; not the same molecule as estradiol	BC Plan NP lists oral Premarin; other provinces vary
Low-dose vaginal estradiol Vagifem, Imvexxy, Estring	Local treatment for vaginal dryness, burning, painful sex and selected urinary symptoms	Regulated estradiol; tablet, soft insert or vaginal ring	BC Plan NP lists Imvexxy but not Vagifem or Estring as Plan NP benefits; other public plans vary
Vaginal estrogen creams Premarin Vaginal Cream, Estragyn	Local treatment; cream can also be applied to affected external tissues when prescribed	Premarin is conjugated estrogens; Estragyn contains estrone	BC Plan NP lists Premarin Vaginal Cream but not Estragyn as a Plan NP benefit; other provinces vary

Progesterone and other progestogens

If you have a uterus and use systemic estrogen, a progestogen is usually added to prevent the uterine lining from becoming too thick. It may be prescribed continuously or for part of each month in a cyclic regimen. These schedules have different bleeding patterns; the choice should be made with your prescriber.

Medicine and common products	What it does	Source/type	Public coverage snapshot
Micronized progesterone Prometrium and generics	Protects the uterine lining when systemic estrogen is used; may cause sleepiness, which is why it is commonly taken at night	Regulated progesterone, molecularly identical to human progesterone; micronized to improve absorption	Generic oral micronized progesterone is a full BC Plan NP benefit; Manitoba MEPP covers most eligible MHT; other plans vary
Medroxyprogesterone acetate Provera and generics	Protects the uterine lining; also has other gynecologic uses	Synthetic progestin	Selected generics are BC Plan NP benefits; coverage elsewhere is formulary- and plan-specific
Norethindrone acetate Norlutate	A progestin that may be used for uterine protection or other gynecologic indications	Synthetic progestin	Coverage varies by province, indication and plan
Levonorgestrel intrauterine system Mirena 52 mg	Releases progestin inside the uterus; may provide endometrial protection as part of an MHT plan and also provides contraception	Synthetic progestin in an intrauterine device	Coverage varies; the MHT use may be off-label even though the device itself is Health Canada authorized
Fixed estrogen–progestogen combinations Bijuva, Activelle/Activelle LD, Angeliq, Estalis	Combines systemic estrogen and uterine protection in one product	Combination varies: estradiol plus micronized progesterone or a synthetic progestin	Highly product-specific. Some are not BC Plan NP benefits; check the current formulary and exact product

When is testosterone indicated?

The evidence-based indication is hypoactive sexual desire disorder (HSDD) in postmenopausal women: persistent low sexual desire that causes personal distress and is not better explained by pain, vaginal dryness, medication effects, relationship factors, mood, another health condition or a different cause. Diagnosis requires a biopsychosocial assessment—not simply a low testosterone blood result.

• Canada has no testosterone product authorized specifically for menopausal women.
• A knowledgeable prescriber may use a very small, carefully adjusted amount of a regulated male transdermal product off-label.
• Common Canadian products include AndroGel, generic testosterone gel, Taro-Testosterone Gel and Testim. These products are authorized for male hypogonadism, not for menopausal HSDD.
• Treatment requires baseline assessment, follow-up for benefit and side effects, and blood testing to keep levels within the physiologic female range.
• Possible androgenic effects include acne and increased facial or body hair. Voice deepening and clitoral enlargement are uncommon at physiologic doses but may be irreversible if excessive exposure occurs.
• Long-term safety data in women remain limited. Compounded testosterone, pellets and supraphysiologic dosing are not recommended by major consensus guidance.

Product	Canadian status	Source/type	Public coverage
AndroGel and generic testosterone gel	Health Canada–authorized for men; use for menopausal HSDD is off-label	Manufactured pharmaceutical testosterone, molecularly identical to human testosterone	Usually tied to authorized indication and plan rules; do not assume an off-label menopause prescription is publicly covered
Taro-Testosterone Gel	Health Canada–authorized male product; menopausal use is off-label	Regulated transdermal testosterone	Plan- and indication-specific
Testim 1%	Health Canada–authorized male product; menopausal use is off-label	Regulated transdermal testosterone	Plan- and indication-specific

Where do these hormones come from?

Hormone type	What “source” means
Regulated 17β-estradiol	Manufactured from pharmaceutical starting materials, often derived from plants, and converted into a molecule identical to human estradiol. “Plant-derived” does not mean the body can use a raw plant extract as estrogen.
Micronized progesterone	Manufactured progesterone that is molecularly identical to human progesterone. Micronization helps oral absorption.
Conjugated estrogens	A mixture of estrogens derived from pregnant mares’ urine. Premarin is the familiar example.
Synthetic progestins	Laboratory-made molecules with progesterone-like effects, including medroxyprogesterone, norethindrone, levonorgestrel and drospirenone.
Regulated testosterone	Manufactured testosterone with the same molecular structure as human testosterone. Canadian gels are authorized for men; use in menopausal women is off-label.
Compounded “bioidentical” hormones	Custom-mixed products are not the same as regulated estradiol or micronized progesterone. They are not Health Canada–approved finished products and are not recommended over approved options when an approved product is available.

“Bioidentical,” compounded and “natural” are not the same thing

These words are often placed together in advertising, but they describe different things. The distinction matters because a product can be bioidentical and still be a regulated prescription drug—or it can be a custom-compounded preparation that has not undergone Health Canada review as a finished product.

Term	What it actually means	What is known—and not known
Regulated “bioidentical” or body-identical hormone	The molecule has the same structure as a hormone made by the human body. Health Canada–authorized estradiol and micronized progesterone are examples.	The finished product has standardized manufacturing, a DIN, a product monograph, labelled risks and regulatory review.
Custom-compounded hormone	A pharmacy prepares a formulation for an individual patient, sometimes combining estradiol, estriol, progesterone or testosterone in a non-standard strength or dosage form.	Compounding practice is overseen provincially, but the finished preparation is not individually approved by Health Canada and does not undergo the same premarket review as an authorized drug.
Licensed natural health product	A supplement authorized for sale under Canada’s Natural Health Products Regulations. Its label should carry an eight-digit NPN.	An NPN is useful evidence that the product is legally authorized and meets licensing requirements. It does not mean the product has evidence equivalent to prescription MHT or that it can replace estrogen or progesterone.
Unlicensed or imported supplement	A product sold online or brought into Canada without an NPN or DIN.	Health Canada has not authorized the product for sale. Ingredient identity, strength, contamination and interactions may be uncertain.

Why routine compounded MHT is not the safer choice

“Natural” and “customized” can sound reassuring, but neither word proves safety or effectiveness. Canadian quality guidance does not consider compounded bioidentical hormone therapy standard care when a suitable Health Canada–authorized product is available.

• Potency can vary. A preparation may deliver more or less hormone than intended, or absorb unpredictably.
• Too little endometrial protection matters. If compounded progesterone does not reliably counter systemic estrogen in someone with a uterus, the uterine lining can become overstimulated.
• Contamination and sterility are concerns. The risk is especially important for products that must be sterile.
• Safety information may be incomplete. Custom preparations may not come with the standardized product monograph, adverse-effect reporting and warning label supplied with an authorized drug.
• Saliva and urine “hormone balancing” tests are not a reliable way to individualize MHT. Hormone levels fluctuate, and treatment is ordinarily guided by symptoms, clinical history and response—not by repeated commercial testing.
• Pellets and high-dose regimens are difficult to reverse. Once implanted, a pellet cannot simply be removed from exposure in the way a patch can be stopped.

Compounding still has a legitimate, limited role—for example, when a person has a documented allergy to an ingredient in every suitable commercial product or needs a dosage form that is genuinely unavailable. In that situation, ask why compounding is necessary, who is responsible for quality, how the dose will be monitored and what regulated alternatives were considered.

Can a supplement “mimic” estrogen?

Soy isoflavones, red clover and other phytoestrogens can interact weakly with estrogen receptors, but they do not reproduce the predictable dose or clinical effect of prescription estradiol. The SOGC concludes that evidence is insufficient to support any one natural health product for moderate to severe hot flashes. Black cohosh is not an estrogen replacement, and products such as DHEA, “ovarian support,” wild yam creams or glandular extracts should not be assumed to supply usable human estrogen or progesterone.

• Look for an eight-digit NPN on any natural health product sold in Canada, and verify it in Health Canada’s Licensed Natural Health Products Database.
• Avoid products that promise to “balance hormones,” replace MHT, prevent cancer or work for everyone.
• Tell your pharmacist and prescriber about every supplement. Natural products can interact with prescriptions and may affect the liver, bleeding risk or hormone-sensitive conditions.
• Do not replace prescribed progesterone with an over-the-counter cream or supplement. Reliable endometrial protection requires an appropriate, evidence-based regimen.

Public drug coverage across Canada

Coverage checked 10 August 2026. Formularies change. Coverage may depend on age, income, diagnosis, plan enrolment, deductible, prior authorization, the exact Drug Identification Number (DIN), and whether a lower-cost generic is available. Ask your pharmacist to check the exact prescription before assuming it is covered.

Province or territory	Current public-coverage picture	Where to verify
British Columbia	Selected MHT products are fully or partly covered through Plan NP. Coverage includes selected systemic estradiol, local vaginal estrogen, oral conjugated estrogen, micronized progesterone and medroxyprogesterone. Not every brand is included.	BC PharmaCare Plan NP: MHT
Alberta	Coverage is product- and plan-specific through Alberta-sponsored drug plans; it is not universal MHT coverage.	Alberta Drug Benefit List
Saskatchewan	Coverage depends on formulary listing, plan eligibility, deductible and any Exception Drug Status requirement.	Saskatchewan Formulary
Manitoba	The Manitoba Enhanced Pharmacare Program provides no-cost coverage for most MHT to eligible residents with an active Manitoba health card who do not already have full federal or other provincial coverage. Some products may require Exception Drug Status.	Manitoba Enhanced Pharmacare Program
Ontario	Coverage is available only to people who qualify for the Ontario Drug Benefit program, and only for listed products or approved exceptions. There is no universal MHT benefit for all residents.	Ontario medication coverage search
Quebec	Residents must have public or private prescription-drug insurance. Coverage, deductibles and co-insurance depend on the plan and the current drug list.	RAMQ prescription drug insurance
New Brunswick	Coverage is plan-, eligibility- and formulary-specific; premiums and co-payments may apply.	New Brunswick Drug Plans
Nova Scotia	Pharmacare coverage depends on enrolment in an eligible program, such as Seniors’, Family or Community Services Pharmacare, and the product’s formulary status.	Nova Scotia Pharmacare Formulary
Prince Edward Island	Public coverage depends on the specific Pharmacare program and formulary. Current national pharmacare coverage for diabetes medicines and contraception should not be assumed to include MHT.	PEI Pharmacare Formulary
Newfoundland and Labrador	The Newfoundland and Labrador Prescription Drug Program has several eligibility-based plans. Product coverage is formulary-specific.	NLPDP
Yukon	Public drug benefits are eligibility- and program-specific, including Pharmacare for seniors and chronic disease benefits. There is no universal MHT benefit for all residents.	Yukon health coverage
Northwest Territories	Extended Health Benefits and seniors’ benefits may cover drugs listed on the NWT formulary, subject to age, income and program rules.	NWT Pharmacare Formulary
Nunavut	Coverage may come through Non-Insured Health Benefits or territorial Extended Health Benefits, depending on eligibility and formulary rules.	Nunavut NIHB information

Canadian guidance and scientific reading

These are guideline documents, consensus statements and peer-reviewed articles used to prepare this page. Links open the original source or PubMed record.

• Government of Canada: Medical Management of Menopause Symptoms — Canadian clinical overview of systemic and local therapies and commonly used products.
• SOGC Guideline No. 422a: Menopause—Vasomotor Symptoms, Prescription Therapeutic Agents (2021).
• SOGC Guideline No. 422b: Menopause and Genitourinary Health (2021).
• SOGC Guideline No. 422c: Menopause—Mood, Sleep and Cognition (2021).
• SOGC Guideline No. 422d: Menopause and Sexuality (2021).
• Ontario Health and SOGC: Menopause Care for People 40 Years of Age and Older (Quality Standard, 2025).
• The 2022 Hormone Therapy Position Statement of The North American Menopause Society.
• Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? (Circulation, 2023).
• Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review (2023).
• 2025 Menopause Society clinical practice guideline for genitourinary syndrome of menopause.
• Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019).
• ISSWSH Clinical Practice Guideline for Systemic Testosterone for HSDD in Women (2021).
• Diagnostic and therapeutic use of oral micronized progesterone in endocrinology (2024 review).
• Health Canada Drug Product Database — current authorization and marketing status for Canadian drug products.

Additional reading on compounded hormones and supplements

• Government of Canada: The Women and Diversity Health Guide to Menopause — consumer guidance on supplements and compounded bioidentical hormones.
• Compounded Bioidentical Menopausal Hormone Therapy: ACOG Clinical Consensus (2023).
• Health Canada: Natural Health Product Compounding Policy (updated 2026).
• Health Canada Licensed Natural Health Products Database — verify an NPN and read the authorized product information.

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Editorial note: Maple Menopause is an independent educational resource. Brand names are included to help Canadian readers recognize commonly prescribed medicines; their inclusion is not an endorsement. This page contains no affiliate links. Last evidence and coverage review: 10 August 2026.