Menopause occurs at a mean age of 51 years, with 95% of women transitioning between ages 45 and 55. Declining ovarian estrogen production leads to low serum estradiol and vasomotor symptoms in most women, while approximately half develop genitourinary syndrome of menopause (GSM) characterized by vaginal dryness and dyspareunia [1]. Menopausal hormone therapy (MHT) employs unopposed estrogen for women post-hysterectomy and combined estrogen-progestin therapy for those with an intact uterus to prevent endometrial hyperplasia [2]. This article integrates the latest evidence on indications, formulations, dosing, and safety considerations for systemic and local MHT.