Holly L. Thacker, MD Menopausal hormone therapy (MHT) has complex cardio metabolic effects. Age, time since menopause, type and route of administration of MHT and concomitant disease are all factors in the response to MHT and the risk-benefit equation. In general, both estradiol and progesterone are vasodilatory but when given orally can lead to activation of the renin-angiotensin-aldosterone system.