Menopause is associated with bothersome symptoms and long-term morbidities that adversely affect quality of life and reduce longevity. Many women struggle to access high quality menopause care, in part due to lack of clinician education and out-dated knowledge concerning the benefits and risks of menopausal hormone therapy (MHT). Those that do take MHT may be under treated if dose and regimen are not individualised. Older, synthetic MHT formulations are associated with a small increased risk of thrombosis, stroke and breast cancer, but modern body-identical formulations (transdermal 17β-oestradiol and progesterone) are not. MHT prevents bone loss and fracture, and reduces the risk of diabetes, cardiovascular disease, dementia, and premature death. Body-identical MHT may have greater health benefits. There is substantial interindividual variation in transdermal oestradiol absorption. Many women don’t achieve physiological hormone levels using licensed doses of transdermal 17β-oestradiol. Monitoring serum oestradiol levels can be useful to guide dose titration and ensure that all women achieve therapeutic levels. MHT is a safe, effective treatment for menopausal symptoms with proven long-term health benefits.