If you’re in perimenopause or menopause, you’ve probably heard mixed messages about hormone therapy. Some women are told it’s dangerous. Others are told it’s a cure-all. As a nurse practitioner, I want to give you a clear and honest picture so you can decide what’s right for you.
Why women use hormone therapy
The most common reason is relief from hot flashes and night sweats. Estrogen is the most effective treatment we have for these symptoms, and it’s FDA-approved for them. Many women also notice better sleep and quality of life.
Hormone therapy can also help with vaginal dryness, discomfort with intimacy, and urinary symptoms. For these concerns alone, low-dose vaginal estrogen often works well and has very little effect on the rest of the body.
For women who go through menopause early, before age 40, hormone therapy is usually recommended until around the average age of natural menopause, about 51.
What it isn’t for
Hormone therapy is not a way to prevent heart disease, dementia, or cancer. It can help protect bone, but it isn’t the first choice for osteoporosis prevention by itself. The reason to start is symptoms and quality of life.
Why the headlines scared so many women
In 2002, a large study called the Women’s Health Initiative reported risks that caused many women and clinicians to stop hormone therapy overnight. Later reviews found that those results were applied too broadly. The women in that study were older, many had no symptoms, and most took one specific oral combination. Newer research shows that the type of hormone, how you take it, and your own health history all matter.
What I look at with every patient
The route. Oral estrogen carries a higher risk of blood clots and stroke than estrogen through the skin. For many women, a patch is the better choice.
The dose. We start with the lowest dose that works and adjust to how you feel.
Progesterone. If you still have a uterus, you need a progestogen along with estrogen to protect the uterine lining.
Your history. Past breast cancer, blood clots, stroke, and unexplained vaginal bleeding are reasons to avoid systemic estrogen or to talk carefully first. Migraines, diabetes, and family cancer history call for a personal conversation, not a blanket rule.
The risks, in plain terms
For most healthy women with bothersome symptoms, the risks of hormone therapy are small. Estrogen combined with a synthetic progestin has been linked to a modest increase in breast cancer risk with longer use, and that risk falls after stopping. Estrogen alone, for women without a uterus, has not shown the same increase. Staying active, limiting alcohol, not smoking, and keeping a healthy weight matter just as much for your long-term health.
What follow-up looks like
We check in about three months after you start to see how your symptoms and side effects are doing. After that, plan on yearly visits at a minimum. Routine hormone blood levels aren’t needed to guide treatment. How you feel is the best measure. If bleeding returns or doesn’t settle in the first few months, we look into it.
How long should you stay on it?
There’s no set expiration date. For healthy women who still have symptoms, continuing past age 65 can be reasonable, usually at a lower dose and by patch. If you stop, about half of women see symptoms return, so we can plan that together.
Is it right for you?
The answer is personal. At Restoration Healthcare and Aesthetics, I take time to go through your history, symptoms and goals, and we make the plan together. If you’re curious about hormone therapy, book an initial hormone consultation and I will guide you.
This post is for general education and is not medical advice. Please talk with your provider about your own health.
Source: Harper-Harrison G, Carlson K, Shanahan MM. Hormone Replacement Therapy. StatPearls, updated October 2024.