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I<\/span>t happens with some regularity. I offhandedly mention some bodily inconvenience to a fellow middle-aged woman \u2013 indigestion, a headache, a bad mood. Immediately, she says it\u2019s perimenopause and suggests I try hormone therapy.<\/p>\n These moments give me whiplash. In 2002, when I was a medical student, a study frightened a generation of patients and clinicians by suggesting the risks of menopause hormone therapy (MHT) \u2013 blood clots, stroke and breast cancer \u2013 outweighed its benefits. Then, in 2012, scientists took a closer look at the evidence, along with new data, and found the calculus only applied to older women. Now, many clinicians are comfortable prescribing hormones. In fact, some are a bit too comfortable hawking them as a cure-all.<\/p>\n Timely treatment provides immense relief of menopause symptoms, and has the added benefit of lowering fracture risk. But ascribing all your ills to menopause and expecting treatment to fix them is a set-up for disappointment.<\/p>\n Here\u2019s how to tell what\u2019s hype and where menopause treatment can actually help.<\/p>\n In a 2025 Mayo Clinic study, about one-third of women reported having pronounced menopause symptoms. But only 13% sought treatment, and the real-world number is probably even lower, says Nanette Santoro, a professor of obstetrics and gynecology and menopause researcher at the University of Colorado.<\/p>\n One issue is that menopause is not confirmed until a year after one\u2019s last period, by which point \u201cwe\u2019ve missed the window when they have been their most symptomatic\u201d, Santoro says. But lack of appropriate care is also a factor: When women raise concerns about menopause symptoms with their clinicians, many are dismissed.<\/p>\n At the same time, menopause awareness is growing. Celebrity advocacy, social media, and a long-overdue cultural reckoning around women\u2019s health have driven a demand for care.<\/p>\n But menopause isn\u2019t the only thing that happens to women\u2019s bodies with age. By the time women hit perimenopause, at least half already have a chronic medical condition. The same awareness that is finally getting women into doctors\u2019 offices is also convincing them they need hormones for symptoms that may have other causes \u2013 or no cause at all.<\/p>\n \u201cIt can be tricky,\u201d says Lauren Streicher, a gynecologist and menopause researcher at Northwestern University. \u201cIs your mouth dry because you\u2019re post-menopausal, because of the medication you\u2019re taking, or because it\u2019s just one of those things that happens as you get older?\u201d<\/p>\n Claims that treatment reduces weight gain, prevents dementia, averts heart disease, prolongs life and confers \u201chormonal balance\u201d \u2013 whatever that is \u2013 aren\u2019t grounded in evidence.<\/p>\n That doesn\u2019t stop influencers \u2013 even some who are credentialed clinicians \u2013 from making fantastical claims on social media that dramatically inflate estrogen\u2019s abilities. Many are literally invested in the hype: products content creators sell account for about a third of the $10-15bn menopause market.<\/p>\n skip past newsletter promotion<\/p>\n Sign up to Well Actually<\/span><\/p>\n Practical advice, expert insights and answers to your questions about how to live a good life<\/p>\n after newsletter promotion<\/p>\n Most of the loudest public voices making those claims are cherrypicking data, says Streicher. Last November, the Department of Health and Human Services secretary, Robert F Kennedy Jr, and the then Food and Drug Administration commissioner, Marty Makary, announced the removal of the black box warning on hormone therapy. They made inaccurate claims based on low-quality studies about MHT\u2019s ability to prevent Alzheimer\u2019s disease, stave off cognitive decline, and extend life by 10 years.<\/p>\n \u201cWomen are left wondering, \u2018Who do I believe? My clinician, who I\u2019ve been going to for 20 years and who seems real smart, but he or she doesn\u2019t seem to know any of this stuff, or the person on social media who\u2019s got 2 million followers?\u2019\u201d Streicher says.<\/p>\n Estrogen is MHT\u2019s workhorse of symptom relief. In people with a uterus, it\u2019s typically co-prescribed with progesterone, which prevents estrogen-related cancerous overgrowth of the uterine lining. (About one-fifth of peri- or newly menopausal women have had a hysterectomy and thus don\u2019t need it.)<\/p>\n Bodywide estrogen treatment helps reduce hot flashes, night sweats and sleep disturbances due to the presence of estrogen receptors in the parts of the nervous system that control temperature regulation and sleep. Pills or transdermal (via the skin) estrogen applications like patches, creams or gels deliver it throughout the body via the bloodstream. The digestive route leads to the production of tiny quantities of blood clot-causing byproducts, so transdermal application may be safer for many women.<\/p>\n The female reproductive tract also has these receptors, so local therapy works for vaginal and bladder symptoms, such as itching, burning and dryness. Forms of estrogen that only have local effects include vaginal creams, suppositories and insertable rings.<\/p>\n When it comes to progesterone, pills are the best delivery mechanism, although IUDs can also be beneficial.<\/p>\n MHT can also have positive effects on cardiovascular and bone health, although it\u2019s not recommended as first-line prevention for either. And it\u2019s broadly safe: for most women who start hormones within 10 years of their last menstrual period or before the age of 60, the risks are low \u2013 even lower with transdermal or local estrogen.<\/p>\n Not all menopause treatment contains hormones. Women who can\u2019t take estrogen \u2013 for example, because of a history of breast cancer \u2013 may get relief from a range of new and newly studied non-hormonal therapies.<\/p>\n Separating the real benefits of menopause therapy from myths can be challenging. Women who feel persistently powerless within medical establishments and in their own bodies may stake their hopes on MHT as a way to exert control.<\/p>\n It\u2019s important to make the most informed decision you can. That might mean taking hormones when you hit menopause, but it might not. The best way to determine whether MHT can help is to consult with a clinician with up-to-date knowledge about menopause treatment and care. The Menopause Society and author and menopause expert Jen Gunter both offer guidance on finding and vetting practitioners.<\/p>\nMenopause is too often missed \u2026<\/h2>\n
\u2026 and too often blamed<\/h2>\n
Why is there so much hype about MHT?<\/h2>\n
What does MHT actually do?<\/h2>\n
How do I know whether MHT is for me?<\/h2>\n