Every year, about 1.3 million women in the U.S. enter menopause—and yet, so many feel completely unprepared for what’s coming. A mix of limited research, outdated education, and that all-too-familiar silence from the “we don’t talk about these things” generation has left many women facing this life stage without the tools or info they need.
But times are changing. As Gen X women transition into perimenopause and menopause, they’re speaking up, asking questions and demanding better care. One option that often comes up but is still widely misunderstood is hormone therapy. So let’s break it down in simple terms.
What is Hormone Therapy?
Hormone therapy usually involves estrogen or a combination of estrogen and progesterone. If you still have a uterus you’ll need both- progesterone helps protect your uterus from the effects of estrogen. If you’ve had a hysterectomy, you can typically use estrogen on it’s own. (There’s also testosterone therapy but let’s save that for another day.)
Hormone therapy comes in a few different forms: pills, patches and creams.
- Pills (oral estrogen): likely not a good fit if you’ve smoked, have heart disease risk factors, migraines with auras or a history of blood clots.
- Creams: Convenient but can be tricky when it comes to consistent dosing- especially for progesterone which isn’t reliable in cream form for protecting the uterus.
- Patches: These offer more accurate dosing and fewer cardiovascular risks but can cause skin irritation for some women.
You’ll also hear terms like:
- Bio-identical hormones: These are structurally identical to the hormones your body naturally makes (like estrogen and progesterone).
- Conjugated estrogens and progestins: These are synthetic versions.
Personally I lean towards bio-identical hormones but there are times when synthetic progestins work better, especially for things like heavy bleeding or endometriosis.
Why Consider Hormone Therapy?
Hormone therapy can help relieve a range of symptoms including:
- Hot flashes and night sweats
- Sleep disturbances
- Brain fog and low energy
- Mood changes
- Joint pain
And its not just about symptom relief. Hormone therapy may also offer long-term benefits like protecting your heart, bones and brain. That said, hormone therapy isn’t for everyone. If you have a history of breast cancer it’s often not considered an option because estrogens and/or progesterone can fuel the growth of certain cancer cells. To be clear, these hormones do not cause cancer but may influence its growth in those already at risk.
Is Hormone Therapy Right for You?
Maybe yes, maybe no. It depends on your own unique situation including symptoms, health history and family history. There are two key scenarios that are especially important to know about:
1) Early or Premature Menopause:
If you reach menopause before the age of 45 (and especially before 40), hormone therapy is usually recommended until at least the age 52 unless there’s a medical reason not to. This is because early estrogen loss can increase risk for heart disease, osteoporosis and cognitive issues later in life.
2) The “Window of Safety”
This is the ideal time frame for starting hormone therapy- within 10 years of menopause or before age 60. Starting during this window tends to offer more benefits than risks. After this period, hormone therapy becomes more tricky-it can increase cardiovascular risks rather than decrease them.
Final Thoughts
Hormone therapy is just one option- an important one- that women deserve to understand better as they navigate this big life transition. While this phase of life can be hard, it can also be an time to refocus on your health, advocate for your needs and make self-care a priority.
