Menopausal hormone therapy (MHT) has been a topic of debate for years, with some women enthusiastically endorsing its benefits and others harboring concerns about its health risks. Dr. Monica Christmas, director of the Menopause Program and Center for Women’s Integrated Health at the University of Chicago, notes that there are two extremes when it comes to MHT: women who suffer from menopausal symptoms but are wary of hormone therapy due to perceived risks, and those who may not have symptoms but want hormones anyway.
According to Dr. Christmas, prescription data shows that only 5% of menopausal women use hormones in 2020 despite experiencing symptoms. On the other hand, social media influencers and celebrities like Oprah Winfrey have loudly endorsed hormone therapy, presenting it as a “magic elixir.” However, experts emphasize the need for clarity around what MHT can and cannot do.
So, what is MHT? It supplies some of the estrogen and progesterone lost in menopause, alleviating symptoms such as hot flashes, night sweats, and painful sex. There are two broad categories of hormone treatment: systemic (affecting the whole body) and local (applied just to the vagina).
Systemic treatments contain either estrogen alone or a combination of estrogen and progestogen, which can lead to increased risk of endometrial cancer if not used properly. Women who have had their uterus removed can safely use estrogen alone. Local treatments applied to the vagina are lower-dose estrogen and mainly intended to address symptoms like vaginal dryness and pain with sex.
While MHT is not approved to treat dozens of other menopause symptoms, some patients may experience small improvements in those symptoms too. The Menopause Society notes that hormone therapy provides more effective relief and carries fewer risks for women suffering from vasomotor symptoms or genitourinary syndrome who are younger than 60 or less than a decade from their last period.
However, MHT is not recommended for women with a history of stroke, heart attacks, blood clots, liver disease, unexplained vaginal bleeding, or estrogen-sensitive cancers. Recent studies have found that the benefits of hormone therapy can outweigh the risks for symptomatic women younger than 60, but this varies depending on dose, delivery method, and age at initiation.
The landmark Women’s Health Initiative study was prematurely halted due to findings of increased breast cancer risk, but reanalysis has revealed a more nuanced picture. In many cases, the benefits of hormone therapy can improve quality of life, and for women taking estrogen alone, studies have consistently found that hormone therapy reduces breast cancer and cardiovascular risks.
Ultimately, it is essential to educate women about the real risks and benefits of MHT and determine whether it is appropriate for them. By understanding what MHT can do and who should use it, women can make informed decisions about their health and well-being during menopause.
Source: https://www.nytimes.com/2025/03/03/well/hormone-therapy-for-menopause-risks-and-benefits.html