Your Guide to Modern Hormone Therapy

According to Dr. Elizabeth Poynor, Atria's Chair of Women's Health and Gynecology, this can alleviate some of the symptoms that accompany this change, including hot flashes, painful sex, brain fog, osteoporosis, mood, sleep issues, and dozens of other symptoms that too often go untreated.

Each woman’s care is nuanced and requires a detailed and ongoing conversation with your physician. "However, we want all women to understand that for most women, MHT, when correctly timed and dosed, is a safe way to improve the symptoms of menopause and perimenopause,"says Dr. Poynor. In many cases, it has meaningful benefits for long-term heart and brain health as well.

• Decreased hot flashes and night sweats
  • This results in improved sleep, less irritability, greater concentration, and improved quality of life
• Decreased dryness and thinning of the vaginal and vulvar tissues, which can alleviate painful intercourse and unpleasant urinary symptoms
• Improved bone health, including reduced risk of fracture and decreased joint pain
• In women who do not have heart disease at the onset of menopause, improved lipid profiles and a reduced risk of atherosclerosis, which is caused by plaque build-up in the arteries
• Decreased risk of insulin resistance, type-2 diabetes, and colorectal cancer
• Menopause is associated with central weight gain; MHT can attenuate weight gain (though it does not lead to weight loss)
• If initiated during perimenopause or within five years of menopause, MHT can help protect against dementia
• Anecdotally, many women report that MHT helps minimize the brain fog and mood changes they can experience during midlife

• Many women worry that MHT increases breast cancer risk. Here’s what a large body of research shows: Estrogen alone does not increase risk; use of natural progesterone and estrogen does not increase risk for up to five years of use; synthetic progestin, when used for MHT, does increase breast cancer risk and as such, it is no longer routinely prescribed
• Oral preparations of estrogen can increase the risk of clotting; transdermal preparations do not carry the same risk
• Oral estrogen can increase the risk of stroke; the risk increases with age and decreases at lower doses of oral estrogen and with transdermal preparations
• Using estrogen without progesterone can increase the risk of endometrial cancer in women who have a uterus, which is why we recommend using the hormones together
• Certain preparations of MHT can increase the risk of venous thrombosis. This risk is not present when using transdermal estrogen and oral micronized progesterone

The Women’s Health Initiative was a large, long-term study launched in 1991 by the National Institutes of Health (NIH) to address the most common causes of death, disability, and poor quality of life in postmenopausal women. The results were complex and nuanced, and unfortunately, many of the findings were misconstrued or extrapolated incorrectly, leading to widespread confusion and fear about the safety of Hormone Therapy.

It is important to look more closely at the data in the study, which came out in 2002. The data showing an increased risk largely applied to women who started taking MHT at an older age—the average age of the women studied was 63, with some participants as old as 79, whereas the average age of menopause onset is 51 in the United States. Moreover, while the research showed that estrogen and a synthetic progestin increases one’s breast cancer risk, the relative risk was not high, and these preparations are no longer in widespread use.

We now know that starting MHT at a younger age is safer and far more beneficial, and we also know that the formulations of estrogen and progestogen used in the 1990s were not as safe as those commonly used today.

• Timing is key: Starting MHT during perimenopause or within five years of menopause is ideal
• It is still a good option if you are within 10 years of menopause or younger than 60
• Preparations matter: Transdermal estrogen and natural progesterone are generally the best choices
• Personalization—and conversation—are a must: Assessing personal health and risks, monitoring symptoms and side effects closely and sharing them with your physician is the key to the safest and best outcome for you