Menopause symptoms can be challenging, and many patients ask whether hormone therapy might help. Below, Sharon Gabriele, WHNP-BC, MSCP, Menopause Certified Provider Nurse Practitioner, at Summit Health, answers common questions to help you understand your options. For more information, make an appointment with your healthcare provider.
Q. What menopause symptoms can hormone therapy treat?
A. Hormone therapy remains the gold standard treatment for symptoms, such as hot flashes and night sweats. It is FDA-approved for these symptoms, vaginal dryness and discomfort, and bone loss prevention in patients at increased risk of osteoporosis. Some providers may also prescribe it for sleep disturbance, mood changes, joint pain or brain fog.
Q. Should everyone take hormone therapy?
A. No. While it is an effective option for many patients, it’s not recommended for every patient or for general health or longevity. Whether hormone therapy is right for you is an individualized decision based on your symptoms, medical history, risk factors and personal goals.
Q. Can hormone therapy really protect my heart, bones or brain?
A. As mentioned, hormone therapy is FDA-approved to help prevent bone loss in patients at increased risk of osteoporosis. That said, it is not recommended solely for the prevention of heart disease, cognitive decline or dementia, diabetes or weight loss. Research in this area continues to evolve, and future recommendations may change as new evidence emerges.
Q. Are there risks to taking hormone therapy?
A. Yes, hormone therapy has potential risks, which vary based on the types of hormones used, the dose, duration, how it’s given, and your personal health history including your age. Early studies by the Women’s Health Initiative (WHI) found very small increases in risk for a small number of women, mainly related to breast cancer, cardiovascular events and blood clots, with specific hormone formulations.
Today, newer FDA-approved bioidentical hormone formulations, especially transdermal therapies, may carry lower risks for many patients. This is why personalized counseling with your provider is important.
Q. Are bioidentical hormones safer?
A. FDA-approved bioidentical hormones are safe and well-studied. Compounded hormones are not FDA-approved and have not been shown to be safer.
Q. Do I need blood tests to decide if I can take hormones?
A. No. Hormone levels fluctuate widely during perimenopause and menopause and blood testing is not required to determine whether hormone therapy is appropriate. Sometimes providers will test hormone levels during therapy, if needed, to guide optimal dosing.
Q. Can I start hormone therapy more than 10 years after menopause?
A. While the safest window is generally under age 60 and within 10 years of menopause, some women can safely use hormone therapy beyond that timeframe. As health risks evolve as we age, these decisions are more nuanced and depend on your symptoms, health history and personal goals.
Q. If I start hormones, do I have to take them forever?
A. No, most patients will gradually taper after symptoms improve. The timing should be guided by conversations with your provider.
Q. Will brain fog go away?
A. Yes, it usually improves over time, especially with better sleep and symptom control. Keeping your mind sharp, prioritizing sleep, exercise and addressing contributing symptoms can help.
Q. Can testosterone help me feel like my old self again?
A. Testosterone may help improve libido when low desire isn't related to stress, medications or other health conditions. It hasn’t been shown to reliably improve mood or energy. When used, is should be at low, female physiologic doses. For many people, improving sleep and managing stressors makes the biggest difference in how they feel.
Q. What if I can’t take hormones? What works instead?
A. If hormone therapy isn’t appropriate for you, there are still effective options. Several FDA-approved and off-label prescription medications can help treat hot flashes and non-hormonal approaches often focus on treating symptoms individually. Be cautious with supplements as most are not FDA-regulated, have limited or inconsistent evidence and can make symptom claims without proving safety or effectiveness. Some low-risk options may be reasonable, but it's important to discuss them with your provider.
Learn more.
New Jersey patients: Learn about our Menopause and Wellness Center here, or watch a recent webinar on How to Thrive in Menopause here or Menopause Hormone Therapy here.
Westmed patients: Learn about Women’s Health and Wellness Services here and register for an upcoming webinar on menopause led by Westmed doctors on Thursday, April 28. RSVP now.