Is hormone therapy for the menopause safe and worthwhile?
Hormone therapy is worthwhile for menopausal symptoms and bone protection, but safety depends strongly on when you start, which type you use and whether you have a uterus. Discuss the trade-offs with your doctor.
Hormone therapy is the most effective treatment for hot flushes and night sweats during the menopause. It also demonstrably reduces vaginal dryness and painful intercourse. If you only have vaginal symptoms, a low-dose vaginal oestrogen cream or tablet is often sufficient, and you do not need to use systemic hormones.
Timing makes a big difference. Women who start within ten years of the menopause or before the age of sixty have a more favourable balance of benefits and risks. Starting much later shifts the balance, with greater risks of heart disease, stroke, pulmonary blood clots and dementia. HT also demonstrably protects against bone loss and fractures, including hip fractures.
The breast cancer risk differs considerably by type of therapy. Combination therapy (oestrogen together with a synthetic progestogen) increases this risk: in a large American study, there were more than 28% more breast cancer diagnoses per 10,000 women per year compared with the placebo group, and that elevated risk persisted in part after stopping. Oestrogen alone, which is only possible after a hysterectomy, actually showed a lower breast cancer risk over the long term. When a progestogen is needed, natural progesterone appears safer for the breast than the older synthetic variants, although this evidence is indirect.
Combination therapy also increases the risk of stroke and pulmonary blood clots. Hormones delivered via a patch or gel have less influence on blood clotting than those taken as a pill, and are therefore the preferred recommendation. For women whose menopause begins before the age of forty, hormone therapy is especially important: without treatment, they are already at risk of osteoporosis and cardiovascular disease at a younger age.
One point to keep in mind: HT is not intended as prevention of chronic diseases such as dementia or cardiovascular disease as a sole reason. The indication is relief of symptoms, not disease prevention in itself. And it shows no demonstrable effect on overall mortality. Whether HT is the right choice for you depends on your symptoms, age, the time elapsed since the menopause and your medical history. Always discuss this with your doctor.
This answer is based on the large American Women's Health Initiative (WHI), a randomised study with long-term follow-up, supplemented by multiple reviews and guideline publications. The WHI provided the most robust figures on risks, but had the limitation that many participants were older and had started hormone therapy long after the menopause, which influenced the results. The timing conclusions come in part from reanalyses of those same data. The evidence comparing natural progesterone with synthetic progestogens is neither direct nor derived from randomised studies with clinical endpoints, which makes it somewhat weaker.
Does hormone therapy help women age more healthily?
Hormone therapy relieves menopausal symptoms well and shows positive indications for bones and metabolism, but the effects on the heart and brain are uncertain and highly individual. Whether it is worthwhile for you depends strongly on your symptoms, timing and health history: discuss it with your doctor.
Which hormone levels are tested during menopause?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
Which supplements actually help with menopause?
Red clover isoflavones and black cohosh have the strongest evidence for reducing hot flashes; soy isoflavones also help to some extent. For bone health, vitamin D is well supported. The effects are modest, and for severe complaints it is best to discuss the options with your doctor.
Does testosterone help after 50, and is it dangerous?
Testosterone can be worthwhile for men over 50 with a medically confirmed testosterone deficiency, but it is not a treatment for everyone who is getting older: the benefits are real, the risks are too, and a doctor must establish the indication.
Does the menopause disrupt my sleep, and what can help?
The menopause genuinely disrupts your sleep, mainly through hot flushes and hormonal changes. A talking therapy designed specifically for sleep problems is the best first step; hormone therapy or melatonin may come into the picture after that.
What does menopause do to your risk of cardiovascular disease?
Menopause demonstrably increases your risk of cardiovascular disease, primarily through unfavourable changes in fat distribution, cholesterol, and blood pressure. If you experience early menopause or are considering hormone therapy, discuss your personal risk profile with your doctor.