Menopausal hormone therapy: what the evidence actually says now

What it reliably does

Menopausal hormone therapy is the most effective treatment available for vasomotor symptoms — hot flushes and night sweats — and that is not seriously disputed. It also treats genitourinary syndrome of menopause, where low-dose vaginal oestrogen is highly effective with minimal systemic absorption, and it preserves bone density and reduces fracture risk while it is being taken.

What the 2002 headline actually found

The trial that changed practice studied a specific combination, at a specific dose, in women whose average age was well past sixty — many of them more than a decade past menopause. Subsequent analysis by age group found the risk-benefit balance looks substantially different for women who begin therapy near the onset of menopause and under sixty. That observation — usually called the timing hypothesis — is now reflected in major society guidance, which no longer recommends a blanket age cut-off or a fixed stop date.

The risks, stated plainly

Oral oestrogen raises venous thromboembolism risk; transdermal routes appear to carry less of that risk, which is one reason route is a real clinical decision rather than a preference. Combined oestrogen-progestogen therapy is associated with a small increase in breast cancer risk that grows with duration of use. Women with a uterus need a progestogen alongside oestrogen to protect the endometrium — oestrogen alone is not an option. Personal and family history of breast cancer, clotting disorders, stroke, liver disease and unexplained vaginal bleeding all change the calculation.

What we will not tell you

That a compounded preparation is safer or more natural than an approved one because it is compounded. That claim is not supported, and compounded drugs are not FDA-approved and have not been evaluated by FDA for safety or effectiveness. Approved products exist for most of what is prescribed here, and where one fits, it is usually the better answer. Whether hormone therapy suits you, in what form and by what route, is a genuine clinical decision that belongs to a physician who has your labs and your history.

AZZA Medical is not a medical provider and does not practice medicine. Medical services are provided exclusively by independently licensed physicians of our partner physician network and their affiliated professional entities.

Compounded drugs are not FDA-approved and have not been evaluated by FDA for safety or effectiveness.

This is not emergency care. AZZA Medical does not provide urgent or emergency medical services. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room.