It happens with some regularity. I offhandedly mention some bodily inconvenience to a fellow middle-aged woman – indigestion, a headache, a bad mood. Immediately, she says it’s perimenopause and suggests I try hormone therapy.
These moments give me whiplash. In 2002, when I was a medical student, a study frightened a generation of patients and clinicians by suggesting the risks of menopause hormone therapy (MHT) – blood clots, stroke and breast cancer – outweighed its benefits. Then, in 2012, scientists took a closer look at the evidence, along with new data, and found the calculus only applied to older women. Now, many clinicians are comfortable prescribing hormones. In fact, some are a bit too comfortable hawking them as a cure-all.
Timely treatment provides immense relief of menopause symptoms, and has the added benefit of lowering fracture risk. But ascribing all your ills to menopause and expecting treatment to fix them is a set-up for disappointment.
Here’s how to tell what’s hype and where menopause treatment can actually help.
Menopause is too often missed …
In a 2025 Mayo Clinic study, about one-third of women reported having pronounced menopause symptoms. But only 13% sought treatment, and the real-world number is probably even lower, says Nanette Santoro, a professor of obstetrics and gynecology and menopause researcher at the University of Colorado.
One issue is that menopause is not confirmed until a year after one’s last period, by which point “we’ve missed the window when they have been their most symptomatic”, Santoro says. But lack of appropriate care is also a factor: When women raise concerns about menopause symptoms with their clinicians, many are dismissed.
… and too often blamed
At the same time, menopause awareness is growing. Celebrity advocacy, social media, and a long-overdue cultural reckoning around women’s health have driven a demand for care.
But menopause isn’t the only thing that happens to women’s bodies with age. By the time women hit perimenopause, at least half already have a chronic medical condition. The same awareness that is finally getting women into doctors’ offices is also convincing them they need hormones for symptoms that may have other causes – or no cause at all.
“It can be tricky,” says Lauren Streicher, a gynecologist and menopause researcher at Northwestern University. “Is your mouth dry because you’re post-menopausal, because of the medication you’re taking, or because it’s just one of those things that happens as you get older?”
Why is there so much hype about MHT?
Claims that treatment reduces weight gain, prevents dementia, averts heart disease, prolongs life and confers “hormonal balance” – whatever that is – aren’t grounded in evidence.
That doesn’t stop influencers – even some who are credentialed clinicians – from making fantastical claims on social media that dramatically inflate estrogen’s abilities. Many are literally invested in the hype: products content creators sell account for about a third of the $10-15bn menopause market.
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Most of the loudest public voices making those claims are cherrypicking data, says Streicher. Last November, the Department of Health and Human Services secretary, Robert F Kennedy Jr, and the then Food and Drug Administration commissioner, Marty Makary, announced the removal of the black box warning on hormone therapy. They made inaccurate claims based on low-quality studies about MHT’s ability to prevent Alzheimer’s disease, stave off cognitive decline, and extend life by 10 years.
“Women are left wondering, ‘Who do I believe? My clinician, who I’ve been going to for 20 years and who seems real smart, but he or she doesn’t seem to know any of this stuff, or the person on social media who’s got 2 million followers?’” Streicher says.
What does MHT actually do?
Estrogen is MHT’s workhorse of symptom relief. In people with a uterus, it’s typically co-prescribed with progesterone, which prevents estrogen-related cancerous overgrowth of the uterine lining. (About one-fifth of peri- or newly menopausal women have had a hysterectomy and thus don’t need it.)
Bodywide estrogen treatment helps reduce hot flashes, night sweats and sleep disturbances due to the presence of estrogen receptors in the parts of the nervous system that control temperature regulation and sleep. Pills or transdermal (via the skin) estrogen applications like patches, creams or gels deliver it throughout the body via the bloodstream. The digestive route leads to the production of tiny quantities of blood clot-causing byproducts, so transdermal application may be safer for many women.
The female reproductive tract also has these receptors, so local therapy works for vaginal and bladder symptoms, such as itching, burning and dryness. Forms of estrogen that only have local effects include vaginal creams, suppositories and insertable rings.
When it comes to progesterone, pills are the best delivery mechanism, although IUDs can also be beneficial.
MHT can also have positive effects on cardiovascular and bone health, although it’s not recommended as first-line prevention for either. And it’s broadly safe: for most women who start hormones within 10 years of their last menstrual period or before the age of 60, the risks are low – even lower with transdermal or local estrogen.
Not all menopause treatment contains hormones. Women who can’t take estrogen – for example, because of a history of breast cancer – may get relief from a range of new and newly studied non-hormonal therapies.
How do I know whether MHT is for me?
Separating the real benefits of menopause therapy from myths can be challenging. Women who feel persistently powerless within medical establishments and in their own bodies may stake their hopes on MHT as a way to exert control.
It’s important to make the most informed decision you can. That might mean taking hormones when you hit menopause, but it might not. The best way to determine whether MHT can help is to consult with a clinician with up-to-date knowledge about menopause treatment and care. The Menopause Society and author and menopause expert Jen Gunter both offer guidance on finding and vetting practitioners.
