Hormones in menopause — rethought

Few topics are as riddled with half-truths as hormone therapy for menopause. The truth lies somewhere between “the devil’s work” and “a miracle cure for aging.”

Modern, individually dosed hormone therapy is considerably safer and more nuanced today than its predecessors from the nineties. The prerequisites are a careful medical history and a clear indication.

The uncertainty has a history. In the early 2000s, a large American study — the Women’s Health Initiative — reported increased risks under hormone therapy, and prescriptions collapsed worldwide. Only in the years that followed did it become clear how much those results needed context: the study had mainly looked at older women, many years past menopause, using preparations and doses that play hardly any role today.

Today we know that what matters most is the age at which treatment starts, the time since the last period, the preparation and the route of administration. Estrogen through the skin — as a gel or patch — puts less strain on the metabolism than tablets, and micronized progesterone is considered a well-tolerated way to protect the uterine lining. When therapy begins before 60, or within about ten years of menopause, the balance of benefits and risks is often favorable for healthy women — though this can never be promised across the board; it remains a case-by-case decision.

None of which means that every woman needs hormones. The reason to treat is symptoms that noticeably affect daily life — hot flashes, sleep problems, low mood, vaginal dryness; for instance, when lack of sleep and exhaustion start to wear on your work and relationships. Hormone therapy is not a remedy against aging, and we do not prescribe it as one.

How do we proceed? We start with an in-depth conversation and a thorough examination: your symptoms and your history, family risks, blood pressure, the state of your screening. Then we discuss which treatment suits you — and deliberately begin with a low dose, adjusting it as needed. At least once a year, we put the therapy to the test together: is it still needed — in this form, at this dose?

And if hormones are not an option for you, for medical reasons or simply because you don’t want them? That is not a dead end. There are non-hormonal medications for hot flashes, local treatments for vaginal dryness and a number of things you can do yourself — from exercise to sleep habits. And sometimes, understanding your own situation is already a tangible relief. We talk about all of it openly.

Menopause is not an illness. But neither is it a condition you simply have to endure. If symptoms are weighing on you, come and see us — together we will find the path that suits you.