A lot of women were told years ago that hormone therapy was simply dangerous. The picture since then is more nuanced: for many women it is a reasonable, well-studied option, and for some it isn't. Where you land depends mostly on your age, how long it has been since your last period, and your health history.
The Menopause Society's 2022 hormone therapy position statement calls estrogen the most effective treatment for hot flashes and night sweats. FDA-approved estradiol products are also labeled for vaginal dryness and for helping prevent bone loss after menopause. Labeling is just as clear that estrogen should not be used to prevent heart disease or dementia.
Much of the old fear traces back to the Women's Health Initiative, a large trial whose participants averaged about 63 years old, many of them well past menopause. Later analyses found that the balance of risks and benefits looked different depending on age and time since menopause. The 2022 statement concludes that for women under 60, or within 10 years of menopause, who have no contraindications, the benefits generally outweigh the risks for treating bothersome hot flashes and preventing bone loss. Starting after 60, or more than 10 years out, the balance is less favorable because the absolute risks of heart disease, stroke, blood clots, and dementia are higher.
If your periods stopped before 45, whether naturally, from primary ovarian insufficiency, or after surgery to remove the ovaries, the guidance leans toward treatment. The Menopause Society advises that these women, if they have no contraindications, use hormone therapy at least until around the average age of natural menopause, about 52.
Estradiol labeling lists situations where it shouldn't be used, including unexplained vaginal bleeding, known or suspected breast cancer or another estrogen-dependent cancer, a current or past blood clot in the legs or lungs, a past stroke or heart attack, liver disease, a known clotting disorder, and pregnancy. If you still have a uterus, estrogen on its own raises the risk of endometrial cancer, so a provider will pair it with a progestogen. How tablets, patches, and gels compare is covered in our guide to estradiol gel, patch, or tablet.
There is no automatic cutoff. The 2022 statement does not support routinely stopping hormone therapy at age 65; instead, the decision is revisited with your provider over time, weighing symptoms, bone health, and changing risks. FDA labeling likewise asks that the need for estrogen be reassessed periodically. While you are on it, contact a provider promptly about any vaginal bleeding after menopause or a new breast lump, and get emergency care for sudden chest pain, shortness of breath, leg pain or swelling, a sudden severe headache, or changes in vision or speech.
If symptoms are only starting and you're not sure what's going on, our guide to what perimenopause feels like is a good first read. Every Urania hormone therapy program begins with an intake that a licensed provider reviews. They decide whether estrogen fits you at all, and if so, which form and dose.
This guide explains general information and is not medical advice. It doesn't replace a licensed provider reviewing your own history.
