Hormone Therapy Is Proven to Ease Menopause Symptoms—But Fewer and Fewer People Are Using It Here’s why doctors think women aren't choosing hormones, as well as what you need to know about the risks and benefits of this treatment
The use of hormone therapy to ease menopause symptoms continues to decline in the United States, despite research showing that the treatment is effective and safe for most people
- Hormone therapy has been shown to be an effective and safe way to ease menopause symptoms, but a survey found that fewer and fewer women in the United States are using the treatment.
- Only 1.8% of women over 40 used hormone therapy to treat symptoms of menopause in 2023, the survey found, down from 2.5% between 2007 and 2014.
- Experts say that the low numbers stem from misinformation and a lack of opportunity to learn about hormone therapy as a treatment option.
Hormone therapy, a pill or patch containing estrogen or a mix of estrogen and progesterone, has been found safe and effective for treating menopause symptoms such as hot flashes and night sweats. Yet the number of women in the United States using it for this purpose continues to drop.
That’s the major takeaway from a new study presented at The Menopause Society’s annual meeting, which found that just 1.8% of U.S. women over 40 used hormone therapy to treat symptoms of menopause in 2023. That compares to 4.6% in 2007 and 2.5% between 2007 and 2014.
Researchers found a decrease in hormone therapy use across all age groups—women aged 45 to 49, 50 to 54, and 55 to 59, which is within ten years of the mean age of menopause (technically defined as going without a period for a year).
Here’s why doctors think women aren't choosing hormone therapy, as well as what you need to know about the risks and benefits of this treatment.
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Why Did Hormone Therapy Use Drop?
While study author Stephanie Faubion, MD, medical director of The Menopause Society, told Health that the exact reason why fewer women are using hormone therapy than they were in 2007 is “unclear," experts think that the low numbers indicate a general skepticism about the treatment.
The distrust of hormone therapy stems from preliminary results of a clinical trial published in 2003 as part of the long-term Women’s Health Initiative (WHI), which linked hormone therapy to a higher risk of developing serious health conditions, including heart disease and stroke. The results prompted swift action—researchers halted the study early, and millions of women went on to avoid hormone therapy.
But other researchers later debunked the study, finding that the data was skewed because participants were 65 and older and already had a higher risk of stroke, blood clots, and heart attack. The WHI study also didn’t look at how old the women were when they started hormone therapy.
The researchers of the original study even came out with a review of their work in May, suggesting that it’s safe for most women to take hormone therapy to alleviate menopause symptoms.
“There remain lingering fears about the safety of hormone therapy,” said Faubion, who's also a professor of medicine and chair of the Department of Internal Medicine at Mayo Clinic Women’s Health Clinic. “There is also a dearth of menopause education for medical professionals, which has contributed to the problem.”
Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, agrees. “There is a basic mistrust of pharmaceutical companies and doctors, and there is still a lot of misinformation among women and clinical physicians as well."
At the same time, Streicher points out that many women who are going through perimenopause, the symptomatic period leading up to menopause, lack access to care or don’t go to the doctor. “They’re no longer having babies, and a lot of them only go to the doctor if they’re sick or have a problem,” said Streicher, author of Hot Flash Hell. “They’re not going to the doctor for an annual exam to learn about their options.”
When you combine that with rampant misinformation about the latest data on hormone therapy, it can be difficult for women even to know this is an option, Streicher said. “A lot of women aren’t even being offered hormone therapy,” she said. “Many doctors say hormone therapy is a last resort.”
What Are the Risks of Taking Hormone Therapy?
“The risks of hormone therapy vary and also vary based on factors, such as ethnicity, BMI, comorbidities, and also age of starting hormone therapy post-menopause,” Jessica Shepherd, MD, a gynecologic surgeon at Baylor University Medical Center, founder of Modern Meno Health, and author of the upcoming book Generation M, told Health.
“There is a small increased risk for breast cancer in the group that takes the combination of estrogen plus a progestogen,” Faubion said.
But she also stressed that the risk “is similar in magnitude to lifestyle factors such as overweight/obesity, alcohol use, and being sedentary—about one extra case per 1,000 women after five years of treatment—but not in the estrogen-alone group.”
There may also be an increased risk of dementia if you start hormone therapy after the onset of menopause. However, starting the treatment within ten years of hitting menopause “ does not increase the risk of dementia,” Streicher said, and may, in fact, protect against it, especially for women taking estrogen-based treatments.
It’s a good idea to talk to a doctor if you have a history of stroke, heart attack, history of or inherited risk for blood clots, hormone-dependent cancer, severe liver disease, or unexplained vaginal bleeding because these are contraindications for hormone therapy, Faubion said.
What Are the Benefits?
Since the WHI results were published in 2003, a bulk of research has found that hormone therapy can help ease symptoms of menopause.
“With hormone therapy, hot flashes improve, bone density is protected, and fracture risk is reduced,” Faubion said. “There is likely some heart benefit—and reassuringly, no harm—when started in women under age 60 and within ten years of menopause onset.”
What To Do If You’re Interested in Hormone Therapy
According to Faubion, “Women who are under the age of 60 and within ten years of menopause onset who are experiencing bothersome menopause symptoms and do not have a contraindication are likely candidates for HT use.”
If you’re interested in or curious about hormone therapy, Shepherd recommends having a conversation with a healthcare professional who is knowledgeable about menopause. “An experienced menopause expert can explain the differences in hormones, the modalities, and how they’re taken and also the outcomes expected with the use of hormone therapy,” Shepherd said.
Streicher agrees. “You have to see a menopause expert,” she said. “Like everything in medicine, it’s individualized and should involve shared decision-making.”
If you’re having trouble finding a doctor, the Menopause Society has a database of member providers accepting new patients, some of whom have been designated as certified menopause practitioners.
But hormone therapy isn’t for everyone. Faubion recommends that those who aren’t a good candidate for the treatment or who are uninterested in it consider non-hormonal options like Veozah (fezolinetant), as well as some antidepressants and other medications used off-label like oxybutynin and gabapentin. “Additionally, cognitive behavioral therapy and hypnosis may provide some relief for some women,” she said.
This story originally appeared on: Health News - Author:Korin Miller
