New data released today at The Menopause Society‘s annual meeting shows fewer people are opting for hormone replacement therapy for menopause, even though it’s been clinically proven1 to ease some of the toughest symptoms that come with this life transition—like hot flashes and night sweats.
Experts in This Article
OB/GYN and CEO and founder of Evora Women’s Health
medical director of the Menopause Society and director of the Mayo Clinic Center for Women’s Health
The research, conducted by the Mayo Clinic and soon to be published in Menopause, examined medical and pharmacy claims of people ages 40 and older enrolled in commercial insurance or Medicare Advantage over the course of 16 years. The study found that hormone therapy (HT) use was at around 4.6 percent in 2007, but then declined to 2.5 percent between 2007 and 2014, and then flatlined at 1.8 percent in 2023. These numbers demonstrate that menopausal people are opting less and less for hormone therapy as a form of treatment. But why?
Read on to learn more, including what the science actually says about HT’s potential benefits for menopause and overall health.
Why are fewer menopausal people opting for HT?
At one point in time, hormone therapy for menopause was one of the most prescribed treatments in the U.S. That changed in 2002 when the Women’s Health Initiative (WHI)—a large women’s health study sponsored by the National Heart, Lung, and Blood Institute—released a study that sent many people into a panic.
WHI researchers found that taking a specific combination of estrogen and progestin was associated with an increased risk of breast cancer, heart attacks, stroke, and blood clots2. Millions of people around the world quit their HT cold turkey as a result of this finding, according to a January 2004 paper in JAMA3.
Since then, numerous follow-up studies, which take into account things like age and pre-existing disease risk, have revealed more nuance. These newer studies show the benefits of HT often outweigh the risks, especially for young people and those closer to the onset of menopause. They’ve even discovered heart-protective benefits of HT, and reduced breast cancer risk for those who took estrogen alone, according to a May 2013 article in The Journal of Clinical Endocrinology & Metabolism4.
Despite this, the PR and media damage had already been done, as The Menopause Society’s numbers show. It’s been an uphill battle to bring HT back into the treatment conversation. Some people might still be scared by the 2002 findings, or their doctors might be hesitant to prescribe the treatment.
“It’s disappointing to say the least,” Stephanie Faubion, MD, OB/GYN, medical director of The Menopause Society and director of the Mayo Clinic Center for Women’s Health, tells Well+Good. “The WHI has remained a scary specter that we just can’t seem to shake. The people influenced during that time included physicians who are now training the next generation, so even though those of us intimately involved in the menopause space have followed the data and we know the subsequent analysis was much more favorable and reassuring, that message didn’t reach everybody.”
What’s the real risk of using hormone therapy for menopause?
While the WHI study in 2002 made it seem like everyone who takes HT is at risk of things like heart attack, stroke, blood clots, and breast cancer, newer studies have found the risk varies greatly from person to person and often depends on other health factors, per a February 2023 review in Circulation5.
This means, for most people, HT is a safe and effective treatment that can make the menopause transition more bearable. “The majority of women who are under the age of 60 and within 10 years of menopause onset mostly can take hormone therapy and the benefits tend to outweigh the risks,” Dr. Faubion says.
Still, for a smaller number of people, HT may not be the best choice. Generally speaking, this includes those who’ve had a previous heart attack or stroke, or people with a history of blood clots or breast cancer. Some people may even fall into a “gray area,” where they’ll need further assessment from their doctor to see if HT is right for them. Doctors will consider their age, family medical history, the type of hormone therapy used, and dosage before prescribing it.
Certain lifestyle choices can also reduce the risk of HT complications. For example, eating a well-balanced diet, getting regular exercise, maintaining a healthy weight for your body size, and watching your blood pressure and cholesterol levels can also help reduce your risk.
“I do a lot of explaining about the types of hormones we use now compared to what we used back in the ’90s when the WHI data started,” Becky Lynn, MD, OB/GYN, CEO and founder of Evora Women’s Health, tells Well+Good. “They are different and there are other risk factors for breast cancer in particular. Obesity is a risk factor. Alcohol is a risk factor. So if you put it into perspective, the hormones we use now are not going to increase your risk of breast cancer, and even with the ones that did, there are other equivalent risk factors out there.”
Of course, like with any medication, taking HT requires regular contact with your doctor to make sure its benefits continue to outweigh any potential risk.
So, what are the benefits of hormone therapy for menopause?
First and foremost, HT is a great first-line defense against uncomfortable hot flashes—which about 80 percent of people in menopause have, per a March 2019 review in the Journal of Mid-Life Health6. It may also help you sleep better by preventing night sweats, alleviate vaginal dryness (which could make sex during menopause more enjoyable), keep bones healthy and strong7, and regulate mood swings that can happen during the menopause transition, per the Mayo Clinic.
There are some long-term benefits, too: Taking HT within six years of starting menopause may help reduce your risk of heart disease, per a May 2022 study in The Cancer Journal8. It may also help slow biological aging, and therefore promote a healthy aging process, according to preliminary research in an August 2024 study in JAMA Network Open9.
In short: “We should not be shying away from [HT] for management symptoms in menopausal women who are good candidates,” Dr. Faubion says.
“Nobody has to suffer in silence with menopausal symptoms,” Dr. Lynn says. “There are so many benefits you can get from being on hormones.”
How to decide if HT is right for you
Choosing to try hormone therapy during menopause is a highly personal decision; it’s not a one-size-fits-all treatment. Your doctor can help walk you through the pros and cons, taking your menopause symptoms and overall health into consideration. They can also decide the best form of hormone therapy for you—like a pill, patch, or other topical methods like cream or gel.
That said, finding a doctor well-versed in hormone therapy can be challenging. According to Dr. Faubion, there’s a bit of an “educational vacuum.” Essentially, because doctors were hesitant to prescribe HT after the WHI’s initial findings, they ended up receiving less training over time on how to treat menopause symptoms. Case in point: An October 2023 study in Menopause10 found OB/GYN residents had only about 30 percent access to a menopause curriculum in their programs.
If medical professionals are still hesitant two decades after the initial WHI findings, what has to change to get people the support they need?
“I honestly think it’s going to be a groundswell of women demanding better,” Dr. Faubion says. “They’re not going to be satisfied with accepting nothing. They’re going to demand options and they’re going to demand that their providers be educated on this and that someone is able to actually address their symptoms in the office. That’s not what they’re getting right now.”
In other words, prepare to self-advocate
If you’re currently going through menopause and aren’t getting the care you need, don’t be afraid to speak up to your OB/GYN. “You need to be health-savvy going in to talk to your medical provider,” says Dr. Faubion. “But if they just say ‘I don’t believe in [hormone therapy]’ which I’ve heard from my patients, that just tells you, you need to find somebody else.”
If you need help finding a qualified doctor, The Menopause Society’s certified practitioner database can be a great resource.
Ultimately, the conversation around menopause treatment is changing for the better: Dr. Lynn has observed physicians requesting more training, patients realizing that treatment is safe and effective, and social media opening the floor for people to share their experiences. “I feel positive,” she adds. “I really, really do hope this is changing.”
—reviewed by Andrea Braden, MD, OB/GYN
Kaunitz, Andrew M., and JoAnn E. Manson. “Management of menopausal symptoms.” Obstetrics & Gynecology, vol. 126, no. 4, Oct. 2015, pp. 859–876, https://doi.org/10.1097/aog.0000000000001058.
↩︎Rossouw, Jacques E et al. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial.” JAMA vol. 288,3 (2002): 321-33. doi:10.1001/jama.288.3.321
↩︎Hersh ALStefanick MLStafford RS. National Use of Postmenopausal Hormone Therapy: Annual Trends and Response to Recent Evidence. JAMA. 2004;291(1):47–53. doi:10.1001/jama.291.1.47
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Roger A. Lobo, Where Are We 10 Years After the Women’s Health Initiative?, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 5, 1 May 2013, Pages 1771–1780, https://doi.org/10.1210/jc.2012-4070
Cho, Leslie, et al. “Rethinking menopausal hormone therapy: For whom, what, when, and how long?” Circulation, vol. 147, no. 7, 14 Feb. 2023, pp. 597–610, https://doi.org/10.1161/circulationaha.122.061559.
↩︎Bansal, Ramandeep, and Neelam Aggarwal. “Menopausal Hot Flashes: A Concise Review.” Journal of mid-life health vol. 10,1 (2019): 6-13. doi:10.4103/jmh.JMH_7_19
↩︎Stevenson, John, and medical advisory council of the British Menopause Society. “Prevention and treatment of osteoporosis in women.” Post reproductive health vol. 29,1 (2023): 11-14. doi:10.1177/20533691221139902
↩︎Hodis, Howard N, and Wendy J Mack. “Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It Is About Time and Timing.” Cancer journal (Sudbury, Mass.) vol. 28,3 (2022): 208-223. doi:10.1097/PPO.0000000000000591
↩︎Liu YLi C. Hormone Therapy and Biological Aging in Postmenopausal Women. JAMA Netw Open. 2024;7(8):e2430839. doi:10.1001/jamanetworkopen.2024.30839
↩︎Allen, Jennifer T et al. “Needs assessment of menopause education in United States obstetrics and gynecology residency training programs.” Menopause (New York, N.Y.) vol. 30,10 (2023): 1002-1005. doi:10.1097/GME.0000000000002234
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