Hormone therapy (HT) is one of the most effective treatments available for women dealing with the physical and emotional effects of perimenopause and menopause. But it’s also a topic filled with outdated fears, media misconceptions, and conflicting advice.
At Old Mission Lifestyle Medicine, we believe in offering clear, evidence-based guidance—not sales pressure. This guide walks you through what hormone therapy is, how it works, who it helps, what the risks are, and how to know if it’s right for you.
What Is Hormone Therapy and How Does It Work?
Hormone therapy for women typically replaces declining levels of estrogen, progesterone, and sometimes testosterone. This decline usually begins in perimenopause (as early as your late 30s or early 40s) and becomes more dramatic during menopause.
There are several types of hormone therapy:
- Estrogen-only therapy (ET): Prescribed for women who’ve had a hysterectomy
- Combined estrogen-progesterone therapy (EPT): For women with an intact uterus to protect against endometrial hyperplasia
- Testosterone therapy: Sometimes used off-label to address low libido, fatigue, or muscle loss
Bioidentical vs. Synthetic Hormones
- Synthetic hormones (like conjugated equine estrogens in Premarin) are derived from animal sources or chemical compounds and may have slightly different structures than human hormones.
- Bioidentical hormones are chemically identical to those naturally produced by your body and are typically sourced from plants like yams or soy. These may be prescribed as FDA-approved products (like Estrace or Prometrium) or compounded formulations for customized dosing.
While both types can be effective, bioidentical hormone therapy (BHRT) may offer fewer side effects and more individualized dosing—but quality and regulation vary, especially with compounded versions.
What Symptoms Can Hormone Therapy Treat?
Hormone therapy is the gold standard for relieving common menopause symptoms, particularly:
- Hot flashes and night sweats
- Vaginal dryness, itching, and pain during sex
- Insomnia and disrupted sleep
- Mood swings, anxiety, and depression
- Brain fog and memory lapses
- Low libido
- Weight gain and slowed metabolism
According to the North American Menopause Society (NAMS), hormone therapy is the most effective treatment for vasomotor symptoms (hot flashes, night sweats) and genitourinary symptoms of menopause.
The Timing Hypothesis: Why When You Start Matters
The “Timing Hypothesis” is one of the most important factors in evaluating hormone therapy safety. Here’s what the data shows:
- Women who start HT before age 60 or within 10 years of menopause onset tend to experience the most benefit and lowest risk.
- Starting HT more than 10 years after menopause or after age 60 may increase the risk of cardiovascular events or stroke—particularly with oral estrogen.
In fact, a 2020 JAMA update from the Women’s Health Initiative (WHI) found that starting HT closer to menopause was associated with a 20–30% lower risk of coronary artery disease compared to late starters.
Benefits of Hormone Therapy: Short and Long-Term
In addition to symptom relief, hormone therapy may offer long-term health protection:
- Bone Density: Estrogen slows bone loss. HT reduces the risk of osteoporosis-related fractures by 30–40%.
[WHI Findings, 2020] - Heart Health: In early postmenopausal women, HT may reduce coronary heart disease risk by 30% if started within the timing window.
[KEEPS Trial, 2012] - Cognition: Emerging research suggests that HT initiated early may help preserve memory and reduce Alzheimer’s risk, though results are still mixed.
Risks of Hormone Therapy: What You Need to Know
Hormone therapy isn’t without risk—but those risks are often misunderstood. Here’s what the updated science says:
- Breast Cancer: Combined EPT (estrogen + progestin) is associated with a slight increase in breast cancer risk after 5+ years of continuous use. Estrogen-only therapy may decrease breast cancer risk in some groups.
[WHI 20-Year Follow-Up, JAMA, 2020] - Blood Clots and Stroke: Oral estrogen increases the risk of blood clots and stroke, especially in older women. Transdermal estrogen (patch, cream, gel) carries a much lower clotting risk and may be preferred.
- Gallbladder Disease: Slightly increased risk, particularly with oral formulations.
Personal risk varies based on your age, health status, genetics, and lifestyle. A provider trained in hormone therapy should review your full history and labs before making recommendations.
Who Should Avoid Hormone Therapy?
Hormone therapy may not be advised if you:
- Have a personal history of breast, ovarian, or endometrial cancer
- Have had a stroke, heart attack, or blood clots
- Have untreated high blood pressure or liver disease
- Are currently pregnant or trying to conceive
However, many women with “relative contraindications” may still benefit from localized or low-dose options—especially for vaginal symptoms.
Non-Hormonal Alternatives
HT isn’t the only option. Depending on your symptoms and preferences, you might explore:
- Prescription medications: SSRIs, SNRIs, and Gabapentin can reduce hot flashes
- Lifestyle changes: A Mediterranean-style diet, strength training, and stress management can support natural hormone regulation
- Supplements: Some women find mild relief from black cohosh, maca, or rhodiola—but results are mixed and should be discussed with a provider
We often use a stepwise approach, starting with diagnostics and lifestyle optimization before exploring hormone therapy.
Our Approach to Hormone Therapy at Old Mission
We don’t believe in one-size-fits-all protocols or hormone mills. Our team provides:
- Comprehensive diagnostics (including bloodwork, symptom mapping, and metabolic assessments)
- Personalized prescriptions using bioidentical hormones when appropriate
- Ongoing monitoring with regular lab reviews and symptom tracking
- Education and consent—so you understand your options, risks, and long-term plan
If hormone therapy isn’t right for you, we’ll say so. If it is, we’ll help you feel confident and supported every step of the way.
Still Wondering If Hormone Therapy Is Right for You?
You don’t need to figure it out alone.
We offer a free 15-minute discovery call with a hormone therapy specialist to:
- Review your symptoms and history
- Answer your questions about safety and options
- Help you understand your lab work or get tested
- Recommend next steps—whether that includes HT or not
Book your free call here or explore our full Women’s Hormone Optimization Program to learn more about what’s included.
Ready to take control of your health? Let’s create a plan that fits your needs and goals.