Is hormone therapy in the menopause safe? What is commonly misunderstood
Menopause treatment and bioidentical hormone therapy (HRT) explained from current medical guidelines: what the WHI study actually showed, and who benefits.
The menopause is a natural stage of life, but as oestrogen falls it can bring complaints that reach directly into daily life: hot flushes, disturbed sleep, brain fog, weight gain and vaginal dryness.
Many women live with these symptoms without seeking help, because of second-hand or incomplete information. The most common hesitation is the question: does hormone therapy cause cancer?
The WHI study and what is understood today
The Women's Health Initiative study, published in 2002, presented the risks of hormone therapy in an exaggerated way; detailed reviews in the years that followed exposed methodological problems in it. According to current guidance from the International Menopause Society and the British Menopause Society, for modern bioidentical hormone therapy applied through the skin and started before the age of 60 or within the first 10 years of the menopause, the benefits considerably outweigh the risks.
What bioidentical hormone therapy means
Instead of synthetic hormones, these preparations use molecules identical in structure to the hormones the body produces itself. The dose is set individually. Alongside relieving hot flushes, this approach helps reduce the risk of bone loss (osteoporosis) and of cardiovascular disease.
Is hormone therapy necessary in early menopause?
In premature ovarian insufficiency under the age of 40, or in early menopause, hormone therapy is recommended not only to relieve symptoms but to protect bone, heart and brain health — and it is recommended until the usual age of the menopause, around 51.
Why the assessment has to be individual
Menopause care cannot be delivered as a single standard prescription. It is planned after a detailed look at the person's lifestyle, diet, physical activity and personal medical history.
For the detail behind each of these points, see menopause treatment and bioidentical hormone therapy.