For centuries, menopause was viewed as a natural transition that women navigated with varying degrees of support. Today, however, it can sometimes feel as though the pendulum has swung in the opposite direction. Social media is flooded with menopause influencers, celebrities are openly discussing hormone therapy, and many women are hearing the message that they simply need hormones to feel like themselves again.
While hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), can be life-changing for some women, it’s worth asking an important question:
Have we started treating menopause as a disease instead of a normal stage of life?
Menopause Is a Natural Transition
Unlike conditions where the body fails to produce hormones prematurely because of disease, menopause is a biologically programmed stage of life. As women transition through menopause, ovarian production of estrogen and progesterone naturally declines, marking the end of the reproductive years. However, this doesn’t mean hormone production stops entirely. The adrenal glands, fat tissue, and other organs continue to produce or convert hormones, and women often have decades of healthy, vibrant life ahead after menopause.
Of course, that doesn’t mean symptoms aren’t real. Hot flashes, sleep disturbances, mood changes, vaginal dryness, brain fog, and joint pain can significantly affect quality of life for many women.
Recognizing menopause as a natural transition doesn’t diminish these challenges, it simply broadens the conversation. Rather than assuming hormone therapy is the only answer, it encourages us to ask whether each woman’s symptoms, health history, and goals warrant hormone therapy, or whether there are multiple evidence-informed ways to support her through this stage of life.
Hormone Therapy Isn’t the Same as Birth Control but They Share Some Similarities
A common misconception is that hormone therapy and birth control are completely different. While they are prescribed for different purposes and contain different hormone formulations and doses, both involve giving hormones from outside the body to alter hormone signaling.
Birth control is designed primarily to prevent ovulation and pregnancy and given in higher doses. However, birth control has become the standard of treatment for many women’s health concerns such as heavy and painful periods, endometriosis, and PCOS (not PMOS).
Menopausal hormone therapy is intended to replace some of the estrogen (and sometimes progesterone) that naturally declines during menopause in order to reduce symptoms. They are usually dosed in lower amounts and formats can vary from pills and patches to creams and troches.
Although they both use hormones, they are not interchangeable medications and should not be viewed as the same treatment. But bottom line, they are both exogenous hormones, meaning hormones that come from outside the body.
What Hormone Therapy Can Help With
For appropriately selected women, hormone therapy may provide some symptomatic relief and benefits.
It may help:
- Moderate to severe hot flashes
- Night sweats
- Sleep disruption related to vasomotor symptoms
- Vaginal dryness and painful intercourse
- Prevention of bone loss in some women
- Improvements in quality of life for women with significant symptoms
For women who enter menopause early or experience premature ovarian insufficiency, hormone therapy may provide important health benefits until the average age of natural menopause.
The Other Side of the Conversation
The current enthusiasm surrounding hormone therapy can sometimes make it seem like the obvious (or only) solution.
However, there are important considerations that deserve discussion.
Finding the Right Dose Can Take Time
Hormone therapy isn’t one-size-fits-all. Women often require adjustments in dose, formulation, or delivery method before finding what works best.
Symptoms May Return When Stopping
Many women notice that hot flashes or other menopausal symptoms return after discontinuing hormone therapy. Hormone therapy can mask symptoms while it’s being used, and some women continue to experience symptoms after stopping. I’ve found that these symptoms can sometimes return to a severe degree if hormone therapy is discontinued post-menopause.
Hormone Therapy Doesn’t Address Every Root Cause
Not every symptom during midlife is caused solely by changing estrogen levels. Estrogen is only one piece of a much larger hormonal picture.
Hormones such as cortisol, DHEA, testosterone, thyroid hormones, insulin, and even melatonin all influence energy, mood, sleep, cognition, muscle mass, libido, and overall well-being. Chronic stress, poor sleep, nutrient deficiencies, metabolic dysfunction, and changes in adrenal function can all contribute to symptoms commonly attributed to menopause. While much of the menopause research has focused on estrogen because of its role in reproductive aging, other hormonal systems often receive less attention despite their impact on how a woman feels.
Taking a whole-person approach means looking beyond estrogen alone and considering the broader hormonal and metabolic factors that may be contributing to symptoms.
If these underlying issues aren’t addressed, some women may continue to struggle despite hormone therapy and in some cases, feel worse.
Prescribing Practices Vary Widely
One challenge in menopause care is the lack of consistency among practitioners.
Some clinicians follow current major medical society guidelines closely. Others rely heavily on individualized protocols. Some providers test hormones before prescribing. Other providers don’t test hormones at all.
As a result, two women with similar symptoms may receive very different recommendations depending on who they see.
This variation can make it difficult for patients to know which approach is best and highlights the importance of working with a knowledgeable clinician who explains the risks, benefits, and uncertainties.
A Whole-Person Approach
Hormone therapy is one tool, but it isn’t the only tool.
Many women benefit from addressing:
- Nutrition
- Exercise and muscle strength
- Stress resilience
- Sleep quality
- Blood sugar regulation
- Nutrient deficiencies
- Thyroid health (also known as “thyropause”)
- Gut health
- Targeted herbal medicine
- Appropriate supplementation
For some women, these interventions significantly improve symptoms. For others, they complement hormone therapy and allow for lower doses or better overall health.
The Bottom Line
Hormone therapy should neither be feared nor viewed as a cure-all.
It’s one treatment that may offer benefits for some women, particularly those with moderate to severe menopausal symptoms. At the same time, menopause is not a disease that automatically requires medication, and there are many paths to supporting women through this transition.
As Dr. Aviva Romm so aptly explains, “While Menopause Hormone Therapy can be tremendously helpful, menopause is not a hormone deficiency, and this narrative is being used to medicalize for profit.”
It’s also worth considering that women in some parts of the world report fewer or less severe menopausal symptoms than women in North America. While cultural differences, genetics, diet, lifestyle, healthcare practices, and even the way symptoms are perceived and reported likely all play a role, it raises an important question: What factors in the lives of American women may be influencing their experience of menopause?
The best treatment plan is one that considers the whole person, not just hormone levels. Every woman deserves individualized care, informed consent, and a thoughtful discussion of all available options and not feel pressure by an influencer on social media, their friends, or even healthcare providers to pursue treatments that don’t align with their views on their body and health.
