Age and Starting Menopausal Hormone Therapy

Risks and Recommendations

Just as there is a spectrum for the benefits of hormone therapy (ranging from “yes and likely to help”, to “might help”, to “not recommended”), there is also a spectrum for risks. Meaning, we can also divide people into low-risk, medium-risk, and high-risk (i.e., hormones are contraindicated) categories. 

(If you are new to this series on the hormone menoverse, you can find the Table of Contents here, with links to the topics already covered). 

Before we go any further, I want to remind people that no professional society recommends menopausal hormone therapy (MHT) for the prevention of cardiovascular disease or dementia, or for increasing longevity. Here is a quote from the 2022 Menopause Society Guidelines, “Long-duration hormone therapy use and use in older women is not appropriate for reduction in the risk of coronary heart disease or dementia."

I bring this up because I know there are people, some who are even doctors, making claims that incorrectly suggest otherwise. This gives a lot of women estrogen FOMO (fear of missing out). I’ve also seen social media posts where women encourage other women to mislead their providers about symptoms, suggesting they might claim to have severe hot flashes in order to get estrogen for “protection” against heart disease or dementia. I’m not really what to say about this, except suggesting that people lie to their health care provider makes you no one’s ally. And I’ll say it once again: if the data showed that every single woman should start hormone therapy, those would be the recommendations from all the medical professional societies. And it’s not.

Every menopause society considers MHT safe for the following people, assuming it is being prescribed for hot flashes or night sweats, or for the yellow light reasons: