Who Should Take Menopausal Hormone Therapy?

A practical guide to the hormone menoverse

The idea that every woman should take menopausal hormone therapy or MHT (meaning estrogen and a progesterone or progestin if they have a uterus) appears to be gaining traction in the media and online. Almost every article I read (and that I am interviewed for) feels as if it is trying very hard to reach the conclusion of “estrogen for all my friends.”

And for those who miss the articles and the influencers, there are deceptive questionnaires. Like the one from Alloy that I recently completed. I specifically stated that I was a 57 year old woman in menopause for 7 years with no symptoms, just to see what happened. I was offered transdermal MHT because it helps with “none.” This is not reflective of the guidelines.

Then I filled the questionnaire out again, this time as a 63 year old who was more than 10 years from her last period, someone who based on age and time since last period should not be offered a new start for menopausal hormone therapy…and this time they offered me oral estrogen for no symptoms! Oral estrogen is even a worse option for a 63 year old with no symptoms compared with transdermal!

So, it’s easy to see how people reach the false conclusion that everyone should have estrogen in menopause.

Okay, so if everyone doesn’t need hormone therapy, then who does?

Thinking About what “Should” Means in this Context

When people discuss MHT in this context they mean preventative care. In medicine, when we say someone should be on a preventative therapy, that typically means we have good data that one or more significant health outcomes will be improved by this therapy and that the benefits outweigh the risks. For example taking folic acid to prevent neural tube defects during pregnancy is something everyone should take before getting pregnant. Another one is statin therapy for adults ages 40-75 years with a 10% risk of having a heart attack or stroke in the next 10 years, as it lowers that risk.

Should in this context only applies to menopausal hormone therapy for one reason: