Let’s be honest: the story of hormone therapy (HT) has been a rollercoaster of hype, fear, misinformation—and finally, clarity. In their latest expert review, Drs. Levy and Simon strip away the noise and give us a much-needed refresh on what we actually know about menopausal hormone therapy in 2024.
What’s the Big Idea?
HT has been misunderstood for decades. Much of this confusion traces back to the Women’s Health Initiative (WHI), a large study released in 2002 that scared everyone off hormones based on data that… well, didn’t apply to most menopausal women. (More on that in a moment.)
But today, we know better. Thanks to better research, smarter formulations, and a deeper understanding of timing and physiology, the evidence is clear: hormone therapy is safe and beneficial for most women—especially when it’s started early and tailored to the individual.
Timing Is Everything
One of the biggest takeaways? The “timing hypothesis”. Starting HT within 10 years of menopause (or before age 60) reduces risks of heart disease, osteoporosis, and all-cause mortality. Wait too long, and the cardiovascular benefits fade, although there are still other benefits that you can reap!
Not All Hormones Are Created Equal
The WHI studied an outdated combo of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in older, asymptomatic women. Today’s options are wildly different—and far safer. The article outlines how bioidentical estradiol and micronized progesterone (molecularly identical to what your body makes) are associated with:
- Lower cardiovascular risk
- Better bone health
- Fewer blood clots with oral estradiol as opposed to oral CEE (no increase in blood clots with estradiol through the skin)
- No increase in breast cancer incidence when used appropriately
It’s like comparing an old rotary phone to a modern smartphone. Both technically “phones,” but wildly different user experiences.
The Breast Cancer Myth, Busted (Again)
One of the most persistent myths? That HT “causes breast cancer.” The authors dismantle this with clarity:
- Estrogen-only therapy (CEE) was shown to decrease breast cancer risk and mortality in WHI follow-up.
- Combined HT with MPA? No increased mortality. The risks were overblown and misunderstood—mostly due to a weirdly low breast cancer rate in the placebo group.
Translation: It’s time to stop letting bad headlines shape women’s health.
Brain, Bones, Heart—and Quality of Life
Beyond hot flashes and vaginal dryness, HT helps protect your heart, bones, and possibly your brain. It’s not just about surviving menopause—it’s about thriving through it and beyond. The right HT, started at the right time, is about preserving function, not just preventing disease.
✅ The Bottom Line:
It’s 2024. We have better data. Better options. Better understanding.
So let’s give women better care. Menopausal hormone therapy, when personalized and timely, is not dangerous—it’s transformational.
Call to Action:
Feeling confused about hormone therapy? You’re not alone—but you don’t have to stay confused.
💬 Book a free 15-minute call to learn whether hormone therapy could be right for you.
🧬 Let’s bring nuance, science, and empowerment back into menopause care.
Dr. Aoife O’Sullivan is a family physician, board certified by the American Board of Family Physicians and a menopause specialist, certified by the North American Menopause Society, dedicated to empowering women through their midlife health journeys. She is the founder of Portland Menopause Doc, co-founder of the Portland Menopause Collective, podcaster on The Dusty Muffins, and an expert speaker, frequent podcast guest and active contributor to midlife women’s health research.
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