Hormone therapy for women

For many healthy women, particularly those younger than 60 or within about 10 years of menopause, the benefits of hormone therapy can outweigh the risks. Safety depends on your health history, age, symptoms, the hormones being used, dose, and method of delivery. That is why we evaluate first rather than prescribing the same treatment to everyone.

Not all hormone therapy carries the same breast cancer risk. For years, women were given the message that hormone therapy simply “causes breast cancer,” but the research does not support treating every type of hormone therapy the same way.

In 2025, the FDA began removing breast cancer, heart disease, and dementia from the boxed warning on menopausal hormone therapy after reviewing updated evidence. That does not mean hormone therapy has zero risk. It means the conversation is more individualized than women were once led to believe.

Long-term Women’s Health Initiative data also showed very different results depending on the hormones used. In women who had a hysterectomy, estrogen alone was associated with lower rates of breast cancer and lower breast cancer deaths compared with placebo. An older combination of estrogen plus medroxyprogesterone was associated with increased breast cancer risk.

The takeaway: hormone therapy is not one-size-fits-all, and neither is breast cancer risk. The type of hormones used, your personal and family history, and how you respond to treatment all matter. Age alone is not an automatic reason to stop hormone therapy. For many women, continuing treatment can be appropriate when the benefits continue to outweigh the risks and care is monitored over time.

A family history of breast cancer is important, but it is not the same as having had breast cancer yourself. We look at who in your family was affected, age at diagnosis, genetic risk when known, your personal breast history, and the type of hormone therapy being considered before making a recommendation.

A personal history of breast cancer requires a different conversation. Systemic hormone therapy is generally not recommended after hormone-sensitive breast cancer, but your cancer type, treatment history, current medications, symptoms, and oncology recommendations all matter.

For vaginal and urinary symptoms, low-dose vaginal estrogen may still be an option for some breast cancer survivors when non-hormonal therapy is not enough, using shared decision-making with the woman's oncology team when appropriate.

Risk depends on the woman and the route of treatment. Age, cardiovascular history, smoking, obesity, clotting history and the type of hormone all matter. Oral estrogen has a greater effect on clotting factors than estrogen delivered through the skin, which is one reason route matters when we choose treatment.

No. You do not have to wait until your periods stop. Perimenopause can begin years before the final menstrual period, and symptoms may appear while you are still having regular or irregular cycles.

We look at what has changed, your cycle pattern, symptoms, medical history and laboratory results together. Hormone therapy is not birth control, so pregnancy prevention still matters if pregnancy is possible.

There is no single age that answers this question for every woman. In general, the benefit-risk profile is most favorable when systemic hormone therapy is started before age 60 or within about 10 years of menopause. Women outside that window need a more individualized risk assessment.

There is no universal expiration date for hormone therapy.

Estrogen does much more than control your period or stop hot flashes. Estrogen receptors are found throughout the body, including bone, blood vessels, brain, vaginal and urinary tissues.

Estrogen helps maintain bone density, and systemic estrogen is proven to reduce menopause-related bone loss and fracture risk. Estrogen also affects vascular function, cholesterol metabolism and the brain. Research suggests that timing matters when considering cardiovascular and neurologic effects, with a more favorable benefit-risk profile when therapy begins closer to menopause. Hormone therapy is not currently prescribed solely to prevent heart disease or dementia, but those systems are absolutely part of the conversation about estrogen loss and long-term health.

Yes, and this begins earlier than many women realize.

In the SWAN study, bone loss accelerated around the final menstrual period. Approximately 7.4% of lumbar-spine bone density and 5.8% of femoral-neck bone density were lost during the window from roughly one year before the final period through two years afterward.

Body composition changes during this same transition. Lean mass begins to decline and fat gain accelerates beginning around two years before the final menstrual period and continuing for approximately two years afterward. That is why we pay attention to hormones, strength training, protein, body composition and bone health in your 40s and 50s, not decades later.

Hormone therapy is the most effective treatment available for menopausal hot flashes and night sweats and can also improve vaginal symptoms.

Furthermore, women report improvements in sleep, mood, irritability, energy, brain fog and cognition, libido, and muscle and joint discomfort. We follow how you actually feel along with your laboratory results.

If you still have your uterus and use systemic estrogen, progesterone is important because it protects the uterine lining.

After hysterectomy, progesterone is no longer required for uterine protection. However, we may still use oral micronized progesterone in selected women because some women find it beneficial for sleep, mood and their overall treatment plan. The decision is individualized.

Some women benefit from using both systemic and local therapy when systemic hormone therapy does not completely resolve vaginal and urinary symptoms. Low-dose vaginal estrogen treats the tissue directly and can help with vaginal dryness, irritation, painful intercourse and genitourinary symptoms of menopause.

Hormone therapy is not a weight-loss medication, but it is also not generally associated with causing weight gain. Menopause itself changes body composition, increasing abdominal fat while lean mass may decline.

When sleep, energy, insulin resistance, body composition or other hormonal symptoms improve, weight management may become easier. If weight is a major concern, we address metabolic health as its own part of your treatment plan.

Perimenopause cannot always be diagnosed from one blood test. Hormone levels can fluctuate considerably across the menstrual cycle, so a laboratory value is a snapshot, not the whole story.

We interpret your symptoms, cycle changes, medical history and laboratory results together rather than treating one number in isolation.

That is one of the most common fears women have about testosterone. Our goal is female physiologic treatment, not masculinization.

Acne, oily skin, unwanted facial or body hair, or hair shedding can occur when someone is particularly sensitive to testosterone or the dose is too high. Significant voice changes are rare. Careful dosing and monitoring matter.

For women, pellets typically last about three to four months, although each woman metabolizes hormones differently. We follow your symptoms and laboratory results rather than simply inserting another pellet because a date arrived on the calendar.

Hormone therapy is gradual, not a light switch. Some women begin noticing improvement in hot flashes or night sweats within days to weeks, while changes in sleep, energy, cognition, mood or sexual function may take longer.

Finding your best treatment plan can also take more than one treatment cycle, which is why follow-up and dose adjustment are part of the process.

Pellets are not routinely removed once placed. They are designed to gradually dissolve over several months, and trying to surgically retrieve them can cause unnecessary tissue trauma.

If you decide you do not want to continue pellet therapy, you simply do not repeat the insertion once the current pellets have dissolved. Other methods such as patches, gels and creams can be stopped or changed more quickly.

We numb the area with local anesthetic before insertion, so most women feel pressure rather than significant pain during the procedure. Mild tenderness or bruising afterward can occur.

You will receive specific instructions about exercise, water exposure and caring for the insertion site while it heals.

Hormone pellets used in our practice are compounded medications and are not FDA-approved as finished drug products. Ours are obtained from an FDA-registered 503B outsourcing facility that operates under federal compounding requirements and is subject to FDA oversight and inspection.

FDA registration and inspection are not the same as FDA approval, and we want that distinction to be clear. FDA-approved hormone options are also available when they are a better fit.

No. Labs are drawn in house and are not billed to insurance. We can provide a superbill when appropriate, and you will know the cost before anything is drawn.