Hormone Therapy Is Having a Moment. A Doctor Sorts Hype From Evidence.

Menopausal hormone therapy is back in favor with medical groups after years of caution — but it is not the cure-all that social media suggests, family physician Dr. Mara Gordon wrote in an NPR column answering reader health questions.

Gordon, who practices in Camden, New Jersey, said she is not surprised patients are hearing the hype, pointing to an explosion of menopause content from influencers, direct-to-consumer telehealth companies marketing to women in midlife, and new books and podcasts. She called the wider conversation good news, given that menopause has historically been under-studied and stigmatized, while warning that some claims over-promise and that some influencers are selling unproven supplements and vitamins.

Hormone therapy typically means estrogen alone or estrogen plus a progestogen, delivered as transdermal patches, pills, or vaginal creams and rings, Gordon wrote. It can be systemic, absorbed throughout the body, or local, such as a vaginal estrogen. Testosterone is sometimes used to treat sexual dysfunction in women but is generally not included under the term.

The reversal traces back to the Women's Health Initiative, which followed thousands of women through the 1990s and early 2000s and was stopped early because it appeared to show increased risks of heart disease, breast cancer, stroke and pulmonary embolism. Prescriptions collapsed: one study estimated 22% of American women over 40 were receiving hormone therapy in 1999-2000, dropping to about 5% by 2010. Later reanalyses of that data produced a growing consensus that the therapy is far safer than believed for women in their late 40s and 50s, and patient demand spiked as the news spread online.

The main reason doctors prescribe systemic hormone therapy is vasomotor symptoms — hot flashes — which some researchers estimate affect up to 80% of women in the menopausal transition. It can also help prevent fractures in those at high risk of osteoporosis, treat premature menopause after removal of the ovaries, and relieve vulvar dryness and irritation.

But major organizations including the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists and the Menopause Society do not recommend it for longevity, heart health or preventing chronic conditions.

"It's really an unanswered question right now," said Dr. Karen Adams, a professor of obstetrics and gynecology at Stanford, who directs its Program in Menopause and Healthy Aging. Adams said promising research suggests therapy started before age 60, or within ten years of menopause, might help prevent atherosclerosis and heart attacks.