Hormoontherapie verlicht hitteklachten en nachtelijke transpiratie, verbetert de door deze klachten veroorzaakte slaapstoornissen en beschermt het botweefsel. Lokale vaginale oestrogeenbehandeling behandelt vaginale en urinewegklachten direct.
Het schokkende resultaat uit 2002 dat vrouwen en artsen van hormoontherapie afschuwde, was afgeleid van veel oudere vrouwen en is anders te interpreteren voor vrouwen die de therapie starten in de buurt van de menopauze. De risico's zijn specifiek: voornamelijk borstkanker bij langdurig gebruik van gecombineerde preparaten, en bloedstolsels en beroerte die vaker voorkomen bij orale toediening dan bij het gebruik van pleisters.
Findings & Outcomes
What It Is
Menopausal hormone therapy replaces the estrogen the ovaries stop making after menopause. It comes in a few forms, and each differs in what it treats and the risks it carries.
Systemic estrogen travels through the whole body. It treats hot flashes and night sweats, eases the broken sleep they cause, and protects bone. A woman with a uterus takes it together with a progestogen, because estrogen alone thickens the uterine lining over time and a progestogen prevents most of that. After a hysterectomy, estrogen is given alone, and its risk profile differs from the combined form.
Local vaginal estrogen carries little systemic risk because very little reaches the bloodstream. A cream, tablet, ring or gel used in the vagina, it treats dryness, discomfort during sex, and the recurrent urinary symptoms now grouped as the genitourinary syndrome of menopause. Users show no rise in the cancers or clots that systemic therapy can raise. It is a separate decision from systemic hormone therapy, open even to many women who cannot take the systemic form.
How you take estrogen changes the risk, because of its effect on the liver. The same hormone can be swallowed as a tablet or absorbed through the skin from a patch, gel or spray. Swallowed estrogen passes through the liver first, which raises clotting factors; estrogen absorbed through the skin does not.
For a woman who already carries any added clot risk, the skin route is often chosen for that reason.
What It Does, and the Balance of Risk
Hormone therapy cuts hot flashes and night sweats by about 75 percent against a dummy treatment, the largest effect measured for any treatment of these symptoms.
Combined therapy protects bone. It cuts total fractures by about a quarter, a hazard ratio of 0.76, and hip fractures by a third. These are its clearest benefits.
The added breast-cancer risk is mainly with the combined estrogen-plus-progestogen form, and it grows with the years of use. Five years of estrogen with daily progestogen, started at age 50, adds roughly one extra breast cancer per 50 users. Estrogen alone adds about one per 200, counted across ages 50 to 69.
Blood clots rise with the swallowed tablet, an odds ratio of 1.58. They do not rise with the patch, gel or spray, at 0.93. Stroke divides the same way. Oral tablets and high-dose patches raise it; low-dose patches do not.
Women who first started combined therapy at 65 or older had about twice the rate of dementia, roughly 23 extra cases per 10,000 women a year. The signal did not appear in women starting near menopause for symptoms.
Hormone therapy raised ovarian cancer by about a third in pooled observational data. That comes to roughly one extra case per 1,000 women who use it for five years from around age 50.
Women on combined therapy developed diabetes about a fifth less often than on placebo over the trial, 3.5 percent against 4.2 percent. That effect is real, but doctors prescribe for symptoms and weigh it against the specific risks.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Menopause And Vasomotor
Hot flashes about 75% fewer on hormone therapy than placebo, the largest effect measured
Hormone therapy cuts hot flashes and night sweats more than anything else that has been tested, roughly three-quarters fewer than a dummy treatment.
Pooled across randomized trials, oral estrogen and combined estrogen-progestogen therapy reduced the frequency of hot flashes by about 75% against placebo, with a large reduction in severity as well. It is the largest effect measured for vasomotor symptoms. Measured in: Postmenopausal women with vasomotor symptoms across randomized placebo-controlled trials. Placebo alone reduces hot flashes substantially in these trials, so the true drug effect is the gap above a large placebo response, not the raw reduction. Trial durations were mostly short.
Who this may not transfer to:Menopausal hormone therapy is given to women for symptoms of the menopause transition; these findings are not intended to apply to men.
The study · 1
MacLennan et al., oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes · Cochrane Database Syst Rev 2004
A progestogen prevents most of the uterine-lining thickening unopposed estrogen causes
In women who still have a womb, estrogen on its own thickens the lining, and adding a progestogen prevents most of that.
Unopposed estrogen raised endometrial hyperplasia in a dose- and duration-dependent way in postmenopausal women with a uterus. Adding a progestogen, continuously or sequentially, reduced that excess, with continuous combined regimens giving the most reliable protection; sequential progestogen over more than 5 years still carried some increased hyperplasia risk. Measured in: Postmenopausal women with an intact uterus across 46 randomized trials. The endpoint is endometrial hyperplasia and bleeding, not endometrial cancer directly, and the degree of protection depended on the progestogen regimen and how long it was used.
Who this may not transfer to:Endometrial protection applies to women with a uterus; it is not applicable to men.
The study · 1
Furness et al., hormone therapy in postmenopausal women and risk of endometrial hyperplasia · Cochrane Database Syst Rev 2012
Fezolinetant and elinzanetant cut hot flashes by about 2 to 2.5 more a day than placebo
New non-hormonal drugs that block a brain signal, fezolinetant and elinzanetant, cut hot flashes by a couple more per day than a dummy pill.
Fezolinetant, a neurokinin-3 receptor antagonist, reduced the frequency of moderate-to-severe hot flashes by about 2 to 2.5 more per day than placebo over 12 weeks, with a matching drop in severity. The dual neurokinin-1 and 3 antagonist elinzanetant reduced them similarly in the OASIS trials. Neither is a hormone. Measured in: Roughly 500 women per pivotal trial with moderate-to-severe vasomotor symptoms, plus the OASIS elinzanetant trials. These are short trials against placebo, not head-to-head against hormone therapy, so the size of the benefit sits below estrogen's. Fezolinetant carries a liver-monitoring requirement, and long-term safety is still accruing.
Who this may not transfer to:These drugs were trialled in women with menopausal vasomotor symptoms; the findings are not intended to apply to men.
The studies · 2
Lederman et al., fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1) · Lancet 2023
SSRIs, SNRIs, gabapentin and clonidine cut hot flashes by about 1 to 2 more a day than placebo
Some antidepressants, along with gabapentin and clonidine, ease hot flashes by a modest amount, less than hormones, and an option when hormones are not wanted.
SSRIs and SNRIs, gabapentin and clonidine each reduced the frequency and severity of hot flashes more than placebo, with effects smaller than estrogen. Antidepressants and clonidine reduced daily flashes by roughly 1 to 2 more than placebo, and gabapentin by a similar amount. Measured in: Postmenopausal women across 43 randomized and controlled trials of non-hormonal drugs. Trials were mostly short and some included women being treated for breast cancer, so effect sizes vary by drug and population. Paroxetine and fluoxetine can blunt tamoxifen, which matters for women on it.
Who this may not transfer to:These treatments were studied for menopausal hot flushes in women; the findings are not intended to apply to men.
The study · 1
Nelson et al., nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis · JAMA 2006
Cognitive behavioral therapy lowers how much hot flashes bother you, not how often they come
A short course of cognitive behavioral therapy makes hot flashes bother you less, even if it does not lower how often they come.
Group and self-help cognitive behavioral therapy reduced how much hot flashes and night sweats bothered women, with a moderate-to-large effect on the problem rating that held at follow-up. It worked in women having flashes after breast cancer treatment, where hormones are usually avoided. Measured in: Menopausal women in two randomized trials, including one in women who had had breast cancer. The main change is in the distress and interference from flashes, not in their frequency, and outcomes were self-reported, so the benefit is different in kind from a drug that cuts the count.
Who this may not transfer to:These trials enrolled menopausal women; the findings are not intended to apply to men.
The studies · 2
Ayers et al., effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2) · Menopause 2012
Mann et al., cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1) · Lancet Oncol 2012
Longevity And Mortality
No difference in death over 18 years (hazard ratio 0.99)
Over 18 years, women who had taken hormone therapy in the trials were no more or less likely to have died than those who took placebo.
Across a cumulative 18 years of follow-up, all-cause mortality did not differ from placebo, hazard ratio 0.99 (95% CI 0.94 to 1.03) in the pooled cohort, 1.02 for combined therapy and 0.94 for estrogen alone. Neither cancer nor cardiovascular mortality was significantly raised. Measured in: 27,347 postmenopausal women across both Women's Health Initiative trials, 18-year cumulative follow-up. Mortality is a coarse endpoint that can hide benefit in one cause offsetting harm in another. The trials tested oral formulations begun largely in older women, so this neutral mortality result does not by itself settle the risk for a woman starting near menopause.
Who this may not transfer to:Mortality was measured in women in the hormone therapy trials; it is not intended to apply to men.
The study · 1
Genitourinary
Vaginal estrogen relieves dryness and painful sex, odds ratios 4 to 13 across 30 trials
Estrogen used in the vagina reliably relieves dryness and painful sex, and the cream, tablet and ring forms work about equally well.
Across 30 randomized trials and 6,235 women, intravaginal estrogen improved symptoms against placebo, with odds ratios between 4.10 and 12.67 depending on preparation. Creams, tablets and rings did not differ from each other in effect. Measured in: 6,235 postmenopausal women with vaginal atrophy. Most trials ran 12 weeks or less, so long-term safety rests on observational data, not on these trials. Many were manufacturer-funded, and the outcome measures for dryness and discomfort varied enough that pooling them is approximate.
Who this may not transfer to:Vaginal estrogen for genitourinary symptoms applies to women; it is not applicable to men.
The study · 1
Lethaby et al., local oestrogen for vaginal atrophy in postmenopausal women · Cochrane Database Syst Rev 2016
Bone Density
Combined hormone therapy cut total fractures by about 24% (hazard ratio 0.76)
Combined hormone therapy cut fractures by about a quarter and strengthened bone at the hip and spine.
Combined estrogen-progestin lowered total fractures, hazard ratio 0.76, about 24% fewer, and hip fractures, hazard ratio 0.67. Bone mineral density rose at the hip and spine over the trial. This was the first randomized proof that hormone therapy prevents fractures in unselected women. Measured in: 16,608 postmenopausal women aged 50 to 79 with an intact uterus. The women were not selected for low bone density, so the number of fractures prevented is set against the other risks of combined therapy, not read on its own. Bone loss resumes after therapy stops.
Who this may not transfer to:Fracture reduction was measured in postmenopausal women on hormone therapy; it is not intended to apply to men.
The study · 1
Heart And Vascular
Artery-wall thickening slowed only when estrogen started within 6 years of menopause
Estrogen slowed the thickening of an artery wall in women who started soon after menopause, but not in those who started 10 or more years later.
In women less than 6 years past menopause, carotid intima-media thickness rose 0.0044 mm per year on oral estradiol against 0.0078 on placebo (P=0.008). In women 10 or more years past, 0.0100 against 0.0088 (P=0.29). Interaction P=0.007. Measured in: 643 healthy postmenopausal women, stratified by time since menopause. Carotid wall thickness is a surrogate marker. The trial was not powered for heart attacks or strokes and did not measure them as endpoints, so this shows a difference in a marker, not in events. Participants were healthy volunteers.
Who this may not transfer to:Measured in postmenopausal women; the finding is not intended to apply to men.
The study · 1
Hodis et al., vascular effects of early versus late postmenopausal treatment with estradiol (ELITE) · N Engl J Med 2016
Blood Sugar
New diabetes about a fifth lower on combined therapy, 3.5% against 4.2%
Women taking combined hormone therapy were about a fifth less likely to develop diabetes over the trial than those on placebo.
Over 5.6 years, women on combined conjugated equine estrogen with medroxyprogesterone acetate developed treated diabetes less often than on placebo, cumulative incidence 3.5% against 4.2%, hazard ratio 0.79 (95% CI 0.67 to 0.93, P=0.004). The reduction held after accounting for changes in body weight and waist circumference. Measured in: 15,641 postmenopausal women aged 50 to 79 with an intact uterus in the Women's Health Initiative Hormone Trial, mean 5.6 years of follow-up. Diabetes was a secondary finding measured by whether treatment was started, not a target the trial was designed to test, and hormone therapy is not given to prevent diabetes. The effect was seen for the oral combined formulation and sits alongside the trial's other risks.
Who this may not transfer to:The diabetes finding was measured in postmenopausal women on hormone therapy; it is not intended to apply to men.
The study · 1
Margolis et al., effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women's Health Initiative Hormone Trial · Diabetologia 2004
The Timing of When You Start
The 2002 result came from women mostly past 60, over ten years beyond their last period. Sorted by age and by years since menopause, the balance looks better when therapy begins soon after a woman's last period.
In the pooled Women's Health Initiative analyses, outcome tracked with how early therapy started, the timing hypothesis. Women who began at 50 to 59, or within 10 years of menopause, fared better. Those who began at 70 to 79, or more than 20 years out, did worse.
A separate trial measured how fast the wall of an artery thickened. Estrogen slowed the thickening in women who started within six years of menopause, 0.0044 against 0.0078 millimeters a year. It did not slow it in women who started 10 or more years later. Starting systemic therapy long after menopause mainly to protect the heart is not supported.
Non-Hormonal Options
For a woman who cannot or would rather not take hormones, several options help.
- Neurokinin-receptor antagonists (fezolinetant and elinzanetant) are the newest. They block a brain signal involved in hot flashes and cut them by about 2 to 2.5 more per day than a dummy pill.
- Low-dose SSRIs and SNRIs, gabapentin, and clonidine each ease hot flashes by a smaller amount, about one to two fewer a day than placebo.
- A short course of cognitive behavioral therapy lowers how much hot flashes bother you without changing how often they come. It worked in women having flashes after breast cancer.
Each of these is weaker than estrogen for hot flashes.
The everyday basics help whether you take hormones or not.
- Strength training builds bone during the years when bone loss is fastest, worth doing whatever you decide about hormones.
- A cooler room and lighter bedding work against the night sweats directly.
- Regular activity is good for the heart and helps with the mood swings of this stage.
Go Deeper
Three related guides cover the wider transition:
- Menopause and Hot Flashes, the transition itself, the symptoms, and the botanicals people reach for.
- Perimenopause, the years of change before the final period.
- PMS, the monthly pattern in earlier life.
The Chinese Medicine View
Three patterns recur in this season, each pointing to a different classical prescription.
The Chinese Medicine View
The tradition reads the menopausal transition as the Kidneys emptying with age. The cooling, moistening Yin runs low first. As it depletes, the body's normal warmth is felt as empty heat, the heat of depletion. The pattern that fits tells the practitioner what the tradition would use. The aim is to nourish the Yin. A practitioner reads pulse and tongue before choosing among these; the tradition does not treat every woman in the transition the same way.
The core signs: hot flashes to the face and chest, night sweats that stop on waking, heat in the palms and soles. Also dry mouth and eyes, vaginal dryness, and a weak low back and knees. The tradition points here toward nourishing Yin, the Liu Wei Di Huang and Zhi Bai Di Huang families.
Flashes and sweating together with cold feet, aversion to cold, low libido and exhaustion. This is common in the transition, and it is what Er Xian Tang was built for: one prescription that combines warming Yang tonics with fire-draining herbs.
The same Yin depletion with the Shen unsettled by it: waking at two or three, palpitations, anxiety with no object, racing thoughts, vivid dreams. Tian Wang Bu Xin Dan is the classical answer.
Cautions
Extra restraintEverything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Oral estrogen plus progestin (2002): about 7 to 8 more heart events, strokes, clots and breast cancers per 10,000 women a year, and 5 fewer hip fractures
Per 10,000 women per year: 7 more coronary events, 8 more strokes, 8 more pulmonary emboli and 8 more invasive breast cancers, against 6 fewer colorectal cancers and 5 fewer hip fractures. Hazard ratios 1.29 for coronary heart disease, 1.41 stroke, 2.13 pulmonary embolism, 1.26 breast cancer. Mean age at entry was 63 and most participants were more than a decade past their final period, which is not the woman who asks about hormone therapy for symptoms. One oral formulation was tested, conjugated equine estrogen with medroxyprogesterone acetate. The breast cancer confidence interval touched 1.00.Rossouw et al., risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial
Estrogen alone after hysterectomy: breast cancer not raised (HR 0.77), stroke higher (HR 1.39)
In women with a prior hysterectomy taking conjugated equine estrogen alone, the breast cancer hazard ratio was 0.77 (95% CI 0.59 to 1.01), so not raised and possibly lowered. Coronary heart disease was 0.91, stroke 1.39 (1.10 to 1.77), and hip fracture 0.61. This estrogen-alone result disagrees with the observational finding of a smaller breast cancer excess for estrogen alone, and stroke was raised, so 'different profile' does not mean 'no risk'. One oral formulation was tested.Anderson et al., effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial
Combined therapy adds about one breast cancer per 50 users over five years, one per 200 for estrogen alone
Five years of therapy started at age 50 adds roughly one breast cancer per 50 users of estrogen with daily progestogen, one per 70 with intermittent progestogen, and one per 200 with estrogen alone, counted across ages 50 to 69. Ten years is about twice that. Relative risk in current users of 5 to 14 years: 2.08 for estrogen-progestogen, 1.33 for estrogen alone. Individual participant data pooled from prospective observational studies, not from randomized trials, and the direction for estrogen alone disagrees with the trial of estrogen alone. Vaginal estrogens showed no excess. Some excess persisted more than a decade after stopping.Collaborative Group on Hormonal Factors in Breast Cancer, type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence
Hormone therapy outcomes more favorable started at 50 to 59 than at 70 to 79
In the pooled Women's Health Initiative analyzes, results were more favorable in women who started therapy aged 50 to 59, or within 10 years of menopause, than in women aged 70 to 79 or more than 20 years past it. The absolute excess of adverse events was concentrated in the older, later-starting women, and for several outcomes there was a significant trend across age. These are subgroup analyzes stratified after the fact, not the trials' primary comparison, so the age-and-timing reading is hypothesis-generating, not a result the trials were designed to prove. The trials tested oral formulations only.Manson et al., menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials
Blood clots raised by oral hormones (OR 1.58), not by patches, gels or sprays (0.93)
Oral hormone therapy was associated with venous thromboembolism, adjusted odds ratio 1.58 (95% CI 1.52 to 1.64); oral estrogen alone 1.40, oral combined preparations 1.73. Transdermal preparations showed no increase, 0.93 (0.87 to 1.01). Nested case-control drawn from prescribing records, so exposure is what was dispensed, not what was taken. Route was not randomized, and no trial has randomized oral against transdermal with clot as the endpoint.Vinogradova et al., use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases
Stroke raised by oral hormones (RR 1.28) and high-dose patches, not by low-dose patches
Oral hormone therapy was associated with stroke, rate ratio 1.28 (95% CI 1.15 to 1.42). Low-dose transdermal patches of 50 micrograms or less were not, 0.81 (0.62 to 1.05). Higher-dose patches were, 1.89 (1.15 to 3.11). Nested case-control from prescribing records, so exposure is what was dispensed. Route and dose were not randomized, and this shows an association, not a tested causal difference.Renoux et al., transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study
Vaginal estrogen users show no rise in breast or endometrial cancer, stroke or clots over 7.2 years
Over a median 7.2 years, women using vaginal estrogen showed no increase in invasive breast cancer, endometrial cancer, colorectal cancer, stroke, pulmonary embolism, deep vein thrombosis or hip fracture compared with non-users. Risks were similar with and without a uterus. Observational, not randomized, and the number of vaginal estrogen users was modest, so this supports the low-risk reading of local estrogen without proving it to a trial standard. Endometrial safety over many years still depends on watching for bleeding.Crandall et al., breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational Study
Custom-compounded bioidentical hormones show no advantage over approved products
An Endocrine Society scientific statement found custom-compounded bioidentical hormones show no advantage over approved products in safety or effectiveness, that compounded preparations lack the standardization, purity testing and safety monitoring of regulated ones, and that salivary hormone testing used to tailor them does not track a reliable target. FDA-approved bioidentical formulations exist and are regulated. This is a scientific statement synthesizing the literature, not a head-to-head trial, and it addresses the compounded, custom-mixed products specifically, not the regulated bioidentical formulations that carry the same oversight as any approved drug.Santoro et al., compounded bioidentical hormones in endocrinology practice: an Endocrine Society scientific statement
Combined therapy begun after 65 doubled dementia rate, 23 extra cases per 10,000 women a year
In women aged 65 and older, combined conjugated equine estrogen with medroxyprogesterone acetate raised the rate of probable dementia against placebo, hazard ratio 2.05 (95% CI 1.21 to 3.48, P=0.01), which worked out to about 23 extra cases per 10,000 women per year (45 against 22 per 10,000 person-years, 40 cases against 21). Mild cognitive impairment was not significantly changed, hazard ratio 1.07 (95% CI 0.74 to 1.55). Every woman here began therapy at 65 or older and started the oral combined formulation, so the result speaks to late initiation and does not carry over to a woman who starts near menopause for symptoms. Trials that began therapy soon after menopause, KEEPS-Cog and the WHIMSY substudy, found no such effect on cognition. This is one trial and the dementia case numbers were modest.Shumaker et al., estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study (WHIMS)
Ovarian cancer about a third higher in users, one extra case per 1,000 over five years
In the prospective data pooled across these studies, current or recent hormone therapy use carried a higher rate of ovarian cancer, relative risk 1.37 (95% CI 1.29 to 1.46), rising to 1.53 for serous tumors and 1.42 for endometrioid tumors. For a woman using therapy for 5 years from around age 50, this works out to about one extra ovarian cancer per 1,000 users and about one extra ovarian cancer death per 1,700 users. The excess appeared even with under 5 years of use, relative risk 1.43. The pooled evidence is observational, not randomized, and the absolute risk is small, about one extra case per 1,000 five-year users. The excess was largest for the serous and endometrioid subtypes and diminished the longer ago therapy had stopped.Collaborative Group on Epidemiological Studies of Ovarian Cancer, menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies
Start slow, be smart, read the research, and consult a professional if you have any concerns. This is here to inform your choice, not make it for you.
When to See Someone
Hormone therapy is an individualized decision, and one rule matters most: never start or stop a prescribed hormone without your prescriber. These are the signs to see a doctor about, and urgently for the ones marked so:
- Any vaginal bleeding a year or more after your last period, and any unscheduled bleeding on hormone therapy outside an expected withdrawal bleed. Every episode is worth investigating, and spotting counts.
- A new breast lump, a nipple change, or a change in the skin of the breast.
- Sudden swelling, pain or warmth in one leg, or chest pain or breathlessness. These can signal a blood clot; get same-day assessment.(seek urgent care)
- A sudden severe headache, weakness or numbness on one side, trouble speaking, or a sudden change in vision. These are stroke warning signs.(seek urgent care)
- A history of hormone-sensitive cancer, a previous clot or stroke, or active liver disease. Discuss these with the prescriber before starting.
- New pelvic pain that is persistent, or that is new for you.
- Persistent low mood, loss of interest, or thoughts of harming yourself.(seek urgent care)
This is a reference and learning resource, not medical advice, and no substitute for a doctor who knows your history. Hormone therapy helps a great many women, and whether it fits you depends on your own symptoms, your history and your preferences. That conversation, and any change to a prescribed hormone, belongs with the person who prescribes it.
Common Questions
Is the patch safer than the pill?
For clots, yes. For hot flashes and for bone the two routes work about equally, so the choice turns mainly on a woman's clot risk.
Are bioidentical hormones better?
FDA-approved bioidentical hormones exist, are regulated, and are a reasonable option. The custom-compounded versions have no advantage shown over them, with looser oversight of dose and purity. The saliva hormone tests used to set a compounded dose don't measure anything reliable to dose against.
What if I cannot take hormones?
Local vaginal estrogen reaches the bloodstream in only tiny amounts, so it is often an option even when the systemic form is not.
Will it protect my heart or help me live longer?
No. Over 18 years of follow-up, women who had taken it in the trials died at the same rate as those on placebo, a hazard ratio of 0.99. Any heart benefit depends on an early start.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 22 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
Evidence strength
How confidently the research supports a claim. Strength describes the evidence, not our endorsement.