Dr. Mara Gordon, a family physician in Camden, N.J., answers reader health questions monthly. Send in your question to: thrive@npr.org.
Q: I am in perimenopause. I keep seeing posts all over social media talking up menopausal hormone therapy as a cure-all. Should I be taking hormones? Should everyone?
A: I'm not surprised that you've been hearing the hype. There's been an explosion of menopause content from influencers, direct-to-consumer telehealth companies marketing to women in midlife, and new books and podcasts on the topic.
This is great news for women. Menopause has historically been under-studied and stigmatized, so I love seeing more open conversations about this stage of life. And the pendulum has swung on hormone therapy; medical groups now recommend it again for many patients, after years of cautioning against it.
It's about time that women have access to treatments for the very real symptoms that can accompany menopause, rather than being told to "deal with" their hot flashes or sleep disruption.
But I'm also seeing a lot of less-than-scientific misinformation out there that over-promises on what menopausal hormone therapy can do. There are also lots of less-than-ethical influencers who are looking to make a quick buck on unproven supplements and vitamins.
As I navigate the new focus on menopause care alongside my patients, I've realized how critical it is to separate the hype from the reality.
Here's what the science says about menopausal hormone therapy — and what we don't yet know.
Two types of hormones tend to decline in female bodies as we age: estrogen and progesterone.
When doctors prescribe menopausal hormone therapy, it's typically either estrogen alone or estrogen plus a progestogen, a term that includes the progesterone naturally found in the body and the synthetic hormones that mimic it.
These medications come in many different formulations, including transdermal patches, pills, and vaginal creams and rings.
You can get systemic hormone therapy — that's hormones that are absorbed throughout the body — or local therapy, like a vaginal estrogen that only affects the vulva. These treatments have different risks and benefits, and you might need different combinations of them depending on your symptoms.
Some doctors use testosterone to treat sexual dysfunction in women, but doctors generally don't use the term menopausal hormone therapy when they're talking about testosterone.
When I was in medical school in the 2010s, I learned that hormone therapy could be dangerous.
The idea came from the Women's Health Initiative that followed thousands of women in midlife who were taking hormones throughout the 1990s and early 2000s. Researchers actually stopped it early because it seemed to show that hormone therapy increased the risk of heart disease, breast cancer, stroke and pulmonary embolism.