Before she began experiencing night sweats and hot flashes, Jane Singleton considered menopause something to just power through.
“Going through menopause was a normal part of life, and I wanted my body to do that,” says the 52-year-old finance manager. While working from home during the COVID-19 pandemic, Singleton could turn off her camera when she felt a hot flash coming on during virtual meetings. But when she returned to the office, she started experiencing mood swings and additional symptoms at the same time she lost the comfort of home.
“In the office, I often felt like bursting into tears over nothing,” Singleton says. “I would go into the restroom and cry, then pull myself together. It wasn’t normal for me. That’s when I realized I’ve got to get a grip on this situation.”
Singleton made an appointment with Laurie S. Jeffers, NP, DNP, co-director of the Center for Midlife Health and Menopause, which is part of obstetrics and gynecology care at NYU Langone. During that first visit, she felt heard and validated. “It was like a weight was lifted off my shoulders,” Singleton says. “I had been desperate to find someone to talk to.”
Menopause is a natural process, but that doesn’t mean it will necessarily be a breeze. Although every woman’s experience is different, the loss of estrogen can bring on varied symptoms—hot flashes, mood changes, and pain during sex, among others—that can last for years. Hormone therapy, a U.S. Food and Drug Administration (FDA)–approved treatment to ease the symptoms of menopause, is one option to discuss with your menopause practitioner.
“I feel 100 percent better. It was life-changing talking to Laurie Jeffers and having access to the Center for Midlife Health and Menopause.”
Jeffers helped Singleton understand her treatment options. “I felt part of the decision-making process,” Singleton says. “We decided that hormone treatment was the right course of action for me.”
Wondering if hormone therapy is right for you? Here are six facts to help you decide.
Hormone Therapy Can Be Safe and Effective
“Many women have grown up around the myth that hormones are bad and should be avoided at all costs,” Jeffers says. The sentiment may be a holdover from the initial results of the Women’s Health Initiative, a highly publicized study released over 20 years ago that led to confusion about hormone therapy and a woman’s risk of breast cancer and heart disease. Studies published later have clarified the benefits as well as the risks.
Research has since shown that if you’re within 10 years of menopause and healthy and don’t have any contraindications for hormone therapy—such as a history of stroke, blood clot, or a known or suspected history of breast cancer—the benefits of hormone therapy will very likely outweigh the risks for treating menopause symptoms.
To make an appointment with a certified menopause practitioner, please contact the Center for Midlife Health and Menopause. In-person visits take place at NYU Langone Obstetrics and Gynecology Associates, and video doctor visits are also available.
Hormone therapy guidelines published in 2022 from the North American Menopause Society state that the lowest dose of hormone therapy can be safe and provide significant relief for menopause symptoms in women under age 60, or those who are within 10 years of menopause.
Hormone Therapy Works by Replacing Natural Estrogen
In menopause, ovulation permanently stops and estrogen levels drop, which can cause mood changes and other troublesome symptoms. Other symptoms include hot flashes and night sweats—known as vasomotor symptoms, or VMS—as well as insomnia, vaginal dryness, and heart palpitations.
To reduce these symptoms, hormone therapy raises estrogen levels slightly, but not to premenopausal levels. “Estrogen is the most effective medication used for menopausal symptom relief,” says Samantha M. Dunham, MD, co-director at the Center for Midlife Health and Menopause. “We’ll start with a standard dose of estrogen and monitor patients for symptom relief.”
Women who have had a hysterectomy can use estrogen alone to control their menopause symptoms. Those with a uterus also need to take progesterone. “Estrogen stimulates the lining of the uterus to grow,” Jeffers says. “Progesterone keeps it from growing, to protect against endometrial cancer.”
Hormone Therapy Isn’t Forever
Because hormone therapy is available in different doses, it’s possible to taper down and see how you feel. Symptoms tend to last about five years, though sometimes longer. If symptoms return, you may decide with your menopause practitioner to stay on hormone therapy. There is no absolute age cutoff.
“We reassess annually and have a conversation about benefits and risks with patients based on their health and their personal and family history,” says Dr. Dunham.
In general, hormone therapy is meant to help women with symptoms get through the menopause transition. “Although there’s a subset of women, known as ‘super flashers,’ who continue to have hot flashes and night sweats into their 70s and beyond, the majority of women don’t have ongoing debilitating symptoms,” Dr. Dunham says.
Hormone Therapy Isn’t Right for Everyone
Hormone therapy does carry risks, such as blood clots, breast cancer, and gallbladder disease. For that reason, it’s not recommended for women in menopause with a history of blood clots, stroke, breast cancer, deep vein thrombosis, pulmonary embolism, heart attack, or liver dysfunction.
“But if you’re healthy and within 10 years of menopause and under age 60, the benefits of hormone therapy will likely outweigh the risks,” Dr. Dunham says.
Hormone Therapy Comes in Many Forms
Hormone therapy is available as prescription pills, patches, cream, gel, or a vaginal ring. The form you choose depends on your symptoms.
For example, genitourinary syndrome of menopause (GSM) results from estrogen decline, which affects the vulva and vaginal tissues, as well as the urethra, which is the opening to the bladder. As these tissues lose estrogen, they lose elasticity and collagen. A loss of lubrication can cause painful sex, pelvic discomfort, and difficulty with urination.
“Vaginal estrogen is a perfect solution for GSM,” Dr. Dunham says. A vaginal estrogen cream, a tablet, or a ring can relieve GSM symptoms locally. Little if any estrogen circulates in the bloodstream.
Hormone Therapy Can Work Quickly
“Women can get stuck for years in symptoms that can oftentimes feel overwhelming,” Jeffers says. Fortunately, hormonal therapy can act quickly to relieve the symptoms of menopause and improve your quality of life.
“In less than a week, my hot flashes and night sweats stopped and my emotions went back to normal,” says Singleton, who was prescribed an estrogen patch, a progesterone pill, and a vaginal estrogen cream for GSM. “I feel 100 percent better. It was life-changing talking to Laurie Jeffers and having access to the Center for Midlife Health and Menopause.”