Setting The Record Straight On Menopause Hormone Therapy 

Dr. Jen Gunter, a.k.a. “the internet’s most famous gynecologist,” debunks five common myths.

An illustration of a woman speaking to her doctor, who has written a prescription, representing menopause hormone therapy

(Illustration: Nicole Rifkin)

Menopause hormone therapy (MHT) is in desperate need of a rebrand. Despite being considered the gold-standard treatment for hot flashes, night sweats and genitourinary syndrome of menopause, it’s still often associated with negative outcomes. This is largely thanks to overstated risks from a 2002 study that cultivated a culture of fear around MHT (which was then referred to as hormone replacement therapy, or HRT).

In general, the benefits of MHT outweigh the risks for healthy people under the age of 60 or within 10 years of menopause who do not have a personal history of breast cancer, heart disease or blood clots. We asked Dr. Jen Gunter, a.k.a. “the internet’s most famous gynecologist,” to set the record straight on five other common MHT myths.

Myth: Menopause is a natural transition that we just need to grin and bear

You do not have to endure life-limiting symptoms. Instead, talk to your doctor about what you’re going through. “The severity and frequency of your symptoms and how much they affect your quality of life are vital when determining the right treatment,” says Gunter.

Myth: You only need MHT if your symptoms are severe

The definition of “severe” is what matters here. If your symptoms disrupt your everyday life, they’re worth mentioning to your doctor. “Everyone has a different level of what is bothersome,” says Gunter. “It’s important to be open to treatment options and how they could improve your quality of life.”

Myth: You can be too young for MHT

There’s a kernel of truth to this one. “It would be an error to start hormone therapy between the ages of 40 and 45 without clinical evidence to confirm primary ovarian insufficiency (POI) or premature menopause,” says Gunter. POI is when the ovaries start malfunctioning before the age of 40—but periods can return sporadically. Premature menopause is when periods stop completely at the age of 40 or younger.

Myth: There’s only one type of MHT

There are two Health Canada-approved forms of hormone therapy.

Estrogen-only therapy is only prescribed to people who have had hysterectomies because it increases the risk of uterine cancer. Combined estrogen plus progestin therapy is prescribed to people with uteruses, as this hormone combo does not increase the risk of uterine cancer.

MHT can be taken orally or transdermally (via patch, gel, spray, emulsion or vaginal ring). Transdermal hormones have the lowest risk of blood clot and stroke and are also less likely to cause high blood pressure. That said, Gunter describes oral MHT as “still very safe.”

Myth: Compounded bioidentical hormones have been proven safe and effective

Absolutely not. For starters, “bioidentical” is just a marketing term. “It’s meaningless,” says Gunter. And com- pounding hormones—meaning they are custom blended by a pharmacist as opposed to manufactured in a pharmaceutical factory—can result in inconsistent dosages and absorption. “They are not proven to be safe or effective,” she says. “Instead, transdermal estradiol [a form of estrogen] is the recommended starting hormone therapy.”

One more thing: What about dementia risk?

A recently published Danish study suggests an association between MHT and increased dementia risk—but many experts say the research is flawed. “It has too many issues for the results to be considered valid,” says Dr. Stephanie Faubion, medical director for The Menopause Society. What’s more, in an editorial published in the same journal as the study, researchers from the Mayo Clinic and Harvard Medical School noted that “a causal link [between MHT and dementia] remains unlikely.” The Menopause Society has advised its members that they should not change their approach to prescribing MHT.

Read more: Everything You Need To Know About Menopause

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