Menopause Treatment Options: A Modern, Evidence-Based Guide
Hormone therapy for menopause was over-restricted for two decades after a single flawed 2002 study. Here's what modern evidence actually says.
The modern view on menopausal hormone therapy
For most healthy women starting therapy within 10 years of menopause and before age 60, current North American Menopause Society and Society of Obstetricians and Gynaecologists of Canada guidance supports hormone therapy as the most effective treatment for vasomotor symptoms (hot flashes, night sweats), genitourinary symptoms, and bone density protection.
The panic around the original 2002 Women's Health Initiative results — which studied older women, on average 63 years old, on a specific regimen — no longer reflects how we practise today. Modern regimens use transdermal estradiol (patch or gel) and micronised progesterone, at doses matched to symptoms.
Who should not take systemic hormone therapy
Absolute or strong relative contraindications include personal history of breast cancer, endometrial cancer, untreated endometrial hyperplasia, active venous thromboembolism or high-risk clotting disorders, active liver disease, unexplained vaginal bleeding, and recent cardiovascular events.
For these women, local vaginal estrogen and non-hormonal options remain available.
How a menopause consultation actually works at CurAge
A first appointment reviews your menstrual timeline, symptoms (a structured scale is used), medical and family history, current medications, and goals. Baseline blood work often includes TSH, ferritin, vitamin D, HbA1c, lipids, and — in specific situations — FSH/estradiol.
A follow-up appointment is scheduled to review results and, if indicated and desired, initiate treatment. On any regimen, a check-in at 3 months confirms symptom improvement and tolerability, then follow-up is typically annual once stable.
Frequently asked questions
Do I need a Pap smear before starting HRT?+
Cervical screening should be up to date but is not a strict prerequisite for hormone therapy. A pelvic exam is not routinely required before starting systemic HRT.
Will HRT cause weight gain?+
Menopause itself contributes to central weight gain and muscle loss. HRT does not cause weight gain; some women lose weight because sleep and energy improve enough to sustain exercise.