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Women's Metabolic Clarity · Topic 11 of 15

Hormone Therapy Basics

You deserve clear, current facts about hormone therapy, so you can talk with your clinician.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. What does current research say about hormone therapy?
  2. What was the Women's Health Initiative, and why did it scare people?
  3. What about vaginal estrogen and testosterone?
Question 31 of 45

What does current research say about hormone therapy?

Short answer

  • The Menopause Society's 2022 statement says hormone therapy is the most effective treatment for hot flashes and night sweats.
  • For healthy women under 60, or within 10 years of menopause, benefits usually outweigh risks.
  • Risks go up when started at older ages or long after menopause.
  • In late 2025 the FDA began updating labels and removed several boxed warnings. Personal risk review is still needed.

What to look out for

  • Fear based on old headlines.
  • Personal history of breast cancer, clots, stroke or liver disease.
  • Being told 'no' without a real discussion.

Top 3 things to act on or ask your clinician

  1. Ask: 'Am I a candidate for hormone therapy?'
  2. Ask: 'What are my personal benefits and risks?'
  3. Ask: 'What does the 2022 Menopause Society statement mean for me?'
Sources for this answer
  1. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  2. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  3. Peer-reviewed American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123:202-216. PMID: 24463691. DOI: 10.1097/01.AOG.0000441353.20693.78
  4. Peer-reviewed Panay N et al. International Menopause Society (IMS) recommendations and key messages on women's midlife health and menopause. Climacteric. 2025;28:634-656. PMID: 41433054. DOI: 10.1080/13697137.2025.2585487
  5. Society / regulatory guidance U.S. Food and Drug Administration (2025). FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies
  6. Society / regulatory guidance The Menopause Society (Nov 10, 2025). The Menopause Society Comments on the FDA Announcement on Hormone Therapy
  7. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  8. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  9. Expert commentary, not research Dr. Peter Attia with Dr. JoAnn Manson, The Drive #253: Hormone replacement therapy and the Women's Health Initiative (podcast episode, May 2023)
  10. Expert commentary, not research Dr. Peter Attia with Dr. Rachel Rubin, The Drive #348: Women's sexual health, menopause, and hormone replacement therapy (podcast episode, May 2025)
Question 32 of 45

What was the Women's Health Initiative, and why did it scare people?

Short answer

  • The WHI was a large study that reported in 2002. Early headlines said hormones were dangerous.
  • Many women stopped hormones, and many doctors stopped prescribing.
  • Later analysis found age and timing matter a lot. Women in the study were 63 on average.
  • Long-term follow-up found no rise in overall deaths with hormone therapy.

What to look out for

  • Decisions based on 2002 headlines alone.
  • Not knowing which type of hormone was studied.
  • Not knowing your own risk factors.

Top 3 things to act on or ask your clinician

  1. Ask: 'How do the WHI findings apply to me?'
  2. Ask: 'How old was I at menopause, and does that matter?'
  3. Ask: 'What newer evidence should I know?'
Sources for this answer
  1. Peer-reviewed Manson JE et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 2017;318:927-938. PMID: 28898378. DOI: 10.1001/jama.2017.11217
  2. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  3. Expert commentary, not research Dr. Peter Attia with Dr. JoAnn Manson, The Drive #253: Hormone replacement therapy and the Women's Health Initiative (podcast episode, May 2023)
Question 33 of 45

What about vaginal estrogen and testosterone?

Short answer

  • Low-dose vaginal estrogen treats dryness, pain with sex, and some bladder issues.
  • The Menopause Society calls it safe and effective. In 2025 the FDA moved to remove its boxed warning.
  • Testosterone for women is supported in guidance only for low sexual desire (HSDD) after menopause.
  • It is not supported for energy, mood or muscle at this time.

What to look out for

  • Repeat urinary infections or painful sex.
  • Being offered testosterone for weight or energy.
  • Compounded products with no clear dose testing.

Top 3 things to act on or ask your clinician

  1. Ask: 'Could vaginal estrogen help my symptoms?'
  2. Ask: 'What does the evidence say about testosterone for me?'
  3. Ask: 'Is this product FDA-approved?'
Expert vs. evidence: Some expert interviews discuss wider use of testosterone in women. The Global Consensus Position Statement (Davis 2019) supports it only for low sexual desire after menopause. We go with the consensus.
Sources for this answer
  1. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27:976-992. PMID: 32852449. DOI: 10.1097/GME.0000000000001609
  2. Peer-reviewed Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660-4666. PMID: 31498871. DOI: 10.1210/jc.2019-01603
  3. Society / regulatory guidance The Menopause Society (Nov 10, 2025). The Menopause Society Comments on the FDA Announcement on Hormone Therapy
  4. Society / regulatory guidance U.S. Food and Drug Administration (2025). FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies
  5. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  6. Expert commentary, not research Dr. Peter Attia with Dr. Rachel Rubin, The Drive #348: Women's sexual health, menopause, and hormone replacement therapy (podcast episode, May 2025)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  2. Peer-reviewed Stuenkel CA et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015;100:3975-4011. PMID: 26444994. DOI: 10.1210/jc.2015-2236
  3. Peer-reviewed American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123:202-216. PMID: 24463691. DOI: 10.1097/01.AOG.0000441353.20693.78
  4. Peer-reviewed Panay N et al. International Menopause Society (IMS) recommendations and key messages on women's midlife health and menopause. Climacteric. 2025;28:634-656. PMID: 41433054. DOI: 10.1080/13697137.2025.2585487
  5. Peer-reviewed Manson JE et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 2017;318:927-938. PMID: 28898378. DOI: 10.1001/jama.2017.11217
  6. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27:976-992. PMID: 32852449. DOI: 10.1097/GME.0000000000001609
  7. Peer-reviewed Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104:4660-4666. PMID: 31498871. DOI: 10.1210/jc.2019-01603
  8. Society / regulatory guidance U.S. Food and Drug Administration (2025). FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies
  9. Society / regulatory guidance The Menopause Society (Nov 10, 2025). The Menopause Society Comments on the FDA Announcement on Hormone Therapy
  10. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  11. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  12. Expert commentary, not research Dr. Peter Attia with Dr. JoAnn Manson, The Drive #253: Hormone replacement therapy and the Women's Health Initiative (podcast episode, May 2023)
  13. Expert commentary, not research Dr. Peter Attia with Dr. Rachel Rubin, The Drive #348: Women's sexual health, menopause, and hormone replacement therapy (podcast episode, May 2025)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Cortisol and Stress · Brain Fog, Mood and Anxiety · Thyroid · Bloodwork: What to Ask For · Heart and Bone Risk After Menopause · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity