Timely treatment with menopause hormone therapy (MHT) provides significant relief for symptoms such as hot flashes, night sweats, and vaginal dryness, and also reduces fracture risk. However, expecting it to fix every health issue that arises during perimenopause or menopause is a set-up for disappointment, according to experts.
Many women avoid treatment despite symptoms
A 2025 Mayo Clinic study found that about one-third of women reported pronounced menopause symptoms, but only 13% sought treatment. Nanette Santoro, a professor of obstetrics and gynecology and menopause researcher at the University of Colorado, says the real-world number is probably even lower. One issue is that menopause is not confirmed until a year after the last period, by which point women have often been most symptomatic. Additionally, many women who raise concerns with clinicians are dismissed.
Growing awareness fuels demand but also hype
Celebrity advocacy and social media have driven demand for menopause care, but they have also spread misinformation. Lauren Streicher, a gynecologist and menopause researcher at Northwestern University, points out that menopause is often blamed for symptoms that may have other causes, such as medication side effects or normal aging. By the time women reach perimenopause, at least half already have a chronic medical condition.
Unsubstantiated claims about MHT
Claims that MHT prevents dementia, averts heart disease, prolongs life, or confers hormonal balance are not grounded in evidence. Influencers, including some credentialed clinicians, make fantastical claims on social media. Products content creators sell account for about a third of the $10-15 billion menopause market. In November 2024, Robert F Kennedy Jr and Marty Makary announced the removal of the black box warning on hormone therapy, making inaccurate claims based on low-quality studies about MHT’s ability to prevent Alzheimer’s disease and extend life by 10 years.
“Women are left wondering, ‘Who do I believe? My clinician, who I’ve been going to for 20 years and who seems real smart, but he or she doesn’t seem to know any of this stuff, or the person on social media who’s got 2 million followers?’” Streicher says.
What MHT actually does
Estrogen is the workhorse of symptom relief. For women with a uterus, it is typically co-prescribed with progesterone to prevent estrogen-related cancerous overgrowth of the uterine lining. About one-fifth of peri- or newly menopausal women have had a hysterectomy and do not need progesterone. Bodywide estrogen helps reduce hot flashes, night sweats, and sleep disturbances by acting on estrogen receptors in the nervous system. Transdermal application (patches, creams, gels) may be safer for many women than pills, as the digestive route produces tiny quantities of blood clot-causing byproducts. Local estrogen therapy (creams, suppositories, rings) works for vaginal and bladder symptoms. Progesterone is best delivered via pills or IUDs. MHT can also have positive effects on cardiovascular and bone health, but it is not recommended as first-line prevention for either. For most women starting hormones within 10 years of their last period or before age 60, risks are low, especially with transdermal or local estrogen. Non-hormonal therapies are available for women who cannot take estrogen.
How to decide if MHT is right for you
Women should consult a clinician with up-to-date knowledge about menopause treatment. The Menopause Society and author Jen Gunter offer guidance on finding and vetting practitioners. Separating real benefits from myths can be challenging, but an informed decision is key.
