Women's Health
Estrogen
Menopause hormone therapy: what the evidence supports treating, why the route of estrogen changes clot risk, and what the WHI actually found.
Menopause hormone therapy: what the evidence supports treating, why the route of estrogen changes clot risk, and what the WHI actually found.
On 10 November 2025 the FDA began removing the boxed warnings on menopausal hormone therapy for cardiovascular disease, breast cancer and probable dementia. One boxed warning stays: endometrial cancer, on systemic estrogen-alone products. That exception is the clinically important half of the story.
4 min readHormone therapy is the most effective treatment there is for hot flushes, night sweats and genitourinary symptoms, and it prevents bone loss. That list is shorter than the internet suggests, and the benefit-risk balance turns almost entirely on two things: your age, and how long ago menopause happened.
4 min readSwallowed estrogen passes through the liver before it reaches the rest of the body, and that first pass changes clotting proteins. Estrogen absorbed through the skin does not take that route — and across both case-control and randomised evidence, the clot risk tracks the route rather than the hormone.
5 min readGenitourinary syndrome of menopause affects somewhere between a quarter and four-fifths of postmenopausal women, is progressive, and does not resolve on its own. Low-dose vaginal estrogen treats it — and because it acts locally, the position-statement guidance is that a progestogen is not indicated alongside it.
4 min readThe Women's Health Initiative changed prescribing worldwide in 2002. Two later analyses of the same trial complicate the story in opposite directions: risk varied by how long since menopause, and over eighteen years there was no difference in death rate at all. Neither finding is the clean vindication it gets used as.
5 min read