Deciding about hormone therapy isn't a yes/no you look up online — it's a conversation, and the standard of care is explicitly shared decision-making: your clinician brings the evidence, you bring your history and priorities, and you decide together.¹ This article helps you walk in prepared.

Who is generally a good candidate

Broadly, hormone therapy is most favorable for healthy women with bothersome moderate-to-severe hot flashes and night sweats who are under 60 or within 10 years of menopause, with no contraindications. Women who reach menopause early or prematurely are a distinct group who often should be offered therapy — the calculus is different for them.¹²

Contraindications to raise

Some histories generally rule out systemic hormone therapy, or at least change the approach. Be ready to discuss whether any apply to you:³⁴

• A history of breast, ovarian, or uterine cancer
• Unexplained or abnormal vaginal bleeding
• A history of blood clots, stroke, or heart attack
• Active liver disease
• Pregnancy

If systemic therapy isn't appropriate, low-dose vaginal estrogen for dryness or painful sex may still be an option — worth asking about specifically.

You probably don't need a blood test to be diagnosed

A useful thing to know before the visit: in otherwise healthy women over 45 with typical symptoms, perimenopause and menopause can be diagnosed clinically, from your symptoms — hormone blood tests are usually not required.² If a clinician says "your bloods are normal, so it's not menopause," that's a reason to ask more questions.

Questions worth bringing

• Given my age, time since menopause, and history, do my likely benefits outweigh my risks?
• Should I consider a patch or gel rather than a pill to lower clot and stroke risk?
• Do I need a progestogen — do I still have my uterus?
• If my main problem is vaginal dryness or painful sex, would low-dose vaginal estrogen be enough on its own?
• How and when will we review this?

It's a review, not a one-time decision

Good hormone-therapy care is revisited, not set-and-forget. A common pattern is a check-in around three months after starting, then at least yearly once you're stable, reweighing benefits and risks over time.² And current specialist guidance is that there's no arbitrary "stop after X years" rule — duration should be individualized to your symptoms and reviewed, rather than capped by the clock.¹ If you hear the older "lowest dose, shortest time" framing, it's fine to ask how it squares with current guidance.

This article is general educational information, not medical advice, and does not replace a personal consultation. Whether hormone therapy is right for you is an individualized decision to make with a qualified clinician based on your full history.