Hormone Therapy for Women: Clearing the Confusion and Anxiety Around Menopause Care

Why many women are being told to stop hormones, and what modern evidence actually shows

For many women, hormone therapy has felt confusing, or even frightening ever since large studies from more than 20 years ago raised concerns about its safety. Recently, several of my own patients told me they were advised during routine gynecologic visits to stop hormone therapy immediately due to fears of stroke, heart attack, blood clots, or cancer.

That understandably created anxiety.

This blog was written to provide some clarity.

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Why Some Doctors Still Advise Stopping Hormones

Many physicians were trained during the era of the Women’s Health Initiative (WHI) trials in the late 1990s and early 2000s. Those studies evaluated one specific hormone regimen:

• Oral conjugated equine estrogen (a pill)

• Combined with a synthetic progesterone

• Given at fixed doses

• In older postmenopausal women

Based on those results, hormone therapy earned a reputation as broadly dangerous, and that message became deeply ingrained in medical culture.  Modern hormone therapy looks very different from what was studied decades ago.

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What Has Changed Since the WHI

Today’s hormone therapy commonly uses:

• Estradiol, which is identical to the estrogen your body naturally produces

• Transdermal delivery (patches, gels, sprays) instead of pills

• Micronized progesterone, rather than older synthetic forms

• Individualized dosing rather than a one-size-fits-all approach

These differences affect safety.

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What New Research Is Showing

In 2024, a large study published in Menopause analyzed outcomes in over 10 million women aged 65 and older. This is one of the largest hormone-therapy studies ever conducted in this age group.

The key takeaway was that outcomes vary dramatically based on formulation, route, and dose.

Women using estradiol, particularly through non-oral routes, had more favorable safety profiles than those using older oral formulations.

In this study, women who continued estrogen therapy beyond age 65 showed meaningful associations with improved health outcomes when compared with women who never used hormones or who stopped them:

• Lower overall risk of death

• Lower rates of breast cancer

• Lower rates of lung and colorectal cancer

• Lower rates of heart failure and heart attacks

• Lower rates of dementia

These benefits were strongest with estradiol, with non-oral delivery, and with lower doses, which mirrors how I prescribe hormone therapy in women today.

Importantly, the study found no evidence that hormone therapy must automatically be stopped at age 65. And just as important, the data did not show an increased risk when hormone therapy was started after age 65.

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Why I Prefer Transdermal/Subdermal Estradiol

When estrogen is taken as a pill, it passes through the liver first. This process can:

• Increase clotting factors

• Raise triglycerides

• Increase inflammation

When estrogen is delivered through the skin:

• It bypasses the liver

• It has less impact on clotting

• It is associated with lower risks of blood clots and stroke

This is why transdermal estradiol is now considered the preferred option for most women.

Estradiol pellet therapy achieves hormone levels and physiologic effects that are comparable to transdermal estradiol. Studies evaluating estradiol delivery methods show that pellets provide steady estradiol exposure similar to patches or gels.

For women who prefer pellets for convenience or consistency, estradiol pellet therapy can be a reasonable alternative to transdermal therapy. One practical advantage is that pellets typically last 4 to 6 months, avoiding the need to change patches twice per week.

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Hormone Therapy After Age 65

There is no universal rule that hormone therapy must stop at age 65.

The North American Menopause Society states that for women with persistent symptoms, continuing hormone therapy beyond age 65 is reasonable. Initiating hormone therapy after age 65 is also appropriate when done thoughtfully with careful attention to formulation, route, and dose.

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If You Were Told to Stop Hormones Suddenly

If another provider has raised concerns about your hormone therapy, that does not mean they are wrong, and it does not mean your treatment is unsafe.

It means we need to have a conversation in context, not fear.

Many of the risks patients are warned about are associated with specific hormone formulations, not with hormone therapy as a category. Abruptly stopping hormones can itself cause significant symptoms and distress, and decisions should be made collaboratively, using current evidence.

If you have questions or concerns, that conversation should happen with time, nuance, and a clear understanding of which hormones you are using and why.

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The Bottom Line

Hormone therapy today is not the same therapy studied 20–30 years ago. When prescribed thoughtfully, modern hormone therapy:

• Uses hormones identical to those your body produces

• Avoids unnecessary liver exposure

• Prioritizes safety through formulation, dose, and route

• Can be continued beyond age 65 in most women

If you have questions about whether hormone therapy is right for you, or whether your current regimen still makes sense, that discussion should be informed, not fearful.

To Your Good Health,

The Longevity Doctor®