Questions for your doctor: Hormone replacement therapy (HRT)

Why this conversation matters

HRT eligibility has been revised substantially since the WHI study in 2002 that scared a generation of women off it. The current understanding (per 2023 NAMS position statement): for most healthy women within 10 years of menopause and under age 60, HRT benefits outweigh risks. But the conversation is nuanced — type, dose, and delivery method matter.

6 questions to ask

• Based on my history, am I in the "favorable risk" window for HRT? — Age, time since menopause, cardiovascular health, and breast cancer history all factor in. Get an explicit yes/no with reasoning.
• What's the difference between transdermal and oral estrogen for someone like me? — Transdermal (patches, gels) bypasses the liver and has lower clot risk than oral. Often the better choice for women over 50 or with cardiovascular history.
• Do I need progesterone, and what kind? — If you have a uterus, you need progesterone to protect the endometrium. Bioidentical micronized progesterone is generally preferred over synthetic progestins.
• Should I consider adding testosterone? — Low-dose testosterone can help libido, energy, and muscle mass in some women. Off-label in the US but increasingly used. Worth asking.
• What's the monitoring schedule — when do we check labs and re-evaluate? — Initial follow-up at 6-8 weeks, then annually if stable. No re-evaluation = no titration to optimal dose.
• How long can I stay on HRT? — The "five years and stop" rule is outdated. Current guidance: continue as long as benefits outweigh risks. There is no hard time limit.

What to bring

• Symptom log — at least 2 weeks of daily entries (severity, time of day, triggers)
• List of current medications and supplements with doses
• Family history of relevant conditions
• Recent lab results, if any (especially hormones, thyroid, vitamin D, lipids)
• A written list of questions — easy to forget under time pressure

Red flags to escalate

• New unusual breast lumps after starting
• Calf pain, swelling, or shortness of breath (clot signs)
• Severe headaches with visual changes
• Heavy or unusual vaginal bleeding
• Severe mood changes

If they dismiss you

If your doctor refuses to discuss HRT or says "you don't need it" without examining your individual risk profile, find a NAMS-certified specialist. Many primary care providers are not current on the post-WHI evidence.

Frequently asked