Despite its potential effectiveness in reducing a variety of menopause symptoms, the use of hormone therapy for menopause is at an all-time low, according to recent studies.1,2
So, what exactly has led to this decline in use, from its peak at 40 percent pre-2002, down to less than 2 percent in 2023?3,4 There’s more than one reason women are looking for alternatives to traditional hormone replacement for menopause and its symptoms.
According to Bonafide Chief Medical Officer, Dr. Alyssa Dweck, “A decline in hormone therapy usage was quite precipitous after results of the now infamous WHI study suggested a significant increase in breast cancer risk in those taking a particular hormone therapy combination. Although these results have since been reinterpreted to suggest a much lower risk, hormone therapy use has not recovered. Other factors include medical contradiction to hormone use, poor access to medical care, lack of education about hormones, cost and distrust of the pharmaceutical industry, in general.”
Let’s first take a look at what hormone therapy is and why women are searching for other options for their menopause symptom management.
What is Hormone Therapy for Menopause?
Hormone replacement therapy (HRT, HT, or Menopause Therapy, MT) replaces hormones, like estrogen, that a woman's body no longer makes (or makes less of) leading up to, during and after menopause.5 As a woman transitions through perimenopause, her ovaries begin to make less estrogen, which can cause menopause symptoms such as:6
- Hot flashes
- Night sweats
- Trouble sleeping
- Vaginal dryness
- Painful sexual intercourse
- Changes in mood
- Depressed moods and/or anxiety
- Incontinence
According to Dr. Dweck, “Low estrogen is the primary reason for many hormonal symptoms [during menopause]. Since there are estrogen receptors throughout the body, low estrogen can result in multiple signs and symptoms. Low progesterone and testosterone and the ratio of these hormones to each other often lead to many common menopause complaints.”
There are many forms of HRT, with each containing its own list of pros and cons. Estrogen-based HRT can come in systemic or localized formats, including:7
- Pills
- Creams or gels
- Patches
- Vaginal suppositories/tablets
- Vaginal rings
- Pellets
Reasons for a Decline in HRT Use for Menopause Symptoms
Hesitation in seeking out estrogen therapy for menopause and its symptoms varies in reasoning, but typically boils down to two main concerns.
Confusion on the Risks/Benefits of HRT Use
Use of HRT for menopause peaked around the early 2000s, but sharply declined just two years later— with one published study serving as the main driver in its declining popularity. A 2002 publication from the Women's Health Initiative (WHI) stated that overall health risks of HRT exceeded its benefits, halting trials and casting both fear and confusion onto what was once a popular symptom management choice among menopausal women.8
The publication stated higher risks of breast cancer and stroke among those who took hormone replacement for menopause.
After the study published its findings, the Food and Drug Administration ordered all companies making estrogen-containing drugs to include a black-box warning indicating increased risks for certain types of cancer, heart disease, and stroke alongside use.9
Lack of Insurance Coverage
Socioeconomic factors have also played a role in the decline of HRT, according to research. Studies have shown that variables like low income and lack of insurance coverage are common barriers to a woman’s ability to secure hormone therapy treatment for menopause.10,11
While insurance coverage of hormone replacement therapy has expanded in recent years, out-of-pocket costs can remain high.12
Alternatives to Hormone Therapy for Menopause
Many women are saying “no” to hormone replacement therapy and seeking other options for menopause symptom relief.
Fortunately, thanks to a recent spotlight on women’s health and the scientific research dedicated to it, there are now more options than ever before for women hoping to manage menopause symptoms without hormones.
Dr. Dweck explains “Most definitely there are options! Menopausal symptoms can be incredibly debilitating. Many individuals cannot or would prefer not to take hormone therapy. Alternatives are filling an unmet need in this space.”
Some women are looking at hormone-free menopause management, including:
Lifestyle Changes
Simple changes in diet, exercise, and stress management can make a difference for some women experiencing menopause symptoms.
Dr. Dweck notes, “Lifestyle modification is the first step in optimizing not only the menopause experience, but also general health. Diet, exercise, stress reduction and sleep optimization are crucial to supporting symptom relief with or without other treatment options.”
Lifestyle changes that may help combat some menopause symptoms include:
- Cardio (like walking) to decrease hot flashes13
- Strength training and resistance training to increase bone mass and lower the risk for osteoporosis14
- Stress management, therapy, and meditation to manage mood swings and mental wellness15
Hormone-Free Menopause Supplements
There’s also more research than ever before on vitamins, supplements and products made without parabens or phytoestrogens that are designed to reduce menopause symptoms such as hot flashes, vaginal dryness, skin changes, and more.
Talk with Your Healthcare Provider About Managing Menopause Symptoms
The risks and benefits of any menopause symptom management plan, including hormone replacement therapy, is unique for each individual, since everyone’s experience through this transitional period will be different. If you’re experiencing menopause symptoms, discuss management options with a trusted healthcare provider who is aware of your medical history, goals, and other health variables so you can get back to feeling like yourself again.
“Suffering with menopause symptoms is out – safe effective management tools are both in and readily available,” Dr. Dweck concludes.
Resources- https://jamanetwork.com/journals/jama-health-forum/fullarticle/2823978
- https://www.medpagetoday.com/meetingcoverage/tms/111948
- https://www.medpagetoday.com/meetingcoverage/tms/111948
- https://www.medscape.com/viewarticle/hormone-therapy-menopause-remains-historic-lows-despite-2024a1000gtw
- https://my.clevelandclinic.org/health/treatments/15245-hormone-therapy-for-menopause-symptoms
- https://www.nia.nih.gov/health/menopause/what-menopause
- https://www.webmd.com/menopause/which-type-of-estrogen-hormone-therapy-is-right-for-you
- https://jamanetwork.com/journals/jama/fullarticle/195120
- https://www.medscape.com/viewarticle/clinicians-call-easing-fda-warnings-low-dose-estrogen-2024a100093t
- https://jamanetwork.com/journals/jama-health-forum/fullarticle/2823978
- https://jamanetwork.com/journals/jama-health-forum/fullarticle/2823976
- https://www.goodrx.com/conditions/estrogen-replacement/hrt-cost
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9886316.
- https://www.health.harvard.edu/pain/effective-exercises-for-osteoporosis
- https://www.healthline.com/health/menopause/alternatives-to-hrt#stress-management
