CARE & CLINICAL CONTEXT

If symptoms persist, worsen, or begin affecting daily life, clinician-guided care can help provide clarity—even without a clear diagnosis. Care often begins with understanding patterns, not conclusions.

What research suggests:
ACOG notes hormone therapy can help relieve perimenopause and menopause symptoms and that there are hormonal and nonhormonal options—supporting the idea that clinician review is appropriate when symptoms are impacting quality of life and decisions need individualization. 

References (APA):
American College of Obstetricians and Gynecologists. (n.d.). The menopause years. https://www.acog.org/womens-health/faqs/the-menopause-years
American College of Obstetricians and Gynecologists. (n.d.). Managing menopause symptoms (video). https://www.acog.org/womens-health/videos/managing-menopause-symptoms

For some women, initiating hormone therapy closer to the onset of symptoms—rather than years later—may provide broader benefits beyond symptom relief. This concept is often referred to as the timing hypothesis: that estrogen’s effects on tissues such as bone, cardiovascular system, and brain may differ depending on when therapy begins relative to menopause.

This does not mean hormone therapy is preventive medicine for everyone. Timing, symptom burden, personal risk factors, and formulation all matter, and decisions should be individualized.

What research suggests:
Multiple analyses indicate that women who initiate hormone therapy earlier in the menopause transition may experience more favorable benefit–risk profiles compared with those who start later, particularly for bone health and vasomotor symptoms. Evidence around other systems continues to evolve.

References (APA):
Lobo, R. A. (2013). Where are we 10 years after the Women’s Health Initiative? The Journal of Clinical Endocrinology & Metabolism, 98(5), 1771–1780. https://academic.oup.com/jcem/article/98/5/1771/2536695
The North American Menopause Society. (2022). Hormone therapy position statement. Menopause. https://pubmed.ncbi.nlm.nih.gov/35797481/

A clinician-reviewed intake looks at symptom history, timing, health background, and lifestyle factors together. This broader view can reveal patterns that brief visits may miss.

What research suggests:
NAMS emphasizes individualized treatment using the best available evidence, with periodic reevaluation, supporting comprehensive history and context rather than one-off symptom snapshots. 

References (APA):
The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. https://journals.lww.com/menopausejournal/fulltext/2022/07000/the_2022_hormone_therapy_position_statement_of_the.4.aspx
The North American Menopause Society. (2022). The 2022 hormone therapy position statement… (PubMed record). https://pubmed.ncbi.nlm.nih.gov/35797481/ 

Hormone therapy is primarily prescribed to treat bothersome menopausal symptoms. However, when started at the right time in appropriate candidates, it may also help preserve bone density and reduce fracture risk. These potential longer-term benefits are often overshadowed by older messaging that framed hormone therapy as uniformly risky.

It’s important to distinguish between therapeutic use and preventive intent. Hormone therapy is not prescribed solely to prevent disease, but symptom-driven treatment may have broader physiological effects.

What research suggests:
Major medical societies acknowledge that systemic estrogen therapy prevents bone loss and reduces fracture risk when initiated in suitable patients. Ongoing research continues to clarify how timing and formulation influence long-term outcomes.

References (APA):
The North American Menopause Society. (2022). Hormone therapy position statement. Menopause. https://menopause.org
Compston, J. E., et al. (2019). Osteoporosis. The Lancet, 393(10169), 364–376. https://www.sciencedirect.com/science/article/pii/S014067361832006X

Hormonal therapy may be considered for women who experience bothersome perimenopause or menopause symptoms after a clinician reviews their history and risk factors. Symptoms can begin in the mid-30s or later, and hormonal therapy may be discussed when symptoms affect quality of life.

Guidelines emphasize that for systemic menopausal hormone therapy, the benefit–risk profile is generally most favorable for healthy women who are younger than 60 or within about 10 years of menopause onset, and who have no contraindications. Decisions are individualized and based on symptoms, health history, and current medical guidance.

What research suggests:
Professional guidance from NAMS and ACOG supports individualized use of menopausal hormone therapy for symptomatic women, with timing relative to menopause onset playing an important role in benefit–risk considerations. Research also highlights the relevance of estrogen to multiple body systems, including the brain, during midlife transitions.

References (APA):
The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. https://pubmed.ncbi.nlm.nih.gov/35797481/
American College of Obstetricians and Gynecologists. (n.d.). Hormone therapy for menopause. https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
Mosconi, L., et al. (2021). Menopause impacts human brain structure, connectivity, and energy metabolism. Scientific Reports, 11, 10867. https://www.nature.com/articles/s41598-021-90084-y

Not all women are candidates for systemic hormonal therapy, and some prefer nonhormonal options. Evidence-based nonhormonal treatments exist for vasomotor symptoms such as hot flashes and night sweats, and care plans may combine multiple strategies based on individual needs.

One newer non-hormonal option is fezolinetant (brand name Veozah), an FDA-approved neurokinin-3 (NK3) receptor antagonist for moderate to severe menopausal hot flashes. Safe use includes appropriate liver function monitoring, as outlined in prescribing guidance.

What research suggests:
Updated guidance from NAMS supports individualized, evidence-based nonhormonal therapies for symptom relief. Fezolinetant was approved by the FDA in 2023 as the first NK3 receptor antagonist for menopausal vasomotor symptoms.

References (APA):
The North American Menopause Society. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. https://pubmed.ncbi.nlm.nih.gov/37252752/
U.S. Food and Drug Administration. (2023). FDA approves novel drug to treat moderate to severe hot flashes caused by menopause. https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause
U.S. Food and Drug Administration. (2023). VEOZAH (fezolinetant) prescribing information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/216578s000lbl.pdf