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Hormone therapy for menopause: who it helps, who should not, and how we prescribe it
The evidence has moved a long way since 2002. Here is where it stands, and how we decide with you.
Who benefits
Women with bothersome hot flashes, night sweats, sleep disruption or genitourinary symptoms, generally within ten years of their last period or under 60, who do not have a reason to avoid estrogen. For this group, current Menopause Society guidance considers the benefits to outweigh the risks for most.
Who should not, or needs a different plan
A history of breast cancer, blood clots, stroke, heart attack or unexplained vaginal bleeding changes the decision. Many of these women still have excellent options: non-hormonal medication for flashes, local vaginal estrogen, and sleep and mood treatments. The first visit exists to sort this out carefully.
How we prescribe
Transdermal estrogen (patch or gel) is our usual first choice because it does not raise clot risk the way oral estrogen can; progesterone is added when you have a uterus. We start low, review at 6–8 weeks, and adjust. We prescribe FDA-approved products from regular pharmacies and do not sell pellets or compounded hormones.
Monitoring
Blood pressure and symptoms at each visit, mammogram and cervical screening on schedule, and a yearly review of whether to continue. There is no fixed stop date; the decision is revisited every year.
Common questions
Does hormone therapy cause breast cancer?
Combined estrogen plus progestogen is associated with a small increase in breast cancer risk with longer use (beyond about five years); estrogen alone has not shown that increase in the major trials. We go through your personal risk at the consult rather than giving one answer for everyone.
What about testosterone or pellets?
We do not use pellets or compounded hormones, because doses are unpredictable and not FDA-regulated. Testosterone has limited evidence for low libido in postmenopausal women; we discuss it case by case.
Is this a gynecology practice?
No. We are internal medicine physicians with a focus on perimenopause and menopause. We treat the symptoms and the long-term risks that come with this stage, including heart, bone, weight, sleep and mood, and we work with your OB/GYN when a procedure or gynecologic exam is needed.
Do I need a referral?
No. Book directly online, or call or text. If you have an OB/GYN or primary care provider, we send them a summary with your permission.
Is hormone therapy safe?
For most healthy women within ten years of menopause or under 60, current guidelines consider hormone therapy a reasonable and effective option for bothersome symptoms. Some conditions change that answer, which is why the first visit is a full medical review. We follow the Menopause Society guidance and explain the trade-offs plainly.
Is it covered by insurance?
Visits are billed to your insurance as medical visits through Privia Medical Group. Medications are usually covered with a standard copay. See the insurance page.
Can I do visits by video?
Yes. After the first visit most follow-ups can be by secure video anywhere in Virginia.
You do not have to put up with it.
A 45-minute consult that takes your symptoms seriously and looks at the whole picture.