By: Kathy Hubbard
We’ve talked about menopause and perimenopause before. Hot flashes, night sweats, irregular periods, sleep disturbances, brain fog, vaginal dryness, loss of libido, irritability, anxiety, weight change, joint pain and dry skin to name a few symptoms that can be difficult to endure.
Starting in the 1960s and up to the 90s, hormone replacement therapy (HRT) was the gold standard for women experiencing the inconvenient and unpleasant symptoms of menopause. Then in the late 1990s a new clinical trial was started.
National Institutes on Health’s website says, “After the announcement of the first results of the Women’s Health Initiative in 2002, which showed that HRT had more detrimental than beneficial effects, HRT use dropped. The negative results of the study received wide publicity, creating panic among some users and new guidance for doctors on prescribing HRT.”
But that was then. Today, what’s now called menopause hormone therapy (MHT), has gone through much better and much longer studies with a wider variety of women, and the conclusion is that the benefits for most women outweigh the risks. In November, 2025, the Federal Food and Drug Administration removed the “black box” warning on hormone replacement drugs.
To get a professional opinion, I reached out to Nichole Grimm, FNP, and primary care provider at Bonner General Health Family Practice.
“I am a big supporter of MHT to support women during their journey in perimenopause and menopause transition. Obviously, there are a few contraindications, and it is not the right choice for every woman, but the majority of women can benefit from therapy, and I love to sit with them, hear what they are experiencing, and explain the benefits of therapy in addition to lifestyle changes that can support them during this phase of life,” she said.
“I believe the most important aspect to focus on when weighing the pros and cons is the overwhelming evidence that supports the safety, efficacy, and long-term benefit of therapy with women as they age. Not only can MHT significantly improve a women’s quality of life during this time of her life by reducing hot flashes, night sweats and vaginal dryness, it can help improve mood, sleep, and libido while also offering long term benefits like preventing osteoporosis, reducing fracture risk, lowering the risk for type 2 diabetes, and potentially benefiting cardiovascular health if started early during the menopausal years.”
The Menopause Society’s website explains, “At the most basic level, hormone therapy replaces female hormones, primarily estrogen and progestogens, that are lost during the menopause transition. Hormone therapy is FDA-approved as a first-line therapy for the relief of bothersome hot flashes and is shown to be the most effective treatment.”
They also explain that there are two types of hormone therapy, systemic therapy and low-dose therapy. Low dose is a medication that is applied to the vagina for moisturizing and rebuilding tissue. Because little goes into the blood stream, the risks are lower.
“When hormones are delivered throughout the body via pills, patches, sprays, gels, or a vaginal ring, this is known as systemic therapy. Systemic doses are absorbed into the bloodstream at high-enough levels to have significant effects in widespread areas, which is needed to treat symptoms of menopause such as hot flashes,” Menopause Society says.
“Systemic hormones include estrogens, either the same or similar to the estrogens the body produces naturally, and progestogens, which include progesterone — the progestogen the body produces naturally — or a similar compound.”
So, what are the risks? Of course, everyone is different. Mayo Clinic says that risks depend on the type of hormone therapy, the dose of medicine, how long the medicine is taken, your age and personal health risks. “For best results, menopause hormone therapy should be tailored to each person.”
What you’ll discuss with your primary care provider is whether MHT will increase your risk for heart disease, stroke, blood clots, breast cancer, gallbladder disease or endometrial cancer. You’ll also talk about possible adverse effects of the drugs and about how long you will be taking them.
“There is a lot of fear and myths surrounding hormones that need to be addressed. I do this with education and practicing evidence-based using FDA approved therapies, and showing women validated studies that delineates the benefit versus risk,” Grimm said.
Kathy Hubbard was a charter member of Bonner General Health Foundation. She can be reached at [email protected]. This article was written for publication in the Bonner County Daily Bee on January 14, 2025.