Perimenopause, menopause and quality of life: when hormone therapy may be indicated, with what benefits and precautions.
In women, the assessment takes into account menopausal status, symptoms and gynaecological, cardiovascular, thromboembolic, oncological and metabolic history. Blood work is adapted to each situation rather than prescribed identically to all patients.
You are not alone. Many of these changes relate to the hormonal transition and deserve an evaluation, not resignation.
The decision depends on symptoms, age, time since menopause, whether the uterus is present, medical history, thromboembolic and cardiovascular risk, oncological and breast history, and the patient's preferences. In general, the benefit–risk balance is more favourable when started before age 60 or within 10 years of menopause. If the uterus is present, a progestogen is added to protect the endometrium.
When correctly indicated, treatment can reduce hot flashes and night sweats, improve sleep when disturbed by climacteric symptoms, improve the genitourinary syndrome of menopause and prevent bone loss, reducing fracture risk in appropriate situations.
Hormone therapy should not be presented as a treatment for aging, dementia or weight loss, nor as general cancer prevention or primary cardiovascular prevention.
Some situations require careful evaluation: history of breast cancer or a hormone-dependent cancer, unexplained vaginal bleeding, thromboembolic history, significant liver disease, a cardiovascular event or cardiovascular risk factors, and migraine depending on context. Certain situations call for a multidisciplinary decision. There is no simplistic list of contraindications: each case is assessed individually and according to up-to-date recommendations.
We present the options for educational purposes, without prescribing. The choice is always individual and medical.
Estradiol
The most commonly used form of estrogen; dose and route are individualised.
Transdermal route (patch/gel)
Often preferred when thromboembolic risk, excess weight or cardiometabolic risk matter.
Oral route
Possible depending on the context; carries a somewhat higher thrombotic risk than the transdermal route.
Local vaginal treatments
Low-dose local estrogen for isolated genitourinary syndrome.
Progesterone / progestogen
Added when the uterus is present, to protect the endometrium.
Testosterone in women
A very specific, cautious place in certain sexual dysfunction indications, with monitoring.
Educational comparison; not a recommendation.
It is menopausal hormone therapy: it mainly replaces estrogen (plus a progestogen if the uterus is present) to relieve symptoms when indicated.
Perimenopause is the transition with irregular cycles; menopause is confirmed after 12 months without a period.
The benefit–risk balance is usually more favourable when started before age 60 or within 10 years of menopause.
There is no fixed duration: it is reviewed periodically according to symptoms, benefits and individual risk profile.
The risk depends on the type, duration and profile; it is nuanced and assessed individually, not automatic.
The transdermal route is associated with a lower thromboembolic risk than the oral route, a key factor in the choice.
Transdermal avoids first-pass liver metabolism and is often preferred with cardiometabolic or thrombotic risk; oral is an option in other cases.
When the uterus is present, the progestogen protects the endometrium from the effect of estrogen.
Yes; without a uterus, estrogen alone is usually used, with no need for a progestogen.
Surgical menopause can cause intense, early symptoms; the treatment indication is assessed individually.
It is neither a weight-loss nor a weight-gain treatment; weight changes at menopause have many causes.
It can improve sleep when it is disturbed by hot flashes and night sweats.
It can help, especially by improving the genitourinary syndrome and general wellbeing; the response is individual.
It has a very specific, cautious place in certain sexual dysfunction indications, with medical monitoring.
A full clinical evaluation and personalised blood work based on symptoms, age and history.
Periodic clinical follow-up to review symptoms, tolerability and the benefit–risk balance.
Yes; stopping is decided with the doctor and may be gradual depending on symptoms.
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Each key clinical statement is grounded in reference recommendations. Last checked: June 2026.
Scientific review: Doctor Florian A. Vallecillo Cabrera · Metabolic medicine — Last reviewed: 2026-06
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