Is HRT right for you? Here is how we actually decide.
Candidacy is not a feeling and not a slogan. It is a systematic assessment of your symptoms, your timing, and your personal and family history — made before prescribing, not after.
The timing window
The risk–benefit profile of hormone therapy is most favorable for women who begin within about ten years of menopause or before age 60 — sometimes called the "timing hypothesis." Most women in that window with bothersome symptoms are good candidates. Outside it, the conversation changes; it does not automatically end.
Strong indications
Moderate to severe hot flashes or night sweats · sleep disturbance from vasomotor symptoms · premature ovarian insufficiency or early menopause · genitourinary syndrome (local therapy) · bone loss within ten years of menopause.
Reasonable to consider
Mood symptoms in perimenopause · quality-of-life-limiting symptoms outside the "classic" list · prevention of bone loss with risk factors and no contraindications · surgical menopause.
Who shouldn't take systemic hormone therapy
- A history of breast cancer (low-dose vaginal estrogen may still be considered with oncology input)
- Active or recent venous thromboembolism — unless after individualized assessment with transdermal-only preparations
- Active or recent coronary artery disease, stroke, or TIA
- Active liver disease
- Unexplained vaginal bleeding before evaluation
- Untreated endometrial hyperplasia or cancer, and pregnancy
For many of these situations, non-hormonal therapies still meaningfully reduce symptoms — declining HRT does not mean declining treatment.
What the evaluation covers
Before anything is prescribed, we build your individual risk profile: hormonal status; thyroid and metabolic labs where they add information; bone and cardiovascular risk; and your personal and family history of clotting, breast disease, and migraine. Diabetes and hypertension, when well controlled, are not contraindications — they change the route we choose (transdermal is preferred), not whether treatment is possible.