If you’ve been struggling with brain fog, fatigue, mood swings, hot flashes, sleep changes, low libido, or simply not feeling like yourself anymore, you may have wondered:


  • Should I consider hormone therapy?
  • And is it actually safe?


In this episode of Reclaim Vitality, I sit down again with Dr. Amy Hawkins, a licensed naturopathic doctor and North American Menopause Society-certified practitioner in North Carolina, to unpack one of the most misunderstood topics in women’s health: hormone replacement therapy (HRT).


We talk about where the fear around hormones came from, what has changed in menopause medicine over the last 20 years, and how women can make informed decisions without getting lost in conflicting information or outdated messaging.

Why So Many Women Are Afraid of HRT

For many women, the conversation around hormone therapy immediately brings up fear around breast cancer, blood clots, stroke, or heart disease.


A large part of this fear comes from the Women’s Health Initiative (WHI) study published over 20 years ago.1 When that study came out, it dramatically changed how doctors viewed hormone therapy. Many women were taken off hormones, and many physicians stopped being trained in menopause care altogether. Unfortunately, much of the interpretation and reporting around that study was incomplete, oversimplified, or outdated.


Today, menopause specialists interpret the data very differently.

What Was Different About the Women’s Health Initiative Study?

One of the biggest takeaways is that the hormones used in the original WHI study are very different from many of the hormones used as treatment today.


The study primarily involved:


  • synthetic hormones
  • conjugated equine estrogens (derived from pregnant mare urine)
  • synthetic progestins


Modern hormone therapy often uses bioidentical hormones, including:


  • estradiol
  • progesterone
  • testosterone


These hormones are chemically identical to the hormones naturally produced in the human body. A simple analogy I use to help make the difference is:  Fresh strawberries versus strawberry-flavored gummies. One is bio-identical, and the other is synthetic and not the exact same as the hormone produced in our body.  Both are called “strawberries,” but they are not the same thing.

What Is Bioidentical Hormone Therapy?

Bioidentical hormones are hormones designed to match the same molecular structure as the hormones naturally produced in the body.


The most commonly used forms include:


  • estradiol
  • progesterone


Many women assume bio-identical hormones are only available through specialty compounding pharmacies, but that is no longer true. Today, many bio-identical hormones are available through standard pharmacies and may even be covered by insurance.  However, compounded ones are valuable when we need special dosing, delivery methods or combinations when the patient can't tolerate the ones from standard pharmacies.

Timing Matters: When Is HRT Most Safest?

Current menopause guidelines suggest that hormone therapy tends to have the best balance of risk and benefit when:


  • started before age 60
  • or within 10 years of menopause


This is why early conversations matter. Many women spend years suffering through symptoms before seeking help because they assume they just need to “push through it.”

When Is Hormone Therapy Helpful?

Hormone therapy is FDA-approved and clinically proven to help with:


  • Hot flashes and night sweats
  • Sleep disruption and insomnia related to menopause
  • Vaginal dryness and painful intercourse
  • Genitourinary symptoms of menopause (recurrent UTIs, vaginal irritation, tissue thinning)
  • Prevention of bone loss and osteoporosis after menopause


Many women may also notice improvements in:


  • Brain fog and cognitive symptoms
  • Mood and emotional resilience
  • Joint aches and stiffness
  • Energy and exercise recovery
  • Libido and sexual health


Some studies also suggest hormone therapy may help reduce the risk of developing type 2 diabetes when started appropriately in early menopause.

Who May Be a Good Candidate for HRT?

Hormone therapy is generally considered safest and most beneficial for:


  • Healthy women under age 60
  • Women within 10 years of menopause onset
  • Women experiencing moderate to severe menopausal symptoms affecting quality of life
  • Women with early menopause or premature ovarian insufficiency
  • Women at increased risk for osteoporosis or rapid bone loss


The decision to use HRT should always be individualized and based on symptoms, personal goals, family history, and overall health profile.

Who May NOT Be a Good Candidate for Estradiol or HRT?

Hormone therapy may not be recommended for women with certain medical conditions or histories, including:


  • History of stroke or transient ischemic attack (TIA)
  • History of heart attack (MI)
  • History of pulmonary embolism (PE) or venous thromboembolism (VTE)
  • Active or history of estrogen-sensitive breast cancer
  • Active endometrial or ovarian cancer
  • Active liver disease
  • Unexplained vaginal bleeding (until fully evaluated)
  • Known clotting disorders or thrombophilia (such as Factor V Leiden, Protein C or Protein S deficiency)
  • Metastatic cancer
  • Uncontrolled hypertension

Conditions That Require a More Individualized Risk–Benefit Discussion

Some women may still be candidates for hormone therapy, but treatment should involve a thoughtful discussion about risks, benefits, route of delivery, and monitoring.


These situations may include:


  • Migraine with aura (especially with oral estrogen)
  • Diabetes or insulin resistance
  • Smoking history
  • Elevated cardiovascular risk
  • Elevated breast cancer risk
  • Hypertriglyceridemia (especially if considering oral estrogen)
  • Gallbladder disease
  • Endometriosis
  • Asthma


This is why working with a menopause-informed practitioner is so important. Hormone therapy is not one-size-fits-all, and the safest, most effective approach depends on the whole picture of your health.

Understanding Breast Cancer Risk

One of the biggest fears women have is breast cancer risk.


The increased breast cancer risk associated with older studies was primarily linked to synthetic progestins, not necessarily the bio-identical progesterone more commonly used today. And even if we have to look at risk of taking the synthetic progestins, in relative terms, it is about the same risk of developing breast cancer as those women who have 1 alcohol beverage a day.  This is why individualized risk assessment and discussion matters so much.

Testosterone Therapy for Women

Testosterone has become a major topic in women’s hormone health.


While official guidelines primarily support testosterone therapy for postmenopausal low libido, many practitioners also use it thoughtfully for women experiencing:


  • very low libido
  • low motivation
  • fatigue
  • reduced vitality
  • brain fog


Testosterone should be carefully monitored and used within physiologic female ranges to minimize side effects.

Vaginal Estrogen and Genitourinary Symptoms

One of the most overlooked areas of menopause care is vaginal and urinary health. Many women experience:


  • vaginal dryness
  • painful intercourse
  • recurrent UTIs
  • recurrent BV or yeast infections
  • tissue thinning
  • odor changes


This group of symptoms is called genitourinary syndrome of menopause. Vaginal estrogen therapy is considered extremely safe because very little is absorbed systemically. It works locally within vaginal tissues and can be life-changing for women dealing with these symptoms.

Do You Need Hormone Testing?

This is one of the most common questions women ask. Perimenopause is primarily a clinical diagnosis. Symptoms, menstrual history, age, and overall clinical picture are often more important than lab numbers alone. During perimenopause, hormones fluctuate constantly. This is why hormone labs often do not perfectly match how a woman feels.  


Hormone testing may still be helpful in certain situations, especially when monitoring testosterone therapy or ruling out other causes of symptoms before establishing it as a perimenopausal cause.

Looking Beyond Hormones

Hormones do not exist in isolation. Women in midlife may also need evaluation for:


  • thyroid dysfunction
  • insulin resistance
  • metabolic changes
  • nutritional deficiencies
  • autoimmune conditions
  • chronic stress patterns


This is why personalized, whole-person care matters.


Listen to the Full Episode

In this episode of Reclaim Vitality, Dr. Amy Hawkins and I discuss:


  • hormone myths and misconceptions
  • who may benefit from therapy
  • vaginal estrogen safety
  • hormone testing

If you’ve been struggling with brain fog, fatigue, mood swings, hot flashes, sleep changes, low libido, or simply not feeling like yourself anymore, you may have wondered:


  • Should I consider hormone therapy?
  • And is it actually safe?


In this episode of Reclaim Vitality, I sit down again with Dr. Amy Hawkins, a licensed naturopathic doctor and North American Menopause Society-certified practitioner in North Carolina, to unpack one of the most misunderstood topics in women’s health: hormone replacement therapy (HRT).


We talk about where the fear around hormones came from, what has changed in menopause medicine over the last 20 years, and how women can make informed decisions without getting lost in conflicting information or outdated messaging.

Why So Many Women Are Afraid of HRT

For many women, the conversation around hormone therapy immediately brings up fear around breast cancer, blood clots, stroke, or heart disease.


A large part of this fear comes from the Women’s Health Initiative (WHI) study published over 20 years ago.1 When that study came out, it dramatically changed how doctors viewed hormone therapy. Many women were taken off hormones, and many physicians stopped being trained in menopause care altogether. Unfortunately, much of the interpretation and reporting around that study was incomplete, oversimplified, or outdated.


Today, menopause specialists interpret the data very differently.

What Was Different About the Women’s Health Initiative Study?

One of the biggest takeaways is that the hormones used in the original WHI study are very different from many of the hormones used as treatment today.


The study primarily involved:


  • synthetic hormones
  • conjugated equine estrogens (derived from pregnant mare urine)
  • synthetic progestins


Modern hormone therapy often uses bioidentical hormones, including:


  • estradiol
  • progesterone
  • testosterone


These hormones are chemically identical to the hormones naturally produced in the human body. A simple analogy I use to help make the difference is:  Fresh strawberries versus strawberry-flavored gummies. One is bio-identical, and the other is synthetic and not the exact same as the hormone produced in our body.  Both are called “strawberries,” but they are not the same thing.

What Is Bioidentical Hormone Therapy?

Bioidentical hormones are hormones designed to match the same molecular structure as the hormones naturally produced in the body.


The most commonly used forms include:


  • estradiol
  • progesterone


Many women assume bio-identical hormones are only available through specialty compounding pharmacies, but that is no longer true. Today, many bio-identical hormones are available through standard pharmacies and may even be covered by insurance.  However, compounded ones are valuable when we need special dosing, delivery methods or combinations when the patient can't tolerate the ones from standard pharmacies.

Timing Matters: When Is HRT Most Safest?

Current menopause guidelines suggest that hormone therapy tends to have the best balance of risk and benefit when:


  • started before age 60
  • or within 10 years of menopause


This is why early conversations matter. Many women spend years suffering through symptoms before seeking help because they assume they just need to “push through it.”

When Is Hormone Therapy Helpful?

Hormone therapy is FDA-approved and clinically proven to help with:


  • Hot flashes and night sweats
  • Sleep disruption and insomnia related to menopause
  • Vaginal dryness and painful intercourse
  • Genitourinary symptoms of menopause (recurrent UTIs, vaginal irritation, tissue thinning)
  • Prevention of bone loss and osteoporosis after menopause


Many women may also notice improvements in:


  • Brain fog and cognitive symptoms
  • Mood and emotional resilience
  • Joint aches and stiffness
  • Energy and exercise recovery
  • Libido and sexual health


Some studies also suggest hormone therapy may help reduce the risk of developing type 2 diabetes when started appropriately in early menopause.

Who May Be a Good Candidate for HRT?

Hormone therapy is generally considered safest and most beneficial for:


  • Healthy women under age 60
  • Women within 10 years of menopause onset
  • Women experiencing moderate to severe menopausal symptoms affecting quality of life
  • Women with early menopause or premature ovarian insufficiency
  • Women at increased risk for osteoporosis or rapid bone loss


The decision to use HRT should always be individualized and based on symptoms, personal goals, family history, and overall health profile.

Who May NOT Be a Good Candidate for Estradiol or HRT?

Hormone therapy may not be recommended for women with certain medical conditions or histories, including:


  • History of stroke or transient ischemic attack (TIA)
  • History of heart attack (MI)
  • History of pulmonary embolism (PE) or venous thromboembolism (VTE)
  • Active or history of estrogen-sensitive breast cancer
  • Active endometrial or ovarian cancer
  • Active liver disease
  • Unexplained vaginal bleeding (until fully evaluated)
  • Known clotting disorders or thrombophilia (such as Factor V Leiden, Protein C or Protein S deficiency)
  • Metastatic cancer
  • Uncontrolled hypertension

Conditions That Require a More Individualized Risk–Benefit Discussion

Some women may still be candidates for hormone therapy, but treatment should involve a thoughtful discussion about risks, benefits, route of delivery, and monitoring.


These situations may include:


  • Migraine with aura (especially with oral estrogen)
  • Diabetes or insulin resistance
  • Smoking history
  • Elevated cardiovascular risk
  • Elevated breast cancer risk
  • Hypertriglyceridemia (especially if considering oral estrogen)
  • Gallbladder disease
  • Endometriosis
  • Asthma


This is why working with a menopause-informed practitioner is so important. Hormone therapy is not one-size-fits-all, and the safest, most effective approach depends on the whole picture of your health.

Understanding Breast Cancer Risk

One of the biggest fears women have is breast cancer risk.


The increased breast cancer risk associated with older studies was primarily linked to synthetic progestins, not necessarily the bio-identical progesterone more commonly used today. And even if we have to look at risk of taking the synthetic progestins, in relative terms, it is about the same risk of developing breast cancer as those women who have 1 alcohol beverage a day.  This is why individualized risk assessment and discussion matters so much.

Testosterone Therapy for Women

Testosterone has become a major topic in women’s hormone health.


While official guidelines primarily support testosterone therapy for postmenopausal low libido, many practitioners also use it thoughtfully for women experiencing:


  • very low libido
  • low motivation
  • fatigue
  • reduced vitality
  • brain fog


Testosterone should be carefully monitored and used within physiologic female ranges to minimize side effects.

Vaginal Estrogen and Genitourinary Symptoms

One of the most overlooked areas of menopause care is vaginal and urinary health. Many women experience:


  • vaginal dryness
  • painful intercourse
  • recurrent UTIs
  • recurrent BV or yeast infections
  • tissue thinning
  • odor changes


This group of symptoms is called genitourinary syndrome of menopause. Vaginal estrogen therapy is considered extremely safe because very little is absorbed systemically. It works locally within vaginal tissues and can be life-changing for women dealing with these symptoms.

Do You Need Hormone Testing?

This is one of the most common questions women ask. Perimenopause is primarily a clinical diagnosis. Symptoms, menstrual history, age, and overall clinical picture are often more important than lab numbers alone. During perimenopause, hormones fluctuate constantly. This is why hormone labs often do not perfectly match how a woman feels.  


Hormone testing may still be helpful in certain situations, especially when monitoring testosterone therapy or ruling out other causes of symptoms before establishing it as a perimenopausal cause.

Looking Beyond Hormones

Hormones do not exist in isolation. Women in midlife may also need evaluation for:


  • thyroid dysfunction
  • insulin resistance
  • metabolic changes
  • nutritional deficiencies
  • autoimmune conditions
  • chronic stress patterns


This is why personalized, whole-person care matters.


Listen to the Full Episode

In this episode of Reclaim Vitality, Dr. Amy Hawkins and I discuss:


  • hormone myths and misconceptions
  • who may benefit from therapy
  • vaginal estrogen safety
  • hormone testing

Your health won’t wait—why should you?

Let’s get to the root of what’s getting you stuck.

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References:

1. The Women’s Health Initiative Hormone Therapy Trials: Update and Overview of Health Outcomes During the Intervention and Post-Stopping Phases. Manson JE, Chlebowski RT, Stefanick ML, et al. JAMA. 2013;310(13):1353–1368. PMCID: PMC3963523. PMID: 24084921

2.The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. doi:10.1097/GME.0000000000002028.

3. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline. Kaufman MR, Ackerman AL, Amin KA, et al. Endorsed by The International Society for the Study of Women’s Sexual Health (ISSWSH) and The Menopause Society (TMS). American Urological Association. 2025.

4. The Menopause Society. (2024). Menopause and the workplace: consensus recommendations from The Menopause Society. Menopause, 31(9), 741–749


Disclaimer:

This information is for educational purposes only and is not intended as medical advice. Consult a qualified healthcare professional before making any health-related decisions. Individual results may vary.