Editor's note: This popular story from the Daily Briefing's archives was republished on June 2, 2023.

Writing for the New York Times Magazine, Susan Dominus explains why menopause treatments are "often overlooked" by doctors and outlines five things you need to know about menopause and hormone therapy.

Why menopause treatments are 'often overlooked'

During menopause, women can experience a myriad of symptoms including hot flashes, night sweats, sleeplessness, mood changes, depression, weight gain, joint pain, vaginal dryness, pain during sex, and accelerated bone loss. 

"Menopause has the worst P.R. campaign in the history of the universe, because it's not just hot flashes and night sweats," said Rachel Rubin, a sexual-health expert and assistant clinical professor in urology at Georgetown University.

Roughly 85% of women experience menopausal symptoms during this transition. According to Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, many menopausal women have been underserved — an oversight Thurston regards as one of the great blind spots of medicine. "It suggests that we have a high cultural tolerance for women's suffering," Thurston said. "It's not regarded as important."

There is "a treatment for all these symptoms that doctors often overlooked," Dominus writes. According to Dominus, this paints a "depressingly accurate picture of menopausal care for women."

The treatment, known as menopausal hormone therapy, helps mitigate some of the symptoms associated with menopause, including hot flashes, sleep disruption, and possibly depression and aching joints.

In the 1990s, around 15 million women received menopausal hormone therapy. Then, in 2002, a study found links between hormone therapy and elevated health risks among women of all ages. Within one year, the number of prescriptions declined significantly.

While there are risks associated with hormone therapy, dozens of studies have since provided evidence that the benefits outweigh the risks for healthy women under 60.

Still, the treatment's reputation has never fully recovered, resulting in "wide-reaching" consequences, Dominus writes.

5 things you need to know about menopause and hormone therapy

1. Hormone therapy alleviates menopause symptoms

Evidence suggests that hormone therapy can help alleviate several symptoms associated with menopause. In addition, it helps prevent and treat menopausal genitourinary syndrome, which affects almost half of postmenopausal women. The treatment also lowers the risk of diabetes and protects against osteoporosis.

"Because of the health risks associated with hormone therapy, it is recommended for women who have 'bothersome' hot flashes and certain other menopausal symptoms, not for preventive care," Dominus writes.

2. The health risks vary by age

Typically, a woman's risk of heart disease, stroke, and dementia from the treatment depends on when they start hormone therapy. However, all women face an increased risk of breast cancer after taking hormones for around five years.

Women who have had a heart attack, breast cancer or a stroke or clot, or women with significant health problems face the highest risk from hormone use.

"For everyone else," said Stephanie Faubion, the director of the Center for Women's Health at the Mayo Clinic, "the decision has to do with the severity of symptoms as well as personal preferences and level of risk tolerance."

3. Concern over hormone therapy can largely be traced to a single study

In 2002, the Women's Health Initiative study raised serious concerns about the health risks associated with hormone therapy, leading many doctors and patients to stop prescribing and taking it.

Since then, analyses of the data from that study, along with many others, have shown that the risks are low for healthy women under 60. However, the treatment's reputation remains largely unchanged.

4. Research and education is lacking

In 2017, when researchers surveyed medical residents across the country, they discovered that 20% of them had not heard a single lecture about menopause.

"If many doctors aren't discussing hormone therapy with their patients, it may be because of gaps in their own knowledge," Dominus writes.

5. There are treatment options beyond hormone therapy

For high-risk individuals, there are other treatments that can help alleviate menopause symptoms. For example, a selective serotonin reuptake inhibitor called paroxetine is approved to relieve hot flashes. However, it is not as effective as hormone therapy. Some women have also managed their hot flashes with cognitive behavioral therapy, which can help them address how much they bother them.

Currently, doctors who treat menopause are waiting for FDA to review a nonhormonal drug that targets the part of the brain believed to trigger hot flashes. The treatment could be approved this month.

Meanwhile, the North American Menopause Society (NAMS) provides a resource that allows users to search by ZIP code for NAMS-certified health care professionals who are certified in menopause care.

"Women should talk to their doctors about their symptoms and treatment options," Dominus writes. (Dominus, New York Times Magazine, 2/5; Dominus, New York Times Magazine, 2/1)