11 Things About Menopause Treatment That Were Widely Believed in 2003 and Are Still Being Told to Women in Clinic Today
The number of messages I get from women who were told to 'just try antidepressants first' or 'it's only a few years, push through' is genuinely heartbreaking. The gap between what the current evidence says and what some women are hearing in clinic is still enormous — and closing that gap starts with knowing exactly what's outdated and why.
Learn more about Rose →HRT Causes Breast Cancer — Full Stop
The 2002 WHI study reported an increased breast cancer risk with combined HRT that was later shown to be statistically small, confined to specific formulations, and comparable to the risk associated with drinking one glass of wine a day. Subsequent reanalysis and decades of follow-up data have clarified that the risk varies significantly depending on the type of progestogen used, the route of administration, and a woman's individual history. Body-identical progesterone, for example, appears to carry a substantially lower risk than the synthetic progestogens used in the original WHI trial.
HRT Should Never Be Used for More Than Five Years
The five-year rule was a direct clinical fallout from the 2002 WHI panic, and it has no robust evidence base as a universal cap. Current guidance from bodies including the British Menopause Society and the Menopause Society (formerly NAMS) states that duration of HRT use should be an individualised decision based on symptom burden, quality of life, and personal risk profile — not a blanket time limit. For many women, the benefits of continuing HRT — including bone protection, cardiovascular benefit when started early, and symptom control — outweigh the risks well beyond five years.
Hot Flushes Are the Main Symptom Worth Treating
Hot flushes are visible, measurable, and well-studied — which is part of why they dominate the clinical conversation. But perimenopause and menopause can cause a wide cascade of symptoms including joint pain, brain fog, heart palpitations, low mood, anxiety, dry eyes, and changes in skin and hair, all linked to declining oestrogen. Women whose primary complaints are cognitive or psychological are often sent away without any consideration of hormonal causes, even though the evidence connecting these symptoms to hormonal change is strong and growing.
Depression and Anxiety at This Life Stage Are Just Psychological
It is still common for women in perimenopause to be prescribed antidepressants without any discussion of hormonal drivers, even when mood changes coincide precisely with menstrual irregularity or other perimenopause markers. Oestrogen has well-established effects on serotonin, dopamine, and GABA pathways, and fluctuating or declining oestrogen levels during perimenopause can directly destabilise mood regulation. For women without a prior history of depression, hormonal treatment should be considered as a first-line option alongside or before SSRIs — not as an afterthought.
Genitourinary Symptoms Are Just 'Dryness' — Use a Lubricant
Vaginal dryness is a lay-friendly shorthand for what is actually a more significant condition: genitourinary syndrome of menopause (GSM), which involves thinning of vaginal and urethral tissues, changes in the vaginal microbiome, increased UTI susceptibility, and urinary urgency or incontinence. Unlike hot flushes, which often improve over time without treatment, GSM is progressive if untreated. Local oestrogen applied topically is the most effective and targeted treatment, and unlike systemic HRT, it has a well-established safety profile even for women with a history of hormone-sensitive cancers in many cases.
If Periods Are Still Happening, It's Not Menopause Yet — Come Back Later
Perimenopause can begin years before periods stop, and it is during this transitional phase that many women experience the most disruptive symptoms, including erratic cycles, sleep disruption, anxiety, and cognitive changes. Waiting until twelve consecutive months without a period — the clinical definition of menopause — before considering hormonal support means leaving women unsupported through some of the most difficult years of the transition. Oestrogen levels can be highly variable during perimenopause, which is also why a single hormone blood test taken on a random day is not a reliable diagnostic tool.
A Blood Test Will Tell You Whether You're Menopausal
FSH and oestradiol blood tests are frequently used in clinics to 'confirm' or 'rule out' perimenopause, but in women who are still cycling — even irregularly — hormone levels fluctuate so dramatically from week to week that a single reading is almost meaningless. Current guidance from the UK's NICE is explicit: perimenopause in women over 45 is a clinical diagnosis based on symptoms and history, not a blood test. Women who are told they 'can't be perimenopausal' because their FSH came back normal are being given a significant disservice.
HRT Causes Heart Disease
The original WHI findings suggested an increased cardiovascular risk with HRT, but this was heavily confounded by the age and health status of participants — many of whom were in their sixties and seventies and had started HRT well after menopause. The 'timing hypothesis,' now supported by substantial evidence, shows that oestrogen started within ten years of menopause or before age sixty is cardioprotective rather than harmful, reducing the risk of coronary heart disease. Transdermal oestrogen, unlike oral forms, also does not increase clotting risk in most women.
Testosterone Is Only for Men — or Is Experimental in Women
Testosterone therapy for women has been available and studied for decades, yet it remains poorly understood and rarely offered in general practice. Evidence supports its use for hypoactive sexual desire disorder (HSDD) in postmenopausal women, and there is emerging research on its role in energy, mood, muscle maintenance, and cognitive function. Testosterone is not a fringe treatment — it is included in multiple international menopause society guidelines — but many women are still told it is unsuitable or untested when they raise it.
Sleeping Badly Is Just Part of Getting Older — Nothing to Do With Hormones
Sleep disruption is one of the most commonly reported and most underaddressed symptoms of perimenopause and menopause, and it has direct hormonal underpinnings. Oestrogen and progesterone both influence sleep architecture: progesterone has a GABAergic, calming effect that promotes deeper sleep, while oestrogen affects thermoregulation and REM sleep cycles. Women who report new-onset insomnia or poor sleep quality in their forties and early fifties — especially those who wake hot or with a racing heart — are experiencing a recognisably hormonal pattern that deserves a hormonal conversation.
Symptoms Should Be Managed With Lifestyle Changes First — HRT Is a Last Resort
Exercise, reduced alcohol intake, and improved sleep hygiene are genuinely supportive during menopause and should be part of any woman's toolkit — but framing them as a prerequisite to hormone therapy, rather than a complement to it, reflects an outdated and paternalistic hierarchy of treatment. For women with moderate-to-severe symptoms, lifestyle changes alone are rarely sufficient, and delaying effective treatment while trialling interventions with limited evidence means prolonging unnecessary suffering. Current best practice positions HRT as an appropriate first-line option for most healthy women under sixty with troublesome symptoms, not a measure of last resort.
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