Menopause hormone therapy: benefits, risks and questions to ask

What menopausal hormone therapy is used for

Systemic menopausal hormone therapy can be an effective option for bothersome hot flashes and night sweats, and it may help some other menopause symptoms. Local vaginal treatments address a different set of vaginal and urinary symptoms. The appropriate choice depends on which symptoms matter most, your health history, whether you have a uterus, your preferences, and the clinician’s assessment.

Benefits and risks are personal, not a yes-or-no headline

Current Canadian guidance supports individualized shared decision-making. Age and time since the final menstrual period can influence the balance, but they do not replace a complete assessment. Route, dose, duration, type of progestogen when needed, smoking, migraines, blood pressure, clotting history, cardiovascular health, liver health, cancer history, and bleeding pattern can all change the discussion.

If systemic estrogen is considered for a person with a uterus, endometrial protection is normally part of the regimen. Local vaginal estrogen is different from systemic therapy and may have a different safety discussion. These distinctions are clinical decisions, not instructions to start, stop, or change a medication on your own.

Seven questions worth asking

• Which of my symptoms is this option expected to address, and which might need another assessment?
• Do my bleeding pattern, migraines, blood pressure, smoking, clotting, heart, liver, breast, or cancer history change the options?
• How do systemic and local treatments differ for the symptoms I have?
• If I have a uterus, what endometrial protection would be needed and why?
• What non-hormonal options are reasonable if I prefer them or hormones are not suitable?
• What side effects or new symptoms should prompt an earlier review or urgent care?
• When will benefit, tolerability, dose, and the continuing need for treatment be reviewed?

What about compounded “bioidentical” hormones?

Ontario Health distinguishes Health Canada-authorized hormone products from custom-compounded products marketed as “natural” or “safer.” Its patient guide states that compounded bioidentical hormones are not recommended for menopause symptoms because evidence for effectiveness and safety is lacking. Ask a clinician to explain the regulatory status, evidence, cost, and alternatives before paying for a custom product.

How a MedVibe consultation fits

An adult physically located in Quebec or Ontario can request a private MedVibe menopause consultation for CAD $150. The clinician can review symptoms, history, existing results, preferences, and whether virtual care is appropriate. A consultation does not guarantee hormone therapy, another prescription, testing, diagnosis, coverage, or a specific treatment. Medication and follow-up, if appropriate, are separate.