Discover the truth about Hormone Replacement Therapy
Menopause remains one of the most misunderstood life stages for women, particularly in low- and middle-income countries where cultural stigma, outdated medical narratives, and limited public education persist. In the Philippines, these factors have contributed to widespread misconceptions surrounding menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), despite decades of global research and evolving clinical guidance.
“This article does not promote or oppose hormone therapy. Its purpose is to clarify what current, credible evidence from established medical organizations and peer-reviewed studies indicates and where common beliefs no longer align with contemporary science.”
Menopause and Hormone Therapy: A Clarified Context
Menopause is medically defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity, leading to a sustained decline in estrogen and progesterone levels, as defined by the World Health Organization. Because estrogen receptors are distributed across multiple body systems including the brain, cardiovascular system, bone, and skin hormonal decline can manifest in diverse physical and cognitive symptoms.
Menopausal hormone therapy has been studied for more than half a century and remains one of the most extensively researched interventions for menopause-related symptoms. According to the North American Menopause Society, hormone therapy is the most effective treatment for vasomotor symptoms such as hot flashes and night sweats, when used appropriately and evaluated on an individual basis (NAMS, 2022).
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Myth 1: Hormone Therapy Inevitably Causes Breast Cancer
Fear of breast cancer remains one of the strongest deterrents to considering hormone therapy. This concern is often traced to early interpretations of the Women’s Health Initiative (WHI) study published in 2002. Subsequent analyses and updated research have substantially refined those conclusions.
Current evidence indicates that breast cancer risk varies by type of hormone therapy, duration of use, timing of initiation, and individual health profile. Large reviews published in leading medical journals have emphasized that estrogen-only therapy, particularly when initiated before age 60 or within ten years of menopause, does not demonstrate the same risk profile originally feared (NAMS, 2022; American College of Obstetricians and Gynecologists).
Major health organizations do not describe hormone therapy as risk-free, but neither do they characterize it as uniformly dangerous. Instead, they emphasize individualized evaluation and risk stratification.
Myth 2: Hormone Therapy Is Inaccessible or Only for the Wealthy
Another persistent belief is that hormone therapy is financially inaccessible. In practice, access and cost vary by healthcare system and formulation. In the Philippine context, public hospitals and government-supported clinics provide menopause-related consultations and medications at substantially lower cost than private-sector pricing.
International health agencies emphasize that affordability should not be conflated with efficacy. Generic formulations of estradiol and progesterone are widely used in many health systems globally and are included in essential medicines lists in several countries. Cost remains a health-system issue rather than an inherent limitation of hormone therapy itself (World Health Organization).
Myth 3: Hormone Therapy Alters Identity or Causes Masculinization
Concerns that estrogen therapy leads to masculinization reflect a misunderstanding of endocrine physiology. Estrogen-based menopausal therapy is designed to address estrogen deficiency and does not induce androgenic effects. Masculinization is associated with excess androgen exposure, not estrogen replacement. Clinical guidelines consistently distinguish between estrogen therapy for menopausal care and androgen therapies, which have separate indications, dosing frameworks, and risk profiles (NAMS, 2022).
Safety, Timing, and Individual Variation
Across all major clinical guidelines, one principle remains consistent: timing and individual health context matter. Evidence suggests that initiating hormone therapy closer to the onset of menopause is associated with different benefit–risk profiles compared with later initiation (NAMS, 2022; WHO).
Equally important, hormone therapy is not indicated for disease prevention, anti-aging purposes, or performance enhancement. Its role is limited to symptom management and quality-of-life considerations under medical supervision. These boundaries are repeatedly emphasized by professional societies to prevent misuse and oversimplification. By documenting your symptoms, you and your physician can monitor progress and adjust treatment to suit your unique needs.
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What the Evidence Supportsand Where It Draws the Line
In many countries, including the Philippines, menopause education remains limited in both medical training and public discourse. This gap contributes to persistent myths, delayed care-seeking, and unnecessary distress among midlife women. From a public health perspective, accurate information rather than persuasion is foundational. The World Health Organization and regional professional bodies emphasize that informed choice requires access to evidence, trained clinicians, and health systems capable of supporting midlife care without stigma.
When the research is taken as a whole, a few points come through clearly. First, menopause-related symptoms are not imagined or exaggerated. They are biologically real, and their impact varies widely from one woman to another. Some experience mild disruption, while others face symptoms that meaningfully affect daily life. The science recognizes this variability rather than treating menopause as a single, uniform experience.The next chapter of your life can be the most vibrant and fulfilling yet. Menopause is not the end. It is your awakening. Take charge of your health and let the world adjust to your renewed strength and confidence.
Author’s Reflection
This article was written in the belief that menopause deserves both care and clarity. As societies age, how information is framed becomes as important as the policies that follow. By grounding discussion in evidence rather than fear, the hope is to support more humane, informed conversations about women’s health and the systems that shape it.
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Primary Peer-Reviewed & Institutional Sources
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New England Journal of Medicine
Manson, J. E., et al. Women’s Health Initiative hormone therapy trials: Update on cardiovascular outcomes and mortality. -
Journal of the American Medical Association
Hodis, H. N., Mack, W. J., Azen, S. P., et al. Timing of hormone therapy and progression of atherosclerosis: The ELITE Trial. -
North American Menopause Society
The 2022 Hormone Therapy Position Statement. -
World Health Organization
Menopause; Ageing and Health.
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