Pathway
Menopause and Midlife
The Approach
How We Approach This Pathway
Why This Approach Fits
Hot flashes, sleep, mood, body composition, bone and heart health, considered against your history and your own priorities. Hormone therapy is one option among several, and it is not right for everyone.
How Care Works
Your clinician reviews symptoms, timing since your last period, labs and personal and family history, and coordinates with your gynecologist when you authorize it. Strength, sleep and nutrition are part of the plan whether or not hormones are.
Read Before You Decide
What Is Measured, and What We Ask First
What Is Measured
Laboratory results, symptoms, treatment tolerance and relevant biometric trends are reviewed together by your clinician, on a schedule you agree on at the start.
Before We Show Any Options
We ask about breast cancer, blood clots, stroke, liver disease and unexplained vaginal bleeding before any option is shown, because they change what is appropriate. Hormone therapy decisions depend on your age, time since menopause, dose and route.
By Life Stage
Where Care Starts
Symptoms First
Hot flashes, night sweats, sleep, mood, vaginal dryness and changes in desire are reviewed together, along with thyroid, iron and medication causes that can look like menopause.
Is Hormone Therapy Right for You?
For many women under 60, or within 10 years of menopause, the balance favors treating bothersome symptoms. Starting later, or after certain conditions, looks different. Type, dose, route and whether you need a progestogen all matter, and your history decides.
Bone, Muscle and Heart
Strength training helps bone density and lean mass after menopause, and bone, cholesterol and blood pressure are reviewed on a schedule. These matter whether or not you use hormones.
Options Beyond Hormones
Non-hormonal treatments, sleep changes and nutrition are part of the plan, and for some women they are the right first choice or the only one. We coordinate with your gynecologist when you authorize it.
Care Plans We May Discuss
Options for This Pathway
Hormone Review
Hormone Review
Intimacy and Vitality
Learn More →Longevity Panel
Longevity Panel
Energy and Longevity
Learn More →Metabolic Support
Metabolic Support
Weight and Metabolic Health
Learn More →This page describes a care pathway and is not a treatment recommendation. Compounded medications are not FDA-approved or evaluated for safety, effectiveness or quality. Prescriptions are issued only after clinician review.
The Evidence
What the Research Says
The North American Menopause Society, Menopause, 2022 (hormone therapy position statement)
Hormone therapy remains the most effective treatment for hot flashes and night sweats and for genitourinary symptoms of menopause, and it prevents bone loss and fracture. Risks differ by type, dose, duration, route, timing and whether a progestogen is used. For women under 60 or within 10 years of menopause onset with no contraindications, the benefit-risk balance is favorable. Starting later, or after 60, looks less favorable. Treatment should be individualized and reviewed regularly.
Read the Source ↗Manson et al., JAMA, 2013 (Women's Health Initiative hormone therapy trials, extended follow-up)
Integrated results of two randomized trials of 27,347 postmenopausal women aged 50 to 79, with 13 years of cumulative follow-up. Primary outcomes were coronary heart disease and invasive breast cancer. These trials are a main source of the trial evidence on hormone therapy benefits and risks.
Read the Source ↗Zhao et al., Journal of Orthopaedic Surgery and Research, 2025 (17 randomized trials, 690 women)
Resistance training significantly improved bone mineral density at the lumbar spine, femoral neck and total hip in postmenopausal women.
Read the Source ↗Nunes et al., Archives of Gerontology and Geriatrics, 2024 (14 randomized trials)
In postmenopausal and older women, higher-volume resistance training produced greater whole-body muscle gain than lower volume, with low-certainty evidence.
Read the Source ↗Common Questions
Do You Prescribe Hormone Therapy?+
Whether hormone therapy is appropriate, and who prescribes it, is decided at your clinical review after we see your history, labs and symptoms. Where it is better managed by your gynecologist, we coordinate with them rather than compete.
Who Should Not Take Hormone Therapy?+
Some histories make it inappropriate, including certain breast cancers, blood clots, stroke, liver disease and unexplained vaginal bleeding. That is why we ask about them before any option is shown, and your clinician reviews your answers with you.
Does Timing Matter?+
Yes. The North American Menopause Society's 2022 position statement finds the benefit-risk balance favorable for women under 60 or within 10 years of menopause onset with no contraindications, and less favorable when started later. Your clinician applies that to you.
Does the Type of Hormone Matter?+
Risks differ by type, dose, duration, route and whether a progestogen is used, and transdermal routes and lower doses may carry lower risk of blood clots and stroke. FDA-approved products exist for estradiol and progesterone. Compounded hormone products are not FDA-approved or evaluated for safety, effectiveness or quality.
What If I Am a Pilot?+
FAA guidance says hormone replacement therapy is not disqualifying by itself, and it publishes when an examiner can issue and when your file goes to FAA review. Tell your aviation medical examiner and us. See our pathway for pilots.
Can I Start Without Seeing My Gynecologist?+
You can start with us. We will ask about your gynecologic history, recent mammogram and bone density results, and we encourage you to keep your regular gynecologic care. We coordinate with your gynecologist when you authorize it.
Start Your Assessment
Ten minutes, no card, reviewed by a clinician.