Hormone Replacement Therapy: The Story Behind the Stigma

“Nothing like waking up in the middle of the night soaked in sweat! Thank you, Menopause!!” said an early morning text from a friend of mine. She went on to say, “It’s so disorienting to wake up like that, trying to find something dry to put on in the dark!”  

A few more texts of frustration later, she wrote, “Menopause is not a journey, it’s a BATTLE!” 

So many women feel this way, only to have our symptoms and struggles too often dismissed by our healthcare providers. When I asked my friend if she has considered bioidentical hormone replacement therapy (BHRT), she replied, “What is BHRT?”  


Later that evening, as I was watching Thursday Night Football, I saw an ad for a hormone-free, FDA-approved drug that is supposed to reduce hot flashes for women in perimenopause and menopause. Like many other so-called “menopause treatments” advertised online, these medications, potions, and herbal supplements all offer the same thing: “hormone-free relief” for life-disrupting symptoms associated with the normal female aging process.  

This begs the question: Why is “hormone-free” the preferred way to address menopause symptoms? 

I thought about my friend who was suffering through night sweats, yet has never heard of BHRT – hormone therapy designed to address a host of symptoms associated with perimenopause and menopause. As evidenced by an ad for hot flash medication in the middle of a nationally televised pro football game, our society is now talking publicly about a longstanding taboo topic. 

So, how is it that so many women approaching or experiencing menopause still HAVE NO IDEA ABOUT BHRT? How is it that we are also being led to believe that hormone-free therapies are the most desirable option? 

The Menopause Stigma Has Been Replaced with the Hormone Stigma

In the not-so-distant past, you may have read articles about how today’s women need to “break the stigma surrounding menopause” because until recently, nobody really talked about it – including most medical professionals. Through no fault of their own, most doctors are not trained to help women manage menopause long term.  

However, the stigma of talking about menopause is no longer our biggest concern. We’re talking about it everywhere. Just look at your social media feed if you’ve ever searched online for “menopause symptoms” or “menopause relief” in hopes of finding remedies and making sense out of your own experiences. 

While the conversation about menopause is wide open, the stigma now seems to have shifted to hormones. Available over-the-counter options, and now even the prescription hot flash medication, proclaims “hormone-free relief” from symptoms. This brings me back to my original question: Why is “hormone-free” good, but hormones are perceived as the “bad” medication? 

The Misleading Research 

Back in 2002, the Women’s Health Initiative conducted a controversial clinical study of hormone replacement therapy. This study based its conclusions on two synthetic drugs and concluded that women taking hormone therapy were at higher risk of stroke, heart disease, breast cancer, and several other serious health concerns.  

However, as Belmar Medical Director, Dr. Angela DeRosa, pointed out, the study was poorly designed and highly flawed. Furthermore, a published critique of the original study revealed there was no significant increase in breast cancer risk, as they originally declared. 

For many healthcare providers though, the stigma surrounding hormone replacement therapy has stuck for the last 20+ years. “Doctors have been trained to think hormones are dangerous for women,” Dr. DeRosa says. “But this is not true. Hormone therapy can be safe and effective when prescribed properly.” 

“Doctors have been trained to think hormones are dangerous for women. But this is not true. Hormone therapy can be safe and effective when prescribed properly.” 

Angela DeRosa, DO, MBA, CPE

BHRT Addresses the Root Causes of Your Symptoms

When you have an occasional headache, you might take an over-the-counter pain reliever and quickly recover. However, if you suffer from recurring headaches, you might visit your medical provider to determine the underlying reasons for your headaches. Essentially, you’re trying to get to the root cause of the problem. 

Think of your menopause symptoms the same way.  

If you have a hot flash once in a while, or you can’t sleep every now and then, you might consider cutting back on caffeine, alcohol, or spicy foods – common hot flash triggers. However, if you repeatedly suffer from hot flashes, disruptive night sweats, insomnia, and mood swings, (all potential symptoms of perimenopause and menopause) wouldn’t it make sense to address the root cause of these problems, too? 

If you manage your menopause symptoms the same way you deal with an occasional headache – by taking an over-the-counter, hormone-free medication in hopes of diminishing long-term issues – you may not be taking the most beneficial approach. It’s highly unlikely that your symptoms will just magically disappear over time, and your hormones are not going to replenish themselves to the levels they once were when you were younger. Their decline is a natural part of the aging process. 

For some women, this hormone decline is gradual and tolerable. For others, it’s much more sudden and unbearable. For all of us, we shouldn’t accept this as our “new normal”! 

Like puberty and pregnancy, the menopause transition is a temporary state of being. However, we’ll live the rest of our lives as postmenopausal women! Shouldn’t we feel as healthy as possible as we age? 

For many women, hormone replacement therapy can be a way to reduce unpleasant symptoms and help you feel like yourself again. It’s often that straightforward: When hormones decline, the only way to replenish them is to replace them.

Perception Is Everything

Don’t let the hype sway you. It’s easy to believe the misconceptions surrounding BHRT. Talk to a provider who truly understands the role of hormones in your physical and emotional well-being, and decide which options are best for you. Because, after all, the change is personal.

Bonnie Scerbo