Dr. Lauren Wood Thum explains how outdated interpretations, inconsistent care, and oversimplified messaging continue to shape women’s experiences with menopause and hormone therapy.
Ask Dr. Lauren Wood Thum how she became one of the more outspoken voices on women’s hormones, and she doesn’t have a tidy origin story. She’s a double board-certified urologist and female pelvic reconstructive surgeon by training. Then, a sudden influx of questions drove her to dig deeper into female endocrinology and the changes of midlife:
Sleep that fell apart for no reason.
Joints that ached out of nowhere.
A body that shifted even though nothing else had.
After pouring hundreds of hours into research, she realized something that made her angry enough to break the silence.
“Appropriately monitored and applied hormone treatments can be some of the safest medications we have available with some of the most favorable benefit-risk profiles,” she says, “and almost no one understands them or knows how to prescribe them safely.”
It is time to address the gap between what hormone therapy can do and how poorly it is understood.
How We Got Here
“Did you know that women were not mandated to be in NIH-funded clinical trials until 1993?” Dr. Wood Thum asks.
A deeper dive into the timeline paints an even more jarring picture. In 1977, a Food and Drug Administration policy recommended excluding women of childbearing age from Phase I and early Phase II drug trials, based on drug-related tragedies that occurred with thalidomide use. This policy was only challenged nine years later when the National Institutes of Health encouraged the inclusion of women.
Encouraged. Not required. It took another seven years before it was put into law (1).
Decades of medicine got built on data that didn’t include half the population, and the gaps it left behind are still being filled.
“Then came the events of 2002,” Dr. Wood Thum continues.
Launched in 1991, the Women’s Health Initiative was one of the largest women’s health research programs ever conducted. One of its arms compared an oral estrogen-plus-progestin regimen with placebo in postmenopausal women.
On May 31, 2002, the study’s data and safety monitoring board recommended stopping that arm early after the intervention was deemed more harmful than beneficial. The treatment group showed increased risks of breast cancer, coronary heart disease, stroke, and blood clots, alongside observed benefits such as fewer hip fractures and cases of colorectal cancer (2).
The findings were announced publicly shortly afterward and then (here is the harmful part) applied much more broadly than the study design justified.
The result: a significant drop in hormone replacement therapy use (3).
“The data were announced publicly before prescribing physicians had access to the full paper and the context behind the numbers, disregarding the typical peer-review process in the medical community. Generations of women and practitioners were left to believe that all hormones cause cancer. It was honestly one of the most absurd and harmful events in the history of women’s health,” Dr. Wood Thum laments.
A closer look at the study reveals a multitude of nuances, from vast differences in subgroups with confounding factors to potential benefits hidden in the dataset.
The correction came later than the original headline. A post-hoc analysis, digging back into the data by age group, and more recent randomized controlled studies have produced what’s now called “the timing hypothesis,” which suggests that age and time since menopause influence the balance of benefit and risk.
Taken all together, the full scientific landscape suggests that for many healthy women who begin treatment before age 60 or within roughly 10 years of menopause, hormone therapy has a more favorable safety profile than the original headlines implied (4).
Sadly, this more developed picture has still yet to receive a true press conference of its own.
Perimenopause: Why the Confusion Compounds
Men’s hormone care has a clear diagnostic framework: compatible symptoms paired with consistently low morning testosterone measurements.
“Women’s health doesn’t work the same way,” explains Dr. Wood Thum. “There isn’t a set threshold. Hormone levels fluctuate throughout the menstrual cycle and swing even harder through perimenopause, so the decision to treat rests on symptoms and personal medical history, not a flagged lab result.”
It’s a distinction most women are never actually walked through, and one she thinks is worth asking about directly.
Perimenopause is where that ambiguity starts to compound. “The average age for menopause in the US is roughly 51.5. But the range for that transition is huge [45 to 55 years old], and perimenopause can begin up to 10 years prior, which already makes age a poor marker on its own. Layer on the hormonal swings, and a woman can feel fine on Monday and flattened by Thursday. It’s hormonal chaos,” Dr. Wood Thum says. “Then women get told that their labs are normal or what they are experiencing is all in their head, and no one diagnoses what is happening as perimenopause.”
Three Hormones, Not One
HRT gets talked about like a single treatment. It isn’t. It can mean estrogen, progesterone, and testosterone, alone or in combination. Each hormone plays a different role, and not every woman needs all three. Symptoms, anatomy, health history, treatment goals, and individual risk all shape the decision.
Estrogen carries the reputation, and reasonably so. Its influence extends beyond reproduction, with receptors throughout the brain, bone, cardiovascular system, vaginal tissue, and skin (5). As levels decline, that reach helps explain symptoms such as hot flashes, night sweats, vaginal dryness, and changes in musculoskeletal comfort.
Progesterone gets less airtime, which Dr. Wood Thum considers a mistake. It plays a significant role in female physiology, helping to regulate the menstrual cycle, supporting the uterine lining, and producing neuroactive metabolites that can affect sleep and mood (6).
Testosterone is the one she gets most animated about. “Testosterone gets cornered into being the libido hormone, but there is more to it than that,” she says. “There is evidence to suggest it also influences bone density, muscle mass, cognitive function, mood, and overall energy.” Although its primary therapeutic application in women currently centers on sexual function, its physiological role extends well beyond libido.
Treatment is not static. Hormone selection, dose, and combination can all be adjusted over time as symptoms, goals, and physiological needs change.
Delivery Options
Getting the hormone right is only half of it. Delivery methods and dosing play an important role in efficacy and potential adverse events.
Estrogen is available as systemic patches, gels, mists, rings, and pills, or low-dose vaginal creams and other local products. For women with an intact uterus, systemic estrogen is paired with adequate progesterone or another progestogen (such as a progestin-secreting intrauterine device (IUD)) to protect the uterine lining.
Progesterone is commonly prescribed as an oral capsule, while some combination patches deliver estrogen with a progestogen. Vaginal use may also be considered in certain circumstances.
Testosterone may be delivered through a daily gel, injection, or pellet. Dr. Wood Thum prefers transdermal gels because they allow for more controlled dosing and easier adjustment, while injections and pellets can be harder to control and may produce less predictable exposure.
Hormone therapy is not one-size-fits-all and is not limited to a single hormone. Multiple options are available. Deeper conversations about delivery method and dosing can help create clarity when it comes to the benefits and risks.
Building a Foundation
Dr. Wood Thum emphasizes that while hormone therapy can significantly benefit some women, it is not a cure-all and definitely not a shortcut. “You can’t out-patch a bad diet, no exercise, and poor sleep.”
She goes further to note the importance of muscle mass and doing everything possible to support it. “Not only,” Dr. Wood Thum explains, “does muscle mass help maintain basal metabolic rate in the shift to menopause, which plays an important role in the prevention of visceral fat accumulation, but in my work, we have also noticed that women with stronger baseline fitness and general health often report less severe vasomotor symptoms, including hot flashes and night sweats.”
Adequate protein intake and resistance training easily sit at the top of her list. Notably, both also support bone health (7, 8), which becomes more and more important as estrogen levels decline.
While it won’t stop the hormonal changes of perimenopause, developing strong foundations in healthy nutritional habits, resistance training, and other lifestyle practices like getting enough sleep not only helps set the base for a healthy hormone profile now, but it also supports successful hormone replacement therapy treatments and eases the transition into menopause.
NOBULL Bottom Line
For decades, women were given an incomplete version of the hormone therapy story. Early findings were stripped of context, meaningful differences in age, timing, and formulation and delivery methods were overlooked, and fear often replaced an individualized conversation.
That does not make hormone therapy right for every woman. It does mean that the current evidence supports a more individualized approach than the 2002 headlines suggest.
“Any provider who chalks your symptoms up to ‘aging,’ ‘being too old,’ or another dismissive explanation isn’t giving you a diagnosis,” Dr. Wood Thum says. “They’re giving you a guess. And guessing is no longer acceptable.”
Approaches to women’s health are changing.
HRT application and dosing are becoming more individualized.
In-depth conversations with primary care providers can help shed old stereotypes and provide clarity for adequate health support.
Frequently Asked Questions
1. Does hormone replacement therapy cause cancer?
Not automatically. The fear surrounding hormone therapy largely grew from the broad public interpretation of the 2002 Women’s Health Initiative findings. The study identified real risks, but those findings were being applied too broadly. Every hormone, formulation, delivery method, and patient was considered too risky, despite very important nuances. Individual risk depends on factors such as age, time since menopause, medical history, hormone selection, dose, and route of administration.
2. Can a blood test diagnose perimenopause?
Not by itself. Hormone levels can fluctuate significantly throughout the menstrual cycle and even more during perimenopause, which means a single normal result does not necessarily rule it out or not. Diagnosis generally depends on a combination of factors, including menstrual changes, age, and personal medical history, and bloodwork, rather than on a single flagged laboratory value.
3. Does hormone therapy always include estrogen, progesterone, and testosterone?
No. Hormone therapy is not one standardized treatment. Not every woman needs all three hormones. Estrogen, progesterone, and testosterone have different physiological roles. Each is prescribed according to symptoms, anatomy, treatment goals, health history, and individual risk. Treatment is not static, either. As circumstances change, so can the prescribed hormone (or hormones), dose, combination, and delivery method may also change over time.
4. Can hormone therapy replace nutrition, exercise, and sleep?
No. Hormone therapy may help address specific symptoms, but it is not a shortcut around the foundations of health. Eating adequate protein and other healthy nutritional habits, resistance training, and consistent sleep support muscle, bone, metabolic health, and recovery throughout the menopause transition.
About Dr. Lauren Wood Thum
Dr. Lauren Wood Thum received both her undergraduate degree with distinction and medical degree from the University of Virginia. She completed her urology residency at Cedars-Sinai Medical Center in Los Angeles. She moved to Sioux Falls, South Dakota, after completing a fellowship in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS) at the University of California, Los Angeles. She is double board-certified, both in urology and FPM-RS, also known as Urogynecology and Pelvic Reconstructive Surgery (UPRS), and has authored over a dozen peer-reviewed papers. She treats women with pelvic floor disorders of all kinds, including pelvic organ prolapse and urinary and bowel incontinence. While in practice, she has devoted over 100 hours of continuing medical education to managing hormones in women in perimenopause and menopause and is a Menopause Society Certified Provider (MSCP). She serves as an assistant professor at the Sanford USD School of Medicine.
You can find her on Instagram @betweentwodocs for all things women’s health and hormones.
About the sources
This article was written by Dr. Vince Kreipke, a PhD in Exercise Physiology with a focus in Sports Nutrition, and is not AI-generated. The sources used in this piece are pulled from peer-reviewed research, clinical guidelines, and relevant bodies of authority, then reviewed for quality, context, and alignment with the broader scientific consensus.
