Osteoporosis is a biological process of bone density loss and increased bone breakage. It is part of the natural aging process for both men and women. Strong bones depend on many factors including your genetics, how you grew during puberty, exercise levels, your diet, smoking, and alcohol consumption. Your bones are at peak strength and density around age 30.

HT including estrogen is very effective at supporting bone density and strength, especially when combined with a healthy lifestyle. As well, strength training such as weight lifting or even standing instead of sitting, plus a good diet including calcium and vitamin D3 can help maintain bone strength.

Mid-life sees many hormone changes. Those plus decreased physical activity can contribute to osteoporosis, which can affect you in your early 50’s, causing low-impact bone breaks.


HT can benefit women with mild-to-moderate common symptoms such as 

  • Vaginal weakness and dryness (vaginal atrophy)
  • Urine leak
  • Hot Flashes
  • Osteopenia or weakened bones

Please talk to your healthcare provider about any of your health concerns. Many are manageable and some can be moderated with simple behavioral changes.


Risk for colon-rectal cancer increases with age. Menopause transition and HT/HRT themselves do not increase your risk for colorectal cancer. It is unclear right now whether HT protects you against colorectal cancer. If you do not already, please start medical screening for CRC starting at age 50 as part of your overall self-care regimen.


Data about the influence of HT on stroke are mixed. HT may increase the incidence of stroke, but this is nullified in women who exercise moderately. A stroke (ischemic stroke) is a clogged blood vessel blocking blood flow to the brain. Without blood flow and oxygen, brain tissue will die. Strokes can lead to serious losses of brain function. Strokes are the third leading cause of death in Canadian women and the risk for stroke increases with age.

The key to reducing the risk of stroke is a healthy lifestyle. The risk factors are:

  1. Hypertension
  2. Obesity
  3. Smoking
  4. Excessive alcohol
  5. Lack of exercise
  6. Diabetes
  7. Migraine headaches [with visual aura]
  8. Too little or too much sleep

Please discuss your personal risks for stroke when discussing HT with your healthcare provider.


HT alone does not increase the risk of a heart attack. Heart attacks are the number two killer of women in Canada. Healthy perimenopausal women benefit from a protective effect from HT and in fact have a lowered risk of heart attack.

Post- menopause, as a woman grows older, the risks of heart disease increase. Risks for HT are age and life-style related.

The seven major risk factors for heart disease can all be modified, so a woman can adjust her lifestyle and reduce these risks. These risks are:

  1. Smoking
  2. Abnormal lipid profiles (seen from blood tests ordered by your doctor, these can include high blood levels of low-density lipoprotein (LDL) cholesterol or fats called triglycerides)
  3. Hypertension
  4. Abdominal obesity
  5. Poor diet
  6. Excess alcohol
  7. Chronic stress

If you have any of these risk factors in your life, tell your healthcare provider when you are discussing hormone therapy.


Hormone therapy for treatment of menopausal symptoms was thought to increase the risk of a woman’s chance of breast cancer, stroke and blood clots.  This evidence has been re-evaluated, and HT using estrogen has been shown to be safe and effective. [2] [3] What is now known is:

  • HT remains the most effective treatment for vasomotor symptoms and genitourinary syndromes of menopause and has been shown to prevent bone loss and fracture. 
  • The risks of HT differ depending on the type of hormones, their dose, duration of use, route of administration, timing of initiation, and whether progestogen is used.
  • Treatment should be individualized to identify the most appropriate HT type, dose, formulation, route of administration, and duration of use.
  • HT must use the best available evidence to maximize the benefits and minimize the risks.
  • HT needs periodic reevaluation for the benefits and risks of continuing or discontinuing HT.

Hormone replacement therapy (HRT) is generally safe if you work together with a qualified healthcare provider. HRT is known to help many women with hot flashes, vaginal dryness, and keeping bones strong among other symptoms.


2. Melmed et al.Williams Textbook of Endocrinology 14 th edition.

3. Santoro_2016_Perimenopause: From Research to Practice

4. Allshouse et al._2018_Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms

5. Dasai and Brinton_2019 Autoimmune disease in women: endocrine transition and disease across lifespan


Hot flashes can be addressed in many ways but it’s best to collaborate with your care provider to find a therapy that works for you. Hormone therapy (HT) can be effective at reducing the frequency and intensity of hot flashes for many women. Antidepressants, meditation and relaxation techniques work also well as they lower stress hormones. Ensuring you are eating a well-balanced nutritious diet can also help.

Bio- identical hormones are reproductive steroid hormones, such as estrogen or progesterone, used in hormone therapy (HT). The term “bio-identical” means the hormones in the HT product are chemically identical to those your body produces.

Bio-identical hormones can be easily recognized and used by our bodies so the effects are more consistent with our natural biochemistry. As well there is a smaller risk of unpredictable side effects than with synthetic or non-bio-identical hormones.

There are FDA approved bio-identical hormones that are safe and effective, but there is no evidence to date that bio-identical hormones are more effective or safer than synthetic hormones. There are also FDA approved natural hormones that are derived from plants.


There are options to help reduce or manage some symptoms. The primary tool is called Hormone Therapy (HT), also called hormone replacement therapy (HRT), menopausal hormone therapy (MHT), or hormone management therapy (HMT). HT is helpful for decreasing hot flashes, improving the health of your vagina and urinary systems, and supporting your muscle and bone health and strength.

Unfortunately, other symptoms may not respond as well to HT. Physiotherapy can help with physical pain and psychological counseling and therapy can help with emotional troubles. Lifestyle changes to promote quality sleep, good nutrition, and exercise are important and known to decrease menopausal transition symptoms.