Frequently Asked Questions

Menopause is the natural transition when menstrual periods stop permanently (diagnosed after 12 consecutive months without a period). Perimenopause is the years leading up to it when cycles become irregular and symptoms often begin. Common symptoms include hot flashes, night sweats, vaginal dryness, painful intercourse, low libido, sleep problems, mood changes (irritability, anxiety, depression), brain fog, joint pain, fatigue, weight gain, and bladder issues.

• Systemic hormone therapy (estradiol): patches, gels, or pills – best for hot flashes, night sweats, sleep/mood issues, and bone health.
• Local/vaginal hormone therapy: low-dose estradiol cream, tablets, or inserts – primarily for vaginal dryness, painful sex, and recurrent UTIs.
• Non-hormonal medications for hot flashes: paroxetine, desvenlafaxine, or fezolinetant.
• Testosterone therapy (cream or subcutaneous injection): primarily for low sexual desire/libido in postmenopausal women when other symptoms are controlled and there are no contraindications.
• Progesterone (micronized): required for women with a uterus who take systemic estrogen to protect the uterine lining.

Systemic HRT is generally offered to women under age 60 (or within 10 years of menopause) with bothersome symptoms and no contraindications (for example, history of breast cancer, heart attack, stroke, blood clots, unexplained postmenopausal bleeding, etc.). Women aged 35–39 or 66+ are typically only eligible for local/vaginal therapy. All testosterone prescriptions require synchronous visits and lab monitoring.

Estrogen alone thickens the lining of the uterus and increases the risk of endometrial (uterine) cancer. Adding progesterone (or having a Mirena IUD) protects the lining and dramatically reduces this risk. Women who have had a hysterectomy are not required to take progesterone while on estradiol, but may choose to for symptomatic benefits or relief.

In appropriately selected postmenopausal women, low-dose testosterone can improve low libido, sexual satisfaction, energy, mental clarity, joint pain, loss of muscle tone, sleep, mood, and overall sense of well-being when other menopausal symptoms are managed and estradiol levels are in a good range. Target total testosterone is typically 75–250 ng/dL.

• Topical cream: applied daily to inner arms, thighs, abdomen, or top of foot.
• Subcutaneous injection: small dose (usually 10–40 mg of testosterone cypionate) given once or twice weekly in the abdomen, thigh, glute, or upper arm with a tiny needle. Injections are given subcutaneously (into fat), not deep into muscle.

Common side effects may include acne, oily skin, increased facial or body hair, scalp hair thinning, clitoral enlargement, voice deepening (rare at low doses), irritability, water retention, weight gain, elevated hematocrit, and changes in cholesterol. Most side effects are dose-related and reversible with dose adjustment or discontinuation.

• Initial labs (total and free testosterone, estradiol, hematocrit, etc.) are drawn before starting.
• The first prescription is usually 56 days with a synchronous follow-up visit around day 45 (labs drawn around day 30).
• The dose is adjusted based on symptom relief, side effects, and follow-up labs.
• After the first follow-up, visits are scheduled quarterly (all synchronous) with labs beforehand.

No. Unlike in men, exogenous testosterone in women does not suppress fertility in the same way. However, women who still desire pregnancy are generally not prescribed testosterone.

Yes. Testosterone cream can transfer through skin-to-skin contact for up to 4 hours after application. Wash hands thoroughly after applying and avoid close skin contact (especially with children or pregnant women) until it has dried and the 4-hour window has passed.

• Vaginal estrogen: often 2–6 weeks.
• Systemic estrogen/progesterone for hot flashes, sleep, and mood: usually 4–8 weeks (sometimes sooner).
• Testosterone: 4–12 weeks for full effect on libido and energy.

• Vaginal estrogen: generally recommended indefinitely because genitourinary syndrome of menopause is progressive and does not reverse on its own.
• Systemic HRT and testosterone: re-evaluated periodically. Many women choose to continue as long as benefits outweigh risks and they feel well.

Any vaginal bleeding after menopause is considered abnormal until proven otherwise. Contact your provider immediately. Do not wait for your next visit.

Regular blood work helps ensure that testosterone levels remain in the therapeutic female range (75–250 ng/dL), and allows monitoring of hematocrit (which can rise), liver function, lipids, and estradiol to confirm continued safety and efficacy.

No. Personal history of breast cancer, coronary artery disease, stroke, blood clots, or BRCA 1/2 mutation are contraindications to testosterone and systemic HRT.

Contact your provider right away. Most side effects can be managed with dose adjustment, switching formulations (for example, from cream to injection), or adding supportive medications. Do not stop medications abruptly without medical guidance.

Low-dose vaginal estrogen is often considered safe and is frequently prescribed for breast cancer survivors with severe genitourinary symptoms, but this decision is made on a case-by-case basis in collaboration with your oncologist and menopause provider.

Yes. Routine age-appropriate cancer screenings (including mammogram, Pap smear/HPV testing, colonoscopy, and others as recommended) remain essential while on hormone therapy.