Your menu of treatment options

Everything on the table, in plain language — so you can see the whole menu before choosing.

How to use this: nothing here is a recommendation on its own. It is the full range, so you can see what exists, ask about anything, and rule things out on purpose rather than by omission. We will land on your plan together — and you can change your mind at any point.

1 · Foundations

These are not consolation prizes. Each has real evidence behind it, and they make every other option work better.

2 · Non-hormonal prescriptions

For hot flashes and night sweats when hormones are not wanted, not advised, or not enough.

Compounded “bioidentical” pellets and creams (unregulated dosing, no safety monitoring), over-the-counter progesterone cream, black cohosh, dong quai, evening primrose, and most herbal blends marketed for menopause. Not judgment — just that they have been studied and did not outperform placebo. If you are using something, tell me; I would rather know.

The short version: for most healthy people within 10 years of their last period or under age 60, hormone therapy is the most effective treatment for hot flashes and night sweats — and it protects bone. Benefits and risks shift with age, time since menopause, and personal history, which is exactly what we will go through together.

Through the skin avoids the first pass through the liver — generally preferred with migraine with aura, clotting history, high triglycerides, or gallbladder disease.

Estrogen alone thickens the uterine lining, so it is paired with a progestogen to keep the lining safe. Not needed after hysterectomy.

This is its own category, and it matters. Vaginal dryness, painful sex, and recurrent urinary symptoms do not improve on their own and usually progress. Unlike hot flashes, they respond best to treatment applied right where the problem is — at doses so low that very little reaches the bloodstream. You can use these whether or not you take systemic hormones.