Thoughtful, individualized hormone therapy guided by science, symptoms, and long-term health — including bone, metabolic, and cardiovascular risk.
Hormonal changes during perimenopause and menopause can affect energy, sleep, mood, weight, bone density, and overall quality of life. At The Bone Health Clinic, we provide medically appropriate hormone therapy grounded in the same principles described in The New Menopause — careful evaluation, shared decision-making, and individualized care.
Our approach to menopause care
Much of the confusion around menopause hormone therapy comes from outdated information and one-size-fits-all thinking. We align closely with the approach described in The New Menopause by Dr. Mary Claire Haver:
Hormone therapy is not about chasing youth or prescribing hormones to everyone. It is about treating real symptoms, improving quality of life, and thoughtfully considering long-term health — especially bone and metabolic health.
We commonly work with women who are experiencing:
You do not need to be "miserable enough" to deserve care — but hormone therapy is also not automatic. We help you decide what makes sense for you.
Menopause care that looks beyond symptoms alone
Unlike hormone-only clinics, our recommendations are informed by:
Bone health is a central consideration in menopausal care — not an afterthought. Hormone therapy can play an important role in bone preservation for some patients, and we integrate that into decision-making when appropriate.
Hormone therapy may include:
We follow guidance from The Menopause Society (formerly NAMS) and are listed as menopause-informed providers.
Our care reflects current consensus guidelines while remaining individualized — the same philosophy emphasized in The New Menopause.
This includes a detailed history, symptom review, and discussion of goals. Laboratory testing and imaging are used when helpful — not reflexively.
We review risks, benefits, and alternatives together. Hormone therapy is one option — not an obligation.
If hormone therapy is started, we monitor symptoms, tolerance, and overall health over time, adjusting as needed.
Menopause is a significant life transition — not a diagnosis to ignore and not a condition to overtreat. Our role is to help you navigate this phase with clarity, evidence, and care that considers your whole health.
Schedule a Menopause ConsultationIf you're experiencing perimenopause or menopause symptoms and want an evidence-based approach to hormone therapy, we're here to help.
Perimenopause is the transition phase leading up to menopause, often beginning in the 40s but sometimes earlier. Hormone levels fluctuate, periods may become irregular, and symptoms can start years before the final menstrual period. Menopause is defined as 12 consecutive months without a period.
Common symptoms include hot flashes, night sweats, sleep disruption, mood changes, brain fog, joint pain, vaginal dryness, and changes in body composition. Symptoms vary widely — there is no single "normal" menopause experience.
During perimenopause, estrogen levels fluctuate rather than decline steadily. These swings — not just low estrogen — are responsible for many symptoms.
MHT refers to the use of estrogen, with progesterone when indicated, to relieve menopausal symptoms and support long-term health in appropriate patients.
Many FDA-approved hormone therapies are bioidentical, meaning they are chemically identical to hormones produced by the body. The term "bioidentical" is often misused in marketing and does not necessarily mean safer or better.
Compounded hormones are not FDA-regulated and may have variability in dosing and purity. We generally prioritize FDA-approved options because they are standardized, studied, and monitored for safety.
For many women, hormone therapy is safe and effective when started at the right time and prescribed thoughtfully. Safety depends on age, time since menopause, medical history, and individual risk factors.
Research suggests that starting hormone therapy earlier — typically before age 60 or within 10 years of menopause — is associated with lower risks and greater benefits for many women.
The relationship is complex and depends on the type of hormones used, duration of therapy, and individual risk. Some regimens have little to no increased risk over certain time frames. This is reviewed carefully with each patient.
Risk varies by formulation and route. Transdermal (patch) estrogen is associated with lower clot risk than oral estrogen and is often preferred in women with certain risk factors.
Yes. Systemic estrogen therapy can help prevent bone loss and reduce fracture risk in appropriate candidates. This benefit is an important consideration in midlife and beyond.
Bone protection from estrogen is lost after discontinuation, which is why bone health planning should extend beyond hormone therapy alone.
When started early in menopause, hormone therapy may have neutral or potentially beneficial cardiovascular effects in some women. It is not used solely to prevent heart disease.
Hormone therapy may improve sleep and vasomotor symptoms, which can secondarily improve mood and cognition. It is not a treatment for depression or dementia.
Menopause is associated with changes in body composition, including increased fat mass and loss of lean muscle, even if weight stays the same. Aging, activity, and metabolism all play a role.
No. Hormone therapy does not cause weight gain and may help mitigate unfavorable body composition changes for some women.
Hormone therapy is not a weight loss treatment, but it may help stabilize fat distribution changes when combined with nutrition, strength training, and metabolic care.
Options include oral medications, transdermal patches, gels, sprays, and vaginal therapies. The best choice depends on symptoms, risk factors, and patient preference.
Women with a uterus need progesterone alongside estrogen to protect the uterine lining. Women without a uterus generally do not.
Vaginal estrogen is used to treat local genitourinary symptoms and delivers very low systemic absorption. It is considered safe for most women, even those who cannot use systemic estrogen.
There is no universal time limit. Duration is individualized, with regular reassessment of risks and benefits.
Yes. Doses and formulations often change as symptoms, health status, and goals evolve.
Hormone therapy is one option among many. Non-hormonal treatments, lifestyle strategies, and targeted therapies may also be appropriate.
A menopause-informed provider uses current evidence, individualizes care, avoids one-size-fits-all prescribing, and engages in shared decision-making. We follow guidance from The Menopause Society and align with the principles described in The New Menopause.
If you don't see your question here, we're happy to discuss it during a consultation.
