Podcast episode 133 (in German)
Menopausal hormone therapy – eight cases, two wrong headlines
November 10, 2026
First the alarm of 2002, then in November 2025 the announcement that the warning boxes would be removed: both headlines on hormone therapy during menopause are too simple. The episode translates the numbers from back then into women and listens to what women themselves say.
What it is about
What is given is estrogen, together with a progestogen if the uterus is intact. In the diencephalon sits a thermostat whose temperature window narrows without estrogen; estrogen widens it again, which is why it works against hot flashes like no other remedy. The episode goes through the large 2002 study, translates its percentages into absolute cases and shows what has changed since then: the route through the skin and the choice of progestogen. Added to this are the women themselves, because in a large menopause forum mood and brain fog come up far more often than in doctors’ notes. At the end stands the question that belongs before every decision: against what exactly, with which preparation and by which route.
Key points
- A Cochrane analysis of 24 studies with 3,329 women found hot flashes 75 percent less frequent on hormones than on placebo, which on its own already brought almost 58 percent.
- In the Women’s Health Initiative with 16,608 women, average age 63, the breast cancer risk after 5.2 years was 26 percent higher: 8 additional cases per 10,000 women per year.
- This was offset by 6 fewer colorectal cancer cases and 5 fewer hip fractures, with fractures overall just under a quarter less frequent; all-cause mortality remained unchanged.
- In 10,739 women on estrogen alone, the breast cancer risk after more than 20 years was 0.78, i.e. lower, whereas with the study’s progestogen it was 1.28.
- Across both arms with just over 27,000 women and 18 years, 27.1 percent died on hormones and 27.6 percent on placebo — no difference.
- As a tablet, estrogen had around a 4-fold thrombosis risk in the ESTHER study, through the skin 0.9; with body-identical progesterone, the breast cancer risk in a cohort of 80,000 women was 1.0.
- In the forum, more than 3 in 4 posts were about emotional well-being, in the doctors’ notes a quarter; memory and concentration came up in 1 in 5 versus 1 in 20.
Where the data stop
The 2002 numbers are still correct today but apply to equine estrogens with medroxyprogesterone acetate in women around 63, in a study on the prevention of heart disease. That an early start is more favorable is plausible but not proven: the two studies on this measured the vessel wall, not heart attacks, and only one found something. The progesterone data are observational, not randomized. As prevention against aging, hormone therapy has failed; the German draft guideline of June 2026 provides for it for hot flashes after counseling, not for the heart or against dementia.
The forum analysis is based on the 999 most upvoted posts and is not representative. Both sources are biased, though: the note records what is being treated, the forum what is burdensome. For emotional complaints, talk and behavioral therapy performed best in a survey of 3,062 women. Anyone who does not want or may not take hormones has had a second hormone-free active substance available in the EU since November 2025. Everything here is prescription-only and belongs in a conversation with a doctor.
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Published on November 10, 2026.
The topic in the database
- Estrogen, together with a progestogen if the uterus is intact.Menopausal hormone therapy
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Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Last updated: 2026-10-09.