Menopause Hormone Therapy: Four Sentences, and Where Each One Came From
It's natural. You're too old. Lowest dose, shortest time. Your levels look fine. Three women heard all four in one week.
Betty is fifty two, has not slept through a night since her periods stopped, and was handed an antidepressant and a sleeping pill. Mary is seventy four, has had four bladder infections in eighteen months, and was told she would stroke out. Michelle is fifty eight, has been on an estradiol patch for two years, is still finished by two in the afternoon, and was told her level is fine.
Most doctors saying these things are repeating what they were taught twenty years ago, and one of the four was withdrawn in writing ten months ago by the agency that wrote it. One note on words first: estrogen here means the horse drug the big trial everybody quotes was run on, and estradiol means the human hormone her ovary made until it stopped.
"It's natural"
Losing your teeth was natural for most of human history. Then we could do something about it, and natural stopped being a description and became an instruction: accept the cost.
Menopause is a deficiency disease. The ovaries stop making estradiol, progesterone and, over a longer arc, testosterone, and every tissue built with receptors for them runs without them. So let me count.
In over a hundred thousand British women, current users of hormone therapy had about forty percent fewer fractures. A randomized trial of oral estradiol watched the carotid artery wall thicken at about half the placebo rate in women within six years of menopause, and a Danish trial of a thousand women on oral estradiol saw deaths, heart attacks and heart failure, counted together, cut roughly in half over a decade. Pool the trials, over thirty thousand women, and diabetes ran about thirty percent lower.
Finland keeps a register of nearly half a million women on estradiol, and the longer a woman had been on it, the lower her risk of dying of heart disease. That is a register, not a trial, and its authors say so. Natural means nobody counts.
"You're too old"
That one has a real source. The big trial in 2002 put women averaging sixty three on horse estrogen with a synthetic progestin and found more strokes, and more dementia in the older women. Women who started within ten years of menopause did better, and that became the ten year window. For that drug, it is real. Then the window was copied onto the human hormone, because the label was rewritten for the entire class. Nobody ran the trial.
The same artery trial had a late group, ten or more years out, on one low fixed dose for five years: no measurable difference in the artery wall either way, and no difference in clots, heart attacks or deaths. A low dose late did nothing to the artery. And Medicare looked at ten million women sixty five and older. On estrogen alone, every estrogen product in the country pooled, death from any cause was nineteen percent lower, and the benefit was larger with estradiol than with the horse drug. That is claims data. There is no age at which a woman stops having estradiol receptors. It is a gradient, not a gate.
"Lowest dose, shortest time"
That sentence came from a label. After 2002 the regulator boxed the whole class and added one line: use the lowest effective dose for the shortest duration. Written for the horse estrogen with a synthetic progestin, printed on the human hormone too. It reached Michelle twenty three years on.
On the tenth of November 2025 the same agency wrote to every manufacturer of menopausal hormone therapy and told them to remove that recommendation, and to strip the cardiovascular, breast cancer and dementia language out of the boxed warning. Nobody tells a woman to take the lowest dose of her blood pressure pill for the shortest time.
"Your levels look fine"
Michelle's level was forty. The reference range for a postmenopausal woman's estradiol reads thirty one or less. Not thirty one. Less. There is no bottom to it, so a woman with none at all reads normal. That range assumes she does not need the hormone.
Forty is what a patch produces. A patch trial in the nineties wrote its targets down: twenty five for symptoms, forty for bone. Michelle's forty is the design target of the entire patch literature. My floor is seventy five.
She is on hormones. She is getting one and a half of them.
Michelle is on estradiol. She was given progesterone, which made her groggy. Nobody mentioned testosterone or her thyroid. That is the standard of care, literally.
Progesterone counts as a half because it is prescribed as a uterus drug, at the dose that keeps the lining thin. Which progesterone she gets is the whole breast argument: in eighty thousand French women on estradiol, mostly through the skin, the human molecule carried no increase in breast cancer risk and the synthetic progestins were sixty nine percent higher. Testosterone has thirty six randomized trials behind it that the guidelines do not look at. Her TSH came back normal, so the thyroid conversation ended there. I look at free T3.
The symptom nobody asks about
Mary's bladder infections were never connected to menopause because nobody asked. The tissue of the vulva, vagina, urethra and bladder was built to run on her hormones, and it does not fade the way hot flashes fade. It climbs, on the terminology consensus figures: four percent in early perimenopause, twenty five percent a year after menopause, forty seven percent three years after.
Ninety three older women with recurring infections were randomized to a vaginal cream of estriol, a weaker cousin of estradiol, or a placebo cream: about six infections a year on placebo, half of one on the cream. Pool eight trials and over four thousand women and the vaginal estrogens, in every form they come in, cut recurrent infections by more than half, while oral showed nothing measurable. The bladder wants the hormone delivered to the bladder.
Why she should start them together
Almost every first visit brings the same question: can I add the rest later? The worry is sensible. The logic runs backwards.
She is deficient in all four right now, so a month on two hormones is a month still missing two, and those symptoms do not wait their turn. Exhaustion is thyroid. Low mood, no drive, a brain that will not start, that is testosterone. She feels those in the month she started estradiol, and blames the new thing.
Thyroid sets the speed of everything, including how fast she clears progesterone. A woman whose thyroid is on the floor wakes groggy and says she cannot tolerate progesterone, when her thyroid was never treated. Leaving it for later does not just delay a benefit. It manufactures a side effect.
Betty sleeps through most nights. Mary has not had an infection since she started. If you have been handed one of those four sentences, you are not making it up and you are not just getting older.
The whole argument:
⚠️ Educational content, not individual medical advice or a treatment recommendation. Nobody should start, stop or change a prescription because of an article. Your labs and history belong in a one on one.
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Sources
The complete set for both podcast parts, as promised in the Monday and Wednesday descriptions. APA 7, alphabetical by first author surname then year. 90 entries.
Apperloo, M., Midden, M., van der Stege, J., Wouda, J., Hoek, A., & Weijmar Schultz, W. (2006). Vaginal application of testosterone: a study on pharmacokinetics and the sexual response in healthy volunteers. J Sex Med, 3(3), 541-549. https://doi.org/10.1111/j.1743-6109.2006.00212.x
Arruda de Oliveira, R., Casado dos Santos, S., de Menezes Lima, V. L., & Adami, L. N. G. (2025). Selective Serotonin Reuptake Inhibitors (SSRIs): effects on male fertility. JBRA Assist Reprod, 29(2), 351-358. https://doi.org/10.5935/1518-0557.20240109
Baik, S. H., Baye, F., & McDonald, C. J. (2024). Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses. Menopause, 31(5), 363-371. https://doi.org/10.1097/GME.0000000000002335
Banks, E., Beral, V., Reeves, G., Balkwill, A., Barnes, I., & Million Women Study Collaborators. (2004). Fracture incidence in relation to the pattern of use of hormone therapy in postmenopausal women. JAMA, 291(18), 2212-2220. https://doi.org/10.1001/jama.291.18.2212
Bartoletti, R., Cai, T., Wagenlehner, F. M., Naber, K., & Bjerklund Johansen, T. E. (2016). Treatment of Urinary Tract Infections and Antibiotic Stewardship. Eur Urol Suppl, 15(4), 81-87. https://doi.org/10.1016/j.eursup.2016.04.003
Belaya, Z. E., Melnichenko, G. A., Rozhinskaya, L. Y., et al. (2007). Subclinical hyperthyroidism of variable etiology and its influence on bone in postmenopausal women. Hormones (Athens), 6(1), 62-70.
Bhuvaneswar, C. G., Baldessarini, R. J., Harsh, V. L., & Alpert, J. E. (2009). Adverse endocrine and metabolic effects of psychotropic drugs: selective clinical review. CNS Drugs, 23(12), 1003-1021. https://doi.org/10.2165/11530020-000000000-00000
Brincat, M., Kabalan, S., Studd, J. W., Moniz, C. F., de Trafford, J., & Montgomery, J. (1987). A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman. Obstet Gynecol, 70(6), 840-845.
Brinton, L. A., & Felix, A. S. (2014). Menopausal hormone therapy and risk of endometrial cancer. J Steroid Biochem Mol Biol, 142, 83-89. https://doi.org/10.1016/j.jsbmb.2013.05.001
Cai, T., et al. (2012). The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis, 55(6), 771-777. (Read via Bartoletti et al., 2016.)
Chen Y-Y, Su T-H, & Lau H-H. (2021). Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials. Int Urogynecol J, 32(1), 17-25. https://doi.org/10.1007/s00192-020-04397-z
Corona, G., Ricca, V., Bandini, E., et al. (2009). Selective serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Med, 6(5), 1259-1269. https://doi.org/10.1111/j.1743-6109.2009.01248.x
Costa, L. B. F., et al. (2018). Recommendations for the use of testosterone in male transgender. Rev Bras Ginecol Obstet, 40(5), 275-280. https://doi.org/10.1055/s-0038-1657788
Davis, S. R., Goldstat, R., Papalia, M. A., Shah, S., Kulkarni, J., Donath, S., & Bell, R. J. (2006). Effects of aromatase inhibition on sexual function and well-being in postmenopausal women treated with testosterone: a randomized, placebo-controlled trial. Menopause, 13(1), 37-45. https://doi.org/10.1097/01.gme.0000168061.32917.83
Deligiannidis, K. M., Meltzer-Brody, S., Maximos, B., et al. (2023). Zuranolone for the treatment of postpartum depression. Am J Psychiatry, 180(9), 668-675. https://doi.org/10.1176/appi.ajp.20220785
Drobnis, E. Z., & Nangia, A. K. (2017). Psychotropics and male reproduction. Adv Exp Med Biol, 1034, 63-101. https://doi.org/10.1007/978-3-319-69535-8_8
Eisenegger, C., Naef, M., Snozzi, R., Heinrichs, M., & Fehr, E. (2010). Prejudice and truth about the effect of testosterone on human bargaining behaviour. Nature, 463(7279), 356-359. https://doi.org/10.1038/nature08711
Ensrud, K. E., Guthrie, K. A., Hohensee, C., et al. (2015). Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep, 38(1), 97-108. https://doi.org/10.5665/sleep.4332
Erdemir, F., Atilgan, D., Firat, F., Markoc, F., Parlaktas, B. S., & Sogut, E. (2014). The effect of sertraline, paroxetine, fluoxetine and escitalopram on testicular tissue and oxidative stress parameters in rats. Int Braz J Urol, 40(1), 100-108. https://doi.org/10.1590/S1677-5538.IBJU.2014.01.15
FDA 2013 zolpidem dose change, via Gobinath, A. R., Choleris, E., & Galea, L. A. M. (2017). Sex, hormones, and genotype interact to influence psychiatric disease, treatment, and behavioral research. J Neurosci Res, 95(1-2), 50-64.
Fernandes, T., Costa-Paiva, L. H., & Pinto-Neto, A. M. (2014). Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial. J Sex Med, 11(5), 1262-1270. https://doi.org/10.1111/jsm.12473
Fournier, A., Berrino, F., & Clavel-Chapelon, F. (2008). Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat, 107(1), 103-111. https://doi.org/10.1007/s10549-007-9523-x
Gama, C. R. B., Pombo, M. A. G., Nunes, C. P., et al. (2020). Treatment of Recurrent Urinary Tract Infection Symptoms with Urinary Antiseptics Containing Methenamine and Methylene Blue: Analysis of Etiology and Treatment Outcomes. Res Rep Urol, 12, 639-649. https://doi.org/10.2147/RRU.S279060
Giske, L. E., et al. (2002). The effect of 17beta-estradiol at doses of 0.5, 1 and 2 mg compared with placebo on early postmenopausal bone loss in hysterectomized women. Osteoporos Int, 13(4), 309-316. https://doi.org/10.1007/s001980200030
Glaser, R., Kalantaridou, S., & Dimitrakakis, C. (2013). Testosterone implants in women: pharmacological dosing for a physiologic effect. Maturitas, 74(2), 179-184. https://doi.org/10.1016/j.maturitas.2012.11.004
Glaser, R., & Dimitrakakis, C. (2021). Testosterone implant therapy in women with and without breast cancer: rationale, experience, evidence. Androgens: Clinical Research and Therapeutics, 2(1), 100-113. https://doi.org/10.1089/andro.2021.0003
Goldstat, R., Briganti, E., Tran, J., Wolfe, R., & Davis, S. R. (2003). Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Menopause, 10(5), 390-398. https://doi.org/10.1097/01.GME.0000060256.03945.20
Gordon, J. L., Rubinow, D. R., Eisenlohr-Moul, T. A., Xia, K., Schmidt, P. J., & Girdler, S. S. (2018). Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: a randomized clinical trial. JAMA Psychiatry, 75(2), 149-157. https://doi.org/10.1001/jamapsychiatry.2017.3998
Greene, D. N., Schmidt, R. L., Winston-McPherson, G., et al. (2021). Reproductive endocrinology reference intervals for transgender men on stable hormone therapy. Am J Clin Pathol, 156(5), 766-775. https://doi.org/10.1093/ajcp/aqab029
Grunder, G., Wetzel, H., Schlosser, R., et al. (1999). Neuroendocrine response to antipsychotics: effects of drug type and gender. Biol Psychiatry, 45(1), 89-97. https://doi.org/10.1016/S0006-3223(98)00125-5
Haentjens, P., Magaziner, J., Colón-Emeric, C. S., et al. (2010). Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med, 152(6), 380-390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008
Harding, C., Chadwick, T., Homer, T., et al. (2022). Methenamine hippurate compared with antibiotic prophylaxis to prevent recurrent urinary tract infections in women: the ALTAR non-inferiority RCT. Health Technol Assess, 26(23). https://doi.org/10.3310/QOIZ6538
Heemstra, K. A., Hamdy, N. A. T., Romijn, J. A., & Smit, J. W. A. (2006). The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma. Thyroid, 16(6), 583-591. https://doi.org/10.1089/thy.2006.16.583
Hitchcock, C. L., & Prior, J. C. (2012). Oral micronized progesterone for vasomotor symptoms: a placebo-controlled randomized trial in healthy postmenopausal women. Menopause, 19(8), 886-893. https://doi.org/10.1097/gme.0b013e318247f07a
Hodis, H. N., Mack, W. J., Henderson, V. W., ELITE Research Group, et al. (2016). Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med, 374(13), 1221-1231. https://doi.org/10.1056/NEJMoa1505241
Hodis, H. N., & Mack, W. J. (2022). Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: it's about time and timing. Cancer J, 28(3), 208-223. https://doi.org/10.1097/PPO.0000000000000591
Huang, et al. (2018). Sci Rep, 8, 7257. (Rat model.)
Islam, R. M., Bell, R. J., Green, S., Page, M. J., & Davis, S. R. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol, 7(10), 754-766. https://doi.org/10.1016/S2213-8587(19)30189-5
Kelly, T. (2014). A favorable risk-benefit analysis of high dose thyroid for treatment of bipolar disorders with regard to osteoporosis. J Affect Disord, 166, 353-358. https://doi.org/10.1016/j.jad.2014.04.022
Kraemer, G. R., Kraemer, R. R., Ogden, B. W., Kilpatrick, R. E., Gimpel, T. L., & Castracane, V. D. (2003). Variability of serum estrogens among postmenopausal women treated with the same transdermal estrogen therapy and the effect on androgens and sex hormone binding globulin. Fertil Steril, 79(3), 534-542. https://doi.org/10.1016/s0015-0282(02)04755-6
Kuhl, H. (2005). Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric, 8 Suppl 1:3-63. https://doi.org/10.1080/13697130500148875
Kulkarni, J., de Castella, A., Fitzgerald, P. B., et al. (2008). Estrogen in severe mental illness: a potential new treatment approach. Arch Gen Psychiatry, 65(8), 955-960. https://doi.org/10.1001/archpsyc.65.8.955
Labrie, F., Archer, D. F., Koltun, W., et al. (2016). Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause, 23(3), 243-256 (reprinted Menopause 2018;25(11):1339-1353). https://doi.org/10.1097/GME.0000000000000571
Labrie, F., Martel, C., & Pelletier, G. (2017). Is vulvovaginal atrophy due to a lack of both estrogens and androgens? Menopause, 24(4), 452-461. https://doi.org/10.1097/GME.0000000000000768
Lancel, M., Faulhaber, J., Holsboer, F., & Rupprecht, R. (1996). Progesterone induces changes in sleep comparable to those of agonistic GABAA receptor modulators. Am J Physiol, 271(4 Pt 1), E763-E772. https://doi.org/10.1152/ajpendo.1996.271.4.E763
Lee, J. S., et al. (2015). Effects of hormone therapy on serum lipid levels in postmenopausal Korean women. J Menopausal Med, 21(2), 104-111. https://doi.org/10.6118/jmm.2015.21.2.104
Li, S. H., & Graham, B. M. (2017). Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. Lancet Psychiatry, 4(1), 73-82. https://doi.org/10.1016/S2215-0366(16)30358-3
Lobo, R. A., Archer, D. F., Kagan, R., et al. (2018). A 17β-estradiol-progesterone oral capsule for vasomotor symptoms in postmenopausal women: a randomized controlled trial. Obstet Gynecol, 132(1), 161-170. https://doi.org/10.1097/AOG.0000000000002645
Manson, J. E., Chlebowski, R. T., Stefanick, M. L., et al. (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the WHI randomized trials. JAMA, 310(13), 1353-1368. https://doi.org/10.1001/jama.2013.278040
Mares, C., et al. (2024). Methenamine hippurate for recurrent urinary tract infections. Life (Basel), 14(1), 106.
Mehta, J., Kling, J. M., & Manson, J. E. (2021). Risks, benefits, and treatment modalities of menopausal hormone therapy: current concepts. Front Endocrinol, 12, 564781. https://doi.org/10.3389/fendo.2021.564781
Melisko, M. E., Goldman, M. E., Hwang, J., et al. (2017). Vaginal testosterone cream vs estradiol vaginal ring for vaginal dryness or decreased libido in women receiving aromatase inhibitors for early-stage breast cancer: a randomized clinical trial. JAMA Oncol, 3(3), 313-319. https://doi.org/10.1001/jamaoncol.2016.3904
Meltzer-Brody, S., Colquhoun, H., Riesenberg, R., et al. (2018). Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet, 392(10152), 1058-1070. https://doi.org/10.1016/S0140-6736(18)31551-4
Memi, E., Pavli, P., Papagianni, M., Vrachnis, N., & Mastorakos, G. (2024). Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. Rev Endocr Metab Disord, 25, 751-772. https://doi.org/10.1007/s11154-024-09882-0
Mikkola, T. S., Tuomikoski, P., Lyytinen, H., et al. (2015a). Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause, 22(9), 976-983. https://doi.org/10.1097/GME.0000000000000450
Mikkola, T. S., Tuomikoski, P., Lyytinen, H., et al. (2015b). Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab, 100(12), 4588-4594. https://doi.org/10.1210/jc.2015-1864
Misra, M., Papakostas, G. I., & Klibanski, A. (2004). Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism. J Clin Psychiatry, 65(12), 1607-1618. https://doi.org/10.4088/JCP.v65n1205
Mohamed, M. K., & Abdel-Rahman, A. A. (2000). Effect of long-term ovariectomy and estrogen replacement on the expression of estrogen receptor gene in female rats. Eur J Endocrinol, 142(3), 307-314. https://doi.org/10.1530/eje.0.1420307
Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry, 28(8), 3243-3256. https://doi.org/10.1038/s41380-022-01661-0
Moses-Kolko and Kugaya PET studies, via Kuypers, K. P. C., et al. (2026). Psychedelics and women's mental health: the effects of female sex hormones on psychedelics' efficacy and tolerability. Mol Psychiatry.
Nerattini, M., Jett, S., Andy, C., et al. (2023). Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia. Front Aging Neurosci, 15, 1260427. https://doi.org/10.3389/fnagi.2023.1260427
Nolan, B. J., Liang, B., & Cheung, A. S. (2021). Efficacy of micronized progesterone for sleep: a systematic review and meta-analysis of randomized controlled trial data. J Clin Endocrinol Metab, 106(4), 942-951. https://doi.org/10.1210/clinem/dgaa873
Pae (2009), via Damoiseaux, V. A., Proost, J. H., Jiawan, V. C. R., & Melgert, B. N. (2014). Sex differences in the pharmacokinetics of antidepressants: influence of female sex hormones and oral contraceptives. Clin Pharmacokinet, 53(6), 509-519.
Paganini-Hill, A., Corrada, M. M., & Kawas, C. H. (2006). Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study. Menopause, 13(1), 12-18.
Portman, D. J., Gass, M. L. S., & Vulvovaginal Atrophy Terminology Consensus Conference Panel. (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Menopause, 21(10), 1063-1068. https://doi.org/10.1097/GME.0000000000000329
Raghunandan, C., Agrawal, S., Dubey, P., Choudhury, M., & Jain, A. (2010). A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women. J Sex Med, 7(3), 1284-1290. https://doi.org/10.1111/j.1743-6109.2009.01667.x
Raz, R., & Stamm, W. E. (1993). A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med, 329(11), 753-756. https://doi.org/10.1056/NEJM199309093291102
Reginster, J. Y., Albert, A., Deroisy, R., et al. (1997). Plasma estradiol concentrations and pharmacokinetics following transdermal application of Menorest 50 or Systen (Evorel) 50. Maturitas, 27(2), 179-186. https://doi.org/10.1016/s0378-5122(97)00027-3
Rocca, W. A., Bower, J. H., Maraganore, D. M., et al. (2007). Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology, 69(11), 1074-1083. https://doi.org/10.1212/01.wnl.0000276984.19542.e6
Rohr, U. D., Nauert, C., & Stehle, B. (1999). 17Beta-estradiol delivered by three different matrix patches 50 microg/day: a three way cross-over study in 21 postmenopausal women. Maturitas, 33(1), 45-58. https://doi.org/10.1016/s0378-5122(99)00039-0
Ruiz-Santiago, C., et al. (2024). Effects of selective serotonin reuptake inhibitors on endocrine system (Review). Biomed Rep, 21(5), 128. https://doi.org/10.3892/br.2024.1816
Salpeter pooled randomized trials, via Mauvais-Jarvis, F., Manson, J. E., Stevenson, J. C., & Fonseca, V. A. (2017). Menopausal hormone therapy and type 2 diabetes prevention: evidence, mechanisms, and clinical implications. Endocr Rev, 38(3), 173-188.
Schierbeck, L. L., Rejnmark, L., Tofteng, C. L., et al. (2012). Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ, 345, e6409. https://doi.org/10.1136/bmj.e6409
Schindler, A. E., Campagnoli, C., Druckmann, R., et al. (2003). Classification and pharmacology of progestins. Maturitas, 46 Suppl 1:S7-S16. https://doi.org/10.1016/j.maturitas.2003.09.014
Shah, S., Bell, R. J., Savage, G., Goldstat, R., Papalia, M. A., Kulkarni, J., Donath, S., & Davis, S. R. (2006). Testosterone aromatization and cognition in women: a randomized, placebo-controlled trial. Menopause, 13(4), 600-608. https://doi.org/10.1097/01.gme.0000227333.50867.4e
Shifren (2000) and Braunstein (2005), via Traish, A. M., & Morgentaler, A. (2022). Androgen therapy in women with testosterone insufficiency: looking back and looking ahead. Androgens Clin Res Ther, 3(1), 2-13.
Silva, et al. (2026). J Photochem Photobiol B, 283, 113551. (In vitro.)
Simon, J. A., Goldstein, I., Kim, N. N., et al. (2018). The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review. Menopause, 25(7), 837-847. https://doi.org/10.1097/GME.0000000000001138
Sipila, S., Taaffe, D. R., Cheng, S., Puolakka, J., Toivanen, J., & Suominen, H. (2001). Effects of hormone replacement therapy and high-impact physical exercise on skeletal muscle in post-menopausal women. Clin Sci (Lond), 101(2), 147-157.
Sitruk-Ware, R., Bricaire, C., De Lignieres, B., Yaneva, H., & Mauvais-Jarvis, P. (1987). Oral micronized progesterone: bioavailability pharmacokinetics, pharmacological and therapeutic implications: a review. Contraception, 36(4), 373-402. https://doi.org/10.1016/0010-7824(87)90088-6
Skovlund, C. W., Mørch, L. S., Kessing, L. V., & Lidegaard Ø. (2016). Association of hormonal contraception with depression. JAMA Psychiatry, 73(11), 1154-1162. https://doi.org/10.1001/jamapsychiatry.2016.2387
Sriprasert, I., Hodis, H. N., Karim, R., et al. (2019). Differential effect of plasma estradiol on subclinical atherosclerosis progression in early vs late postmenopause. J Clin Endocrinol Metab, 104(2), 293-300. https://doi.org/10.1210/jc.2018-01600
Thayakaran, R., Adderley, N. J., Sainsbury, C., et al. (2019). Thyroid replacement therapy, thyrotropin concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study. BMJ, 366, l4892. https://doi.org/10.1136/bmj.l4892
Turner, A., Chen, T. C., Barber, T. W., Malabanan, A. O., Holick, M. F., & Tangpricha, V. (2004). Testosterone increases bone mineral density in female-to-male transsexuals: a case series of 15 subjects. Clin Endocrinol (Oxf), 61(5), 560-566. https://doi.org/10.1111/j.1365-2265.2004.02125.x
US Food and Drug Administration. (2025, November 10). Labeling changes for menopausal hormone therapy products [Drug Safety Communication].
Wallace, R. B., Sherman, B. M., Bean, J. A., Treloar, A. E., & Schlabaugh, L. (1979). Probability of menopause with increasing duration of amenorrhea in middle-aged women. Am J Obstet Gynecol, 135(8), 1021-1024. https://doi.org/10.1016/0002-9378(79)90729-4
Waller, T. A., et al. (2018). Urinary tract infection antibiotic resistance in the United States. Prim Care Clin Office Pract, 45(3), 455-466.
Walsh, B. W., Schiff, I., Rosner, B., Greenberg, L., Ravnikar, V., & Sacks, F. M. (1991). Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med, 325(17), 1196-1204. https://doi.org/10.1056/NEJM199110243251702
Witherby, S., Johnson, J., Demers, L., et al. (2011). Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist, 16(4), 424-431. https://doi.org/10.1634/theoncologist.2010-0435
Yang, Y., et al. (2025). Independent and medication-related effects of bipolar disorder on thyroid and reproductive hormones in women. Sci Rep. https://doi.org/10.1038/s41598-025-11460-6
