Women considering hormone therapy for menopausal symptoms can find lots of advice on what they should do and a lot of it isn't so good. It's just something we have to figure out, says Barbara Younger, 61, a children's book author based in North Carolina. It's very confusing now to know what to do.

For decades, people thought hormone therapy (also sometimes called hormone replacement therapy) for menopause symptoms also protected women's hearts, maintained bone strength, and helped prevent cancer. But evidence from the Women's Health Initiative research study found otherwise. The large population study found that American women over the age of 60 who took estrogen and progestin were actually at greater risk of breast cancer, stroke, and dangerous blood clots.

With the publication of one article, hormone replacement therapy went from making women live longer to killing them, says Owen Montgomery, MD, chairman of the department of obstetrics and gynecology at Drexel University College of Medicine in Philadelphia.

In fact, Dr. Montgomery says, risks and benefits of hormone therapy depend on a woman's age and family history of heart disease and cancer, among other factors. I spend a lot of time educating my patients about appropriate use of hormones for their specific case, he adds. Individualization is really important.

Women who have used hormone therapy and leading physicians have a variety of perspectives on the risks and benefits. Here are 10 things your own doctor might not tell you about hormone replacement that you need to know to make the best decision for yourself.

1. I might not be the right doctor for you. Some doctors are better at treating menopausal symptoms than others. Many OB/GYNs know the latest evidence for the benefits and risks of hormone therapy, but others do not. Bedside manner also matters. If your medical professional is not helping you, find another one! says Ellen Dolgen, a speaker, author, and health and wellness advocate who blogs about menopause.

The first doctor I went to didn't help me. So, I decided to find a new one, she adds. I decided to interview three doctors, and then I selected the doctor I felt would be the best business partner for me.

Dolgen suggests finding a provider who specializes in perimenopause and menopause. Menopause is a journey, and you want to go on this journey with a specialist who is up on the latest information and [someone] you feel comfortable speaking openly and honestly with, she says.

2. Hormone therapy may help stabilize your mood swings. Women who've used hormone therapy say it has helped them cope with the irritability and dramatic mood shifts that can accompany perimenopause and menopause. Barbara Younger had already gone through menopause without too much trouble. But after she had her uterus and ovaries removed to treat endometrial cancer, her normally upbeat mood plummeted. She suspected her ovaries had been making just enough estrogen that losing them made her feel PMS and menopausal stuff times three.

Her gynecologist prescribed a low-dose hormone patch. Within 24 hours my mood lifted, and I've been basically fine ever since, she says.

Younger, who blogs about menopause and endometrial cancer at Friend For The Ride, says she's a bit worried about taking hormones given her cancer history. She is planning to begin tapering off hormone therapy soon. For now, she adds, she's staying in close touch with her gynecologist and oncologist.

3. Bioidentical hormones are not better for you, and could be worse. Hormone preparations specially tailored to patients by compounding pharmacies, known as bioidentical hormones, are widely touted as being safer and more natural than Food and Drug Administration (FDA) approved versions of hormones. But this simply isn't true, says Margery Gass, MD, the executive director of the North American Menopause Society (NAMS) and a NAMS-certified menopause practitioner at the Cleveland Clinic in Ohio.

There is no hormone out there that women can use that can be harvested from the field, or the trees, or anyplace else, Dr. Gass says. All go through laboratories and have to be processed with multiple chemical steps to be in the form that humans can use.

Still, many women who take bioidenticals swear by them. Bioidenticals work, and it's a great option, says Candice Storms, 45, of Puyallup, Washington, who suffered severe menopausal symptoms after surgery to treat uterine cancer in which her ovaries were also removed.

4. Compounded hormone drugs are not FDA-tested for safety. Custom-compounded formulations of hormones are not made with FDA oversight, Gass warns. They are also not regulated by the FDA, not tested for safety, nor for quality or effectiveness, notes NAMS. Custom-made compounded drugs could have less, or more, of the hormone than a woman needs, and can also have added ingredients that may affect your safety. Unlike a prescription drug, a compounded preparation is not necessarily the same each time you pick up a new supply, and can vary among pharmacists and pharmacies.

5. You don't need blood or saliva tests of your hormone levels before starting hormone therapy. No physician organization recommends testing hormone levels before prescribing hormone therapy. Since symptoms of thyroid problems can mimic menopausal symptoms, however, doctors will typically test your thyroid function before prescribing hormone therapy. Also, Montgomery says, testing for levels of follicle-stimulating hormone (FSH, a hormone that helps regulate your menstrual cycle) can determine whether a woman's ovaries are still functioning. But testing hormone levels in saliva is nonscientific and almost useless, he adds, and whats more, insurers don't cover it.

6. Hormone therapy means having a new conversation with your doctor every year. Timing matters, when it comes to hormone therapy risks. The biggest misconception among his patients considering hormone therapy, according to Montgomery, is that it causes cancer, stroke, and heart disease in anyone who takes it. In fact, a large research review of studies, published in March 2015, found a slightly decreased risk of heart disease with hormone therapy for women who were younger than 60. However, hormone therapy was associated with a greater risk of stroke in older women.

A study reported in 2015, called the ELITE trial, found that women who took hormone therapy within six years of the onset of menopause saw heart-related benefits. They had slower progression of plaque buildup in their arteries (known as atherosclerosis, this buildup increases the risk of stroke and heart attack) than women who took placebo. But taking hormones later, 10 years or more after menopause onset, did not affect atherosclerosis progression.

Risks and benefits for an individual woman change as she ages, Montgomery says, and women who choose to take hormone therapy should not continue indefinitely. It needs to be a conversation with your doctor every year.

7. Hormone therapy can be tailored to your symptoms and needs. These days, hormone treatment comes in many forms. Systemic estrogen, in which the hormone is delivered to the entire body, can be taken via pills, patches, creams, gels, even sprays. You can also use creams, tablets, or rings to deliver low-dose estrogen directly to the vagina.

For example, if a woman's only problem is vaginal dryness and painful experiences with sexual activity, we can use a very low dose vaginal product that just treats the vagina and has for the most part a local effect, says Gass.

8. Vaginal hormone therapy may help when you have overactive bladder symptoms. Many women begin to experience frequent urination and even incontinence as menopause nears. Hormone therapy delivered locally to the vagina may help ease these symptoms, according to a research review of 34 studies published in 2012.

On the other hand, the same review found evidence that so-called systemic hormone therapy pills and patches that deliver the hormone to your entire body could actually make urinary symptoms worse.

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9. You can take hormone therapy while you are in perimenopause. You're considered to have gone through menopause if you haven't had your period for a full year. But women often experience symptoms for years before menopause actually happens. This time in a woman's life, when she's still menstruating but her body has begun to phase out of childbearing mode, is known as perimenopause.

And perimenopause may last a lot longer than previously thought. The Study of Women's Health Across the Nation, which is following 3,302 women as they transition to menopause, found more than half had hot flashes and night sweats for longer than seven years.

Women in perimenopause can take hormone therapy to address their symptoms, Montgomery says, although he may prescribe a lower dose for these women than for those who have already reached menopause.

10. If you are going through menopause you don't necessarily need to have your hormones replaced. Menopause isn't much fun, to say the least, but it's a normal part of life. In fact, while treating menopausal symptoms with hormones used to be called hormone replacement therapy, Montgomery says, experts now prefer the term hormone therapy. While hormone therapy is great for menopausal symptoms, it won't keep you young forever, no matter what bioidentical hormone advocate Suzanne Somers says.

We take the position that menopause is a normal and natural occurrence in a woman's life, no more pathological than puberty, says Gass. It's a little bit like puberty, in reverse.

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10 Things Your Doctor Won't Tell You About Hormone Therapy

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