Weighing Risks and Benefits: Why Individual Experience Matters

When it comes to prescribing menopausal hormone therapy (MHT), the conversation often centres on weighing risks against benefits. But here’s the thing: it’s hard to weigh that balance if we don’t fully understand what the benefits are—for that individual.

The data shows that when doctors lack confidence in prescribing MHT, they tend to avoid it. That hesitancy often comes from outdated guidelines that frame MHT as useful mainly for hot flushes—and only for a limited time. But in my experience, that barely scratches the surface.

What continues to surprise and teach me is the depth and breadth of benefit some patients experience:

• “I feel like myself again.”
• “I’m not afraid of my own reactions anymore.”
• “My brain is working again.”

These aren’t side notes—they’re life-changing shifts. And many of them, I didn’t learn from textbooks. I learned from listening.

That’s why I find it difficult to apply a purely statistical “risk-benefit” model. How can we quantify the value of a woman reconnecting with herself, her relationships, or her sense of stability? These stories—these individual benefits—must be part of the conversation.

In this course, we’ll look at the evidence, the guidelines, and how to prescribe safely and responsibly. But we’ll also hold space for what the data can’t always capture: the lived experience of real people, and how profoundly hormones affect their daily lives.

Because safe prescribing doesn’t just mean following rules. It means keeping the person at the centre—and staying open to what we’re still learning.

Barber, K., & Charles, A. (2023). Barriers to Accessing Effective Treatment and Support for Menopausal Symptoms: A Qualitative Study Capturing the Behaviours, Beliefs and Experiences of Key Stakeholders. Patient Preference and Adherence, 17, 2971–2980. https://doi.org/10.2147/PPA.S430203

“I Can Walk Again” – The Unexpected Impact of HRT on Pain

Early on in my HRT prescribing journey, I saw a woman who had been on quetiapine for years and was determined to come off it. We started her on hormone therapy, and at her follow-up, she said something I’ll never forget:

“I can’t believe it—my ankle that I broke 10 years ago doesn’t hurt anymore. I can walk up the hills again.”

It was the kind of benefit we don’t talk about enough. Through HRT, her chronic pain had eased, her mobility improved, and she’d reclaimed a part of her life she thought was gone for good. This isn’t an isolated case. There’s research—going back as far as the late 1800s—that notes a connection between hormones and chronic pain, particularly musculoskeletal and joint pain. And yet, it’s still not something we routinely consider when prescribing.

It taught me an important lesson:
HRT doesn’t just target hot flushes and mood—it can improve function, movement, and quality of life in ways we don’t always expect. This is why real-world stories matter. They push us to keep learning, keep listening, and keep broadening our understanding of what hormone therapy can offer.