What we got wrong, and what matters now
How did we end up so confused?
Back in the 1990s, doctors believed oestrogen was the magic shield against heart disease. The Women’s Health Initiative set out to prove it. Five years later, the headlines screamed that women on oestrogen and progestogen had a higher risk of breast cancer. Panic button pressed. Result? Hormone replacement therapy (HRT) went from everyday conversation to taboo topic almost overnight. Patients bolted at the mere mention of it. Many doctors stopped prescribing.
Fast-forward to today, and we’re still untangling the mess. Some women who don’t really need HRT are taking it out of fear of dementia. Meanwhile, thousands of women who could be helped are avoiding it—too scared, or not offered it, or thinking their symptoms aren’t ‘bad enough.’ That’s not a win for anyone.
Who actually benefits?
When you look at over 8,000 Australian women, the picture is clear: hot flushes and night sweats are the big red flags. And those two drag a whole crowd with them—sleep disturbance, anxiety, mood changes, brain fog, weight gain. If you’re waking drenched at 2am or snapping at loved ones because your body thermostat has gone rogue, HRT can bring real relief.
But not every symptom chalked up to ‘menopause’ is about hormones. That patchy memory in perimenopause? The ‘why did I walk into this room?’ moments? The awkward pause when you can’t remember the word ‘cheese’? Those tend to settle as the body completes the transition. And so far, not one clinical trial has proven that oestrogen fixes brain fog.
Who doesn’t need it?
If you’ve stopped having periods but feel fine, HRT might not be necessary. What’s worth checking, though, is your bone density. Even without symptoms, women lose 6–8% of bone mass crossing the menopause line. If you’re at risk of osteoporosis, oestrogen may help protect your skeleton even when your mood and sleep are steady.
It’s not one-size-fits-all
Gels, patches, tablets—your doctor has options. Some women absorb gels beautifully; others don’t. Some thrive on progesterone; others get bloated, foggy, or too sleepy. A few months on synthetic progestogen may be necessary if your uterus lining is still thickening. The real trick is tailoring the mix to the body in front of you, not the latest influencer reel.
And testosterone? It’s being marketed as the miracle cure for everything from sex drive to energy. Yet when women in studies got either testosterone gel or placebo, sexual function improved in both groups. That’s the placebo effect at work, not magic hormone dust.
Beyond the hype
Here’s the blunt truth: sorting out hormones helps with hot flushes, night sweats, sleep, and mood swings. But it won’t fix everything. It won’t rewrite decades of insomnia. It won’t erase the stress of juggling teenagers, elderly parents, or a bad boss. Lifestyle factors—nutrition, sleep hygiene, physical activity—carry their own weight.
The Vietnamese angle
In Vietnam, menopause is spoken of more quietly, often tucked under the umbrella of tự nhiên—what’s natural, inevitable. Many women rely on traditional remedies: herbal teas, acupuncture, or foods thought to ‘cool the body’ such as bitter melon, lotus seeds, or mung bean soup. Western hormone therapy is less commonly discussed, partly due to cultural discomfort about talking openly about reproductive health, and partly due to cost and access.
Doctors here may not always raise HRT as an option, which leaves many women managing symptoms through family advice or local remedies. That doesn’t mean HRT isn’t available—it is, especially in larger cities—but stigma and silence remain barriers. For Vietnamese women living abroad, there can also be pressure from family not to ‘interfere with nature.’
What can be learned from this? That every woman deserves both information and choice. That a conversation with a trusted doctor matters more than Facebook threads or whispered warnings. And that combining the best of modern medicine with the wisdom of local traditions might offer the most compassionate path.
Bottom line
- If you’re having hot flushes, night sweats, anxiety, and disrupted sleep—talk to your doctor. Oestrogen works.
- If you’re symptom-free, check your bones before making decisions.
- Don’t swallow the hype—no single hormone fixes all of life’s problems.
- And wherever you are—Melbourne, Hanoi, Đà Lạt—demand a conversation that includes your culture, your body, and your choices.
📚 References
Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., … Baber, R. J. (2019). Global consensus position statement on the use of testosterone therapy for women. Climacteric, 22(5), 429–434. https://doi.org/10.1080/13697137.2019.1637079
National Institute for Health and Care Excellence. (2015). Menopause: Diagnosis and management (NICE guideline NG23). London: NICE. https://www.nice.org.uk/guidance/ng23
Rossouw, J. E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Kooperberg, C., Stefanick, M. L., … Writing Group for the Women’s Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. Journal of the American Medical Association, 288(3), 321–333. https://doi.org/10.1001/jama.288.3.321
Wikipedia contributors. (2025). Hormone replacement therapy (menopause). In Wikipedia. Retrieved September 11, 2025, from https://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)
Disclaimer
I am a counselling psychologist and mental health practitioner, not a medical doctor. The information in this article is for educational purposes only and should not be taken as medical advice. Always consult a qualified physician about your own health and treatment options.and treatment options.
