How to Menopause: Navigating HRT, Testosterone & the Biggest Controversies in Menopause Management
- Dr Natalie Hutchins
- 3 days ago
- 5 min read
Updated: 3 days ago
Episode Introduction
The renewed focus on menopause over the last decade has been well overdue, and for many women, incredibly transformative. More women are informed about what is happening to their bodies, more clinicians are engaging with the evidence, and research into this space is growing at pace.
But the same attention that has brought menopause into the mainstream, has created a new kind of problem for women. The volume of information women now encounter can be overwhelming. There are still many areas the science has not yet caught up and where doctors themselves disagree, meaning women not only have to contend with volume of information but also conflicting views. And menopause has become big business meaning that there is sometimes a commercial interest in preliminary or substandard evidence overstated as proven fact. It is no wonder that many women are left feeling more confused than ever.
In this episode, I sit down with Mr Vikram Talaulikar, Associate Specialist in Reproductive Medicine and Hon. Associate Professor in Women’s Health at the University College London. We discuss all the major controversies from hormone testing to testosterone use beyond libido to the use of hormones as a longevity drug, to give you an honest account of what we know, what we don’t, and how to navigate the grey in between.
Guest Bio
Mr Vikram Talaulikar is a Consultant Gynaecologist and Menopause Specialist with a subspecialty interest in reproductive medicine. He works at University College London Hospitals and holds an academic position at University College London, where his research focuses on menopause, reproductive endocrinology, and bone health. He is a senior member of the British Menopause Society and has published widely in peer-reviewed journals on menopause management, HRT, and women's health across the lifespan.
What We Cover
00:03:02 Why is there so much controversy in the menopause space?
• How social media has changed the landscape of medical disagreement, and why women are caught in the crossfire.
• How to assess whether a source of information is credible and the questions worth asking about commercial interests.
00:07:43 Perimenopause vs menopause: what is actually happening hormonally
• A clear explanation of the hormonal journey from pre-menopause through perimenopause to post-menopause.
• Why the definition of perimenopause remains contested and why that matters for diagnosis and treatment.
00:10:55 Should you test your hormones to diagnose menopause?
• Why symptom-based diagnosis is the recommended approach for women over 45, and why blood tests can mislead.
• What continuous hormone monitoring technology can and cannot currently tell us about perimenopause management.
00:15:37 Should hormone levels be monitored once you are on HRT?
• Why routine blood monitoring during HRT is generally not recommended and the exceptions where it may be useful.
• What DEXA scanning can tell us that blood tests cannot when it comes to bone health and HRT response.
00:18:18 The pill versus MHT in perimenopause: when does each make sense?
• Why the hormonal fluctuations of perimenopause mean the contraceptive pill can be a helpful tool.
• The key differences between the pill and HRT.
00:26:14 Progesterone beyond endometrial protection
• Whether women without a uterus may benefit from adding progesterone for sleep, mood, or other symptoms.
• The importance of informed consent around progesterone's potential impact on mood and long-term breast cancer risk.
00:28:50 Testosterone for women: what the evidence actually supports
• What the current evidence says about testosterone beyond use for libido.
• Why testing testosterone levels before treatment is not about identifying deficiency.
00:36:29 HRT and cardiovascular disease: what we know and what we do not
• How the Women's Health Initiative studies distorted our understanding of HRT and heart risk and what the evidence actually shows.
• The importance of timing: why starting HRT within the first ten years of menopause matters for any cardiovascular benefit.
00:43:34 HRT and dementia: the evidence so far
• What the evidence shows for HRT and dementia risk.
• The subgroups of women where observational data suggests benefit.
00:48:44 What we do know: the clearest areas of consensus
• The three categories where there is strong agreement: early and premature menopause, bone health, and cancer-related menopause, and what women in each group need to know.
• An important message about vaginal oestrogen.
What You Will Learn
• Why do doctors disagree so much about menopause and HRT?
• How do I know whether information about menopause online is reliable?
• What is the difference between perimenopause and menopause?
• Do I need a blood test to confirm I am in perimenopause or menopause?
• Should I be monitoring my hormone levels while I am on HRT?
• What is continuous hormone monitoring and is it useful for managing perimenopause?
• Can the contraceptive pill be used to manage perimenopause symptoms?
• What is the difference between the pill and HRT in terms of how they work and their risk profiles?
• Can I take progesterone if I have had a hysterectomy?
• What does testosterone do for women beyond libido?
• Should my testosterone be tested before I start treatment?
• Does HRT protect against cardiovascular disease?
• Does HRT prevent or increase the risk of dementia?
• Is it too late to start HRT if I am in my 60s or 70s?
• Can women with a history of cancer use vaginal oestrogen?
• Should everyone be on HRT for longevity?
Key Takeaways
• Treat symptoms, not numbers. After 45, a symptom-based approach to diagnosing and managing menopause is more reliable than blood testing; hormone levels fluctuate too much to be meaningful on any given day.
• There is no one-size-fits-all. Whether it is the type of HRT, the route of delivery, or the decision to add testosterone or progesterone, good menopause management is always individualised, and it should always involve honest discussion about the evidence and the gaps in it.
• Timing matters for some of the bigger benefits. The potential cardiovascular and possibly cognitive benefits of HRT are most likely to apply if you start within the first ten years of menopause.
• Lifestyle remains non-negotiable. Across cardiovascular disease, dementia, and bone health, the evidence for lifestyle; exercise, diet, not smoking, is stronger and more consistent than the evidence for any hormone intervention. HRT can be part of the picture but it is not the whole picture.
Further Resources and Support
Menopause Information and Guidance
• The Menopause Society (NAMS) — North American professional body for evidence-based menopause guidance.
• The British Menopause Society — Professional and patient resources on menopause management and HRT.
• International Menopause Society — Global clinical and research resources on menopause.
• NICE – Menopause: Diagnosis and Management — UK clinical guideline used as the reference standard in this episode.
Bone Health
• International Osteoporosis Foundation — Patient-facing resources on bone health, DEXA scanning, and fracture prevention.
• Royal Osteoporosis Society — UK charity with helpline support and information on osteopenia and osteoporosis.
Premature and Early Menopause
• Daisy Network — UK charity providing support and information for women with premature ovarian insufficiency.
• Premature Ovarian Insufficiency Support — International peer support network for women experiencing early menopause.
Cancer-Related Menopause
• Macmillan Cancer Support – Menopause and Cancer — Information on menopause triggered by cancer treatment and what support is available.
• Ovacome — Support organisation for women affected by ovarian cancer, including those experiencing surgical menopause.
General Women's Health
• Jean Hailes for Women's Health — Evidence-based women's health information across the lifespan, with a strong menopause section.
• Menopause Charity — Patient-led charity offering education, resources, and advocacy around menopause.
Disclaimer: This podcast is for informational and educational purposes only and does not constitute medical advice. The views expressed are those of the host and guest and do not replace individualised clinical assessment. Always consult a qualified healthcare professional before making any changes to your health management.
