A conversation with the gynecologist and hormone expert Dr. Kirstin Golombeck-Banse about myths, risks, opportunities—and the question of who today might benefit from hormone therapy.
In 2002, hormone therapy (HRT) got a big stop sign. The message that stuck with millions of women: hormones increase the risk of breast cancer. More than 20 years later, that fear still has an effect. Yet today we know much more about preparations, dosages, routes of administration, and the right timing. So: what’s myth, what’s risk—and when can HRT actually make sense?
Hormones are probably one of the few medications where the word alone is enough to trigger a fundamental debate. Some are afraid of them. Others now celebrate HRT almost as a longevity tool. In between are women with sleep disturbances, hot flashes, brain fog, or mood swings who ask above all one thing: what is actually true?
Dr. Kirstin Golombeck-Banse, a specialist in gynecology with a focus on gynecological endocrinology, encounters this uncertainty every day. Her most important message: hormone therapy is neither devil’s work nor a miracle cure. It is medicine. And good medicine is individual.
The stop sign from 2002 and why it’s still up
Hormone therapy’s bad reputation has a very concrete origin: the Women’s Health Initiative, or WHI. In 2002, part of this large U.S. study was stopped early after an increased risk of breast cancer was observed under a specific combination of hormones.
The headline was quickly written. The differentiation came much more slowly.
“Studies are important, but studies should always be evaluated in the overall context of all information,” says Dr. med. Kirstin Golombeck-Banse. Because what was studied back then included, among other things, conjugated estrogens and certain progestins—and many participants were significantly older than women who today typically start HRT for menopausal symptoms.
What also often got lost: in another arm of the same WHI study, women without a uterus who received estrogen alone had a different risk profile.
So a complex body of evidence was turned into a very simple message: hormones are dangerous.
And that stop sign is still hanging in many heads today.
Hormones are not all the same
This is probably the most important sentence of the whole topic: there is no such thing as the one hormone therapy.
Estrogen can be swallowed or given through the skin, for example as a gel, spray, or patch. Progesterone can be used orally or vaginally. There are different active ingredients, dosages, and combinations.
Dr. med. Kirstin Golombeck-Banse puts it succinctly: “Not every woman is the same. And not every hormone therapy is the same.”
Today, estrogen is often used transdermally, i.e., through the skin. The advantage: it bypasses the liver. In Dr. Kirstin Golombeck-Banse’s assessment, this makes the risk of thrombosis and thromboembolism lower than with oral intake of estrogen.
If a woman still has her uterus and takes systemic estrogen, she generally also needs a progestogen to protect the endometrium. Body‑identical, or bioidentical, progesterone is often used.
Sounds complicated? In the details, it is. But that’s precisely why the blanket question “Are hormones dangerous?” is about as helpful as “Are medications dangerous?”
Which hormones? How administered? At what dose? In which woman?
Only then does a fear question become a medically meaningful question.
What happens hormonally in menopause?
- Perimenopause: progesterone drops first → poorer sleep, inner restlessness
- Estrogen fluctuates, later low → hot flashes, brain fog, vaginal dryness, skin/bone changes
- FSH/LH rise, the cycle becomes irregular, ovulations less frequent
- Noticeable in everyday life: waking at night, mood swings, dips in performance, weight around the belly
- Note: symptoms are real—and treatable. Options range from lifestyle to HRT
Questions you can take to your doctor’s appointment
- Which of my complaints could be hormone‑related?
- Which other causes should be ruled out?
- Which form of HRT would in principle be an option for me?
- Which personal risk factors play a role for me?
- What are the advantages and disadvantages of transdermal versus oral use?
- Do I need progesterone?
- How will it be checked whether the therapy works and continues to be right for me?
And what about breast cancer?
This is where it gets emotional. Understandably. Especially women with cases of breast cancer in the family often ask: am I taking on an additional risk with hormones?
Dr. Kirstin Golombeck-Banse also warns here against simple answers. Breast cancer is multifactorial. Genetics can play a role, as can age, body weight, alcohol, smoking, and other individual factors. Decisive, therefore, is not only HRT but the personal overall picture.
“That’s why you can never say: hormones are the risk for breast cancer. That is not true,” she says. That does not mean downplaying risks. On the contrary. It means classifying them sensibly.
Was there breast cancer in the family? Is there a genetic predisposition? Were there thromboses or embolisms? What other conditions are present? Which preparations are to be used?
Risk is not a gut feeling. Risk is something that must be assessed individually.
And precisely this individual assessment is far more helpful than a blanket yes or no.
Menopause is more than being a little hot
For decades, many women learned: menopause means a few hot flashes. You put up with it. Eventually it’s over.
Unfortunately, the female body is under no obligation to stick to this short version.
The hormonal remodeling can affect sleep, mood, concentration, and well‑being. Some women have severe hot flashes, others brain fog, massive sleep problems, or mood swings. Still others pass through this phase almost without symptoms.
That’s also why Dr. Kirstin Golombeck-Banse emphasizes: no woman has to take hormones.
HRT is not a mandatory therapy for all women over 45. And it should also not be prescribed on the principle of: “Take this, it’s good for the bones.”
But the opposite position is just as problematic: simply enduring symptoms because menopause is part of life.
If a woman is suffering, she should receive help. That can be hormone therapy. But other medical or non‑hormonal strategies can also make sense.
The crucial point is: enduring is not therapy.
I still have my period — can it already be perimenopause?
Yes. And this is exactly where the big confusion begins for many women.
Because menopause does not begin only with the last menstrual bleeding. Hormonal changes can start years earlier. Golombeck-Banse describes that progesterone often drops earlier. Women in their early or mid‑40s can therefore already suffer from sleep disturbances, mood swings, or other changes—even though they continue to menstruate.
A typical question from her practice is: “I’m only 43 or 44. Can it really already be happening?” It can.
And this knowledge is more important than it may first sound. Because women who can categorize their symptoms are less likely to consider themselves suddenly unfocused, irritable, or exhausted.
Not everything is menopause. But menopause is also not only a topic once the period has disappeared for good.
When can HRT be useful?
The answer is less spectacular than some social‑media debate: when a woman has relevant symptoms and, after medical clarification, the benefits and risks speak in favor of it for her personally.
That can be severe hot flashes, sleep disturbances, mood swings, or other symptoms associated with hormonal change.
But Dr. Kirstin Golombeck-Banse makes an important point: not every symptom is automatically hormonal.
Sweating can also have other causes. So can exhaustion. Thyroid disease, diabetes, stress, or other health problems can cause similar symptoms. That’s why diagnostics come before therapy.
Or, put a bit less medically: don’t blame everything on hormones. But please don’t reflexively ignore hormones either.
Is there a right time?
In the context of HRT, the term window of opportunity often comes up.
Dr. Kirstin Golombeck-Banse explains that it is currently often recommended to start systemic hormone therapy preferably within about ten years after the last menstrual period and preferably before age 60.
But she is equally clear: “The timing is not set in stone.”
It is guidance, not a countdown.
Women who consider HRT later can, together with their physician, check whether treatment makes sense for them. The later the start and the more complex the health situation, the more important the individual weighing becomes.
In short: there is a favorable time frame. But no HRT cut‑off at midnight on your 60th birthday.
What should be clarified beforehand?
If you are now imagining a hormone check with 47 lab values, you can relax.
Dr. Kirstin Golombeck-Banse describes the basic diagnostics as comparatively pragmatic. These include up‑to‑date gynecologic screening, breast examination, history of family risks and pre‑existing conditions, and—by her recommendation—a gynecologic ultrasound of uterus and ovaries. Basic lab values such as liver and kidney function can also be useful.
Above all, it takes a sensible conversation.
Which complaints do you have? Since when? How severely do they impair you? Is there breast cancer in the family? Thromboses? Chronic conditions? Which medications are you taking?
Medicine here is bespoke, not off the rack.
And that is precisely why the decision should be made neither by an Instagram reel nor over dinner with friends. Both can inform. The decision should be made by a well‑informed woman together with medical expertise.
The real problem: who has time to talk about it?
At this point it gets interesting, because suddenly it’s not just about hormones but about our health‑care system.
Dr. Kirstin Golombeck-Banse explains that in a normal gynecology appointment there is often simply little time for in‑depth hormone counseling. Medical care is strongly oriented toward screening. That is right and important. It’s just that the questions of a 46‑year‑old woman who hasn’t slept in months, barely recognizes herself, and wants to know whether that could be hormonally driven, fit poorly into seven or eight minutes.
And this is exactly where many women experience frustration.
They get a “That’s normal.” Or a “You’ll have to get through it.” Or a quick no to HRT.
Dr. Kirstin Golombek-Banse’s recommendation is therefore clear: if you don’t feel your symptoms are being taken seriously, keep at it. Ask for the reasoning. Go back and talk again. And if necessary, get a second opinion. A no without an explanation is not good counseling yet.
HRT is neither poison nor a fountain of youth
Perhaps that is the most important insight from the whole debate.
We like to make medical topics radically simple. First it was: hormones are dangerous. Today it sometimes sounds almost as if every woman must take HRT to remain healthy, young, and high‑performing.
Both are too simple.
Hormone therapy is a medical treatment with opportunities and risks. It can significantly improve quality of life for some women. For others, it is not necessary or not the right solution.
The relevant question is therefore no longer: Hormones—yes or no?
Rather: Which woman, which complaints, which risks, which preparation, which timing—and with which goal?
That is more complicated than a stop sign.
But far more helpful.
And perhaps that is precisely the progress: not talking less seriously about risks. But talking better.
Be the CEO of your body. Not the doctor of your body—that’s what specialists are for. But the woman who asks questions, demands information, and co‑decides.
About Dr. Kirstin Golombeck-Banse
Dr. Kirstin Golombeck-Banse is a gynecologist specializing in reproductive endocrinology and women’s health, as well as a physician-psychotherapist. In her mentoring work, she combines sound hormone medicine with psychological depth. She looks at each person individually rather than promising one-size-fits-all solutions, and she translates complex knowledge so that women can make clear, practical, everyday decisions about their health. You can find her on LinkedIn.
Three things Dr. Kirstin Golombeck-Banse advises women from their mid‑40s
This article is based on the Belle&Yell interview with Dr. Kirstin Golombeck-Banse, a specialist in gynecology with a focus on gynecological endocrinology. It serves for information and does not replace individual medical advice.
Take changes seriously
If sleep, mood, hot flashes, or other complaints are affecting your life, you don’t have to play them down.
Get examined properly
Screening, medical history, and clinical evaluation are part of the process before deciding on HRT.
Get a second opinion if necessary
You don’t have to take hormones. But you are entitled to know your options and to make an informed decision.