When hormone treatment comes up, the conversation often focuses on its possible risks. But there is an equally important question that does not always get the same attention: what are the risks of not treating hormone changes at all?

For many women, low hormone levels during perimenopause and menopause mean far more than hot flushes. They can influence mood, sleep, concentration, relationships, sexual health, confidence and long-term physical health. Today, the evidence is clear that body identical hormones, prescribed at the right dose, are safe for most women. The question of whether not to treat deserves the same careful consideration as the question of whether to treat.

Untreated symptoms can affect every part of life

For some women, symptoms of perimenopause and menopause are manageable. For many others, they are significantly disruptive. Hot flushes, night sweats, poor sleep, brain fog, anxiety, low mood, palpitations, joint pain, fatigue and vaginal dryness can individually be difficult. Collectively, they can make it very hard to function well or feel like yourself.

When symptoms are left untreated, they do not simply fade with time. Hormones affect the whole body, and if estrogen, progesterone or testosterone levels fall and stay low, symptoms can continue for years. Untreated, that means ongoing discomfort, persistent poor sleep and a reduced quality of life that many women have been led to believe is simply part of getting older. It is not.

The effect on mental health

Estrogen plays a significant role in brain chemistry. As levels fall and fluctuate, many women notice changes in mood. This includes anxiety, tearfulness, irritability, low confidence and a sense of feeling overwhelmed. These are not imagined or exaggerated. They are a recognised consequence of hormonal change.

Our research has highlighted that identifying hormone-related mood symptoms, and considering hormone treatment where appropriate, can help some women avoid unnecessary long-term use of antidepressants when hormones are the underlying cause. Yet many women are still prescribed antidepressants first, without a proper exploration of whether hormones are at the root of their symptoms.

The consequences of leaving mental health symptoms untreated can be serious. Research shows that some women develop increasingly difficult coping strategies when symptoms go unaddressed. Around one in three women report drinking more alcohol during menopause, and 15% drink in excess of recommended guidelines. That is not a moral observation – it is evidence of unmet needs on a significant scale.

Work, relationships and everyday life

Hormone symptoms do not stay contained within a health context. They spill into everything. Unmanaged menopause symptoms have been linked to reduced productivity, increased sickness absence, changes in working patterns and, for some women, early retirement. If you are exhausted from broken sleep, struggling to think clearly or feeling unlike yourself, the effects on work are a predictable consequence, not a personal failing.

Relationships can feel the strain too. Changes in mood, reduced libido, vaginal dryness and discomfort during sex can all create distance or frustration between partners. When symptoms are properly treated, women frequently describe feeling more comfortable, more connected and more recognisably themselves. That matters. Both for women, and for the people around them.

Longer-term health consequences

Estrogen has protective effects across the body: on bones, the cardiovascular system, the brain and the genitourinary system. When hormone levels remain low for an extended period, these protections are lost. That can translate into increased risk of osteoporosis, heart disease, cognitive decline and other conditions over time.

This is particularly significant for women with early menopause or premature ovarian insufficiency, where hormone loss happens earlier than expected and the window for long-term consequences is longer. But the principle applies more broadly: symptoms are often a signal of wider hormonal change, not something to dismiss or endure.

Why so many women still go untreated

Despite experts like NICE recommending hormone treatment as a first-line option for menopause symptoms, only around 15% of menopausal women in the UK currently use it. In some areas the figure is even lower. Many women are not offered it. Others are told their symptoms are normal, or are given treatments that do not address the underlying cause.

Dr Louise Newson is unequivocal: women have options, and they can advocate for themselves. Being dismissed does not mean your symptoms are not real. It may mean you need more informed care with a different clinician, a referral, or simply better information to take into an appointment.

Taking stock

The risks of not using hormone treatment are real, and for too long they have been secondary to a conversation dominated by the risks of using it. For many women, untreated hormone changes affect mental health, physical health, relationships, work and quality of life in ways that compound over time.

If you are struggling, the question is not whether your symptoms are bad enough to treat. It is whether you have been given the information you need to make an informed decision. Track your symptoms, understand your options, and speak to a doctor who will take the whole picture seriously.