“Menopause has the worst P.R. campaign in the history of the universe, because it’s not just hot flashes and night sweats,” says Rachel Rubin, a sexual-health expert and assistant clinical professor in urology at Georgetown University. Menopausal symptoms are more varied, and can be more debilitating, than many people know. During the transition to menopause, women may also experience sleeplessness, mood changes, depression, weight gain, joint pain, vaginal dryness and pain during sex, among other symptoms. Bone loss accelerates. In women who have a genetic risk for Alzheimer’s disease, the first plaques are thought to form in the brain around this time.

There has long been an effective, F.D.A.-approved treatment for several of these symptoms, known as menopausal hormone therapy, but because of fear and misinformation, too few women have a clear picture of its risks and benefits. The New York Times Magazine’s cover story this week examines hormone therapy and menopause, unpacking what the research really tells us.

Hormone therapy eases several menopausal symptoms and has some additional health benefits.

Hormone therapy has been shown to ease hot flashes and sleep disruption, and there is some evidence that it helps with depression and aching joints. It also helps prevent and treat menopausal genitourinary syndrome, a collection of symptoms, including urinary-tract infections and pain during sex, that affect nearly half of postmenopausal women. It decreases the risk of diabetes and protects against osteoporosis. Because of the health risks associated with hormone therapy, it is recommended for women who have “bothersome” hot flashes and certain other menopausal symptoms, not for preventive care.

Hormone therapy carries health risks that vary by age.

The age at which a woman begins hormone therapy is important for assessing her increased risk of heart disease, stroke and dementia.

For women who go through early menopause, before age 45, hormone therapy is recommended because they’re at greater risk for osteoporosis if they don’t receive hormones up to the typical age of menopause. For healthy women in their 50s, the increased risks from hormone therapy are considered low. There are greater risks for women who start hormone therapy after age 60. No definitive research has yet followed women who start in their 50s and stay on continuously into their 60s.

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