Hormone Replacement Therapy (HRT):

What is HRT? Hormone Replacement Therapy (HRT) is the use of medications containing female hormones to replace the ones the body stops producing during perimenopause or menopause.

Primary Hormones in HRT:

  • Estrogen – main hormone lost in menopause; helps with hot flashes, sleep, skin, brain, bones
  • Progesterone – used if you have a uterus to protect against endometrial cancer
  • Testosterone (sometimes) – helps libido, energy, mood

Why Consider HRT? HRT may reduce or eliminate:

  • Hot flashes and night sweats
  • Brain fog and memory issues
  • Mood swings, anxiety, or low mood
  • Vaginal dryness and painful sex
  • Sleep disruption
  • Loss of libido
  • Bone density loss
  • Skin thinning and dry eyes

Types of HRT

  • Systemic HRT
  • Pill, patch, gel, spray, or injections
  • Affects the whole body
  • Local (Vaginal) Estrogen
  • Cream, tablet, or ring
  • Targets dryness, irritation, painful sex—very low dose
  • Body-Identical (Bioidentical) HRT
  • Hormones chemically identical to what your body makes
  • Can be prescribed (e.g., estrogen gel + micronized progesterone) Note: Custom “compounded” HRT from wellness clinics is different from regulated body-identical HRT. Always check quality and regulation.

Risks (and How to Understand Them) HRT got a bad reputation after early 2000s studies—but more recent research shows that benefits outweigh the risks for most healthy women under 60 or within 10 years of menopause. Potential risks:

  • Slight increased risk of breast cancer (mainly with long-term combined HRT)
  • Small risk of blood clots or stroke (especially with oral estrogen)
  • Not typically recommended if you’ve had breast cancer, certain clots, or liver disease Risk is lower when:
  • You use transdermal estrogen (gel, patch, spray)
  • You start before age 60 or within 10 years of menopause
  • You’re at a healthy weight and don’t smoke

Who Should Not Use HRT?

  • History of hormone-sensitive cancer (e.g. breast cancer)
  • Active or recent blood clots
  • Liver disease
  • Unexplained vaginal bleeding You may still be eligible for non-hormonal treatments to ease symptoms.

What to Ask Your Doctor

  • What kind of HRT is best for my body and risk profile?
  • Do I need progesterone?
  • Will this help my libido/mood/sleep/brain fog?
  • How will you monitor me on HRT?
  • Can I use local estrogen only?
  • Are the hormones regulated and body-identical?

When to Start (and Stop)?

  • Best results when started during perimenopause or early menopause (within 10 years)
  • There’s no “forced stop” age—some women stay on it safely for decades under supervision
  • Can be tapered off slowly later in life, if desired

HRT Alternatives (If You Can’t Take It)

  • SSRIs or SNRIs (for hot flashes and mood)
  • Gabapentin or clonidine (non-hormonal options for vasomotor symptoms)
  • Herbs & supplements: Black cohosh, red clover, maca root (use with caution—variable quality)
  • Vaginal moisturizers (e.g., Replens, hyaluronic acid gel)
  • Lifestyle: Stress reduction, sleep hygiene, strength training, omega-3s