The Fast Facts
- Hormone replacement therapy (HRT), more accurately known as menopausal hormone therapy (MHT), may help some folx supplement estrogen and progesterone lost during menopause.
- The decline of hormones during menopause is what causes menopause symptoms.
- Several at-home tests are available with unique features. Everlywell Perimenopause Test and LetsGetChecked offer subscription-based hormone monitoring.
Menopause occurs when people assigned female at birth
These hormonal changes are associated with a variety of symptoms that can range from mild to severe. They commonly include hot flashes, night sweats, trouble sleeping, joint pain, mood changes, vaginal dryness, and pain during sex.
HRT — also called menopausal hormone therapy (MHT) — may help ease these symptoms by
MHT can be particularly helpful with hot flashes and night sweats, two of the most common symptoms associated with menopause. Certain HRT regimens are also approved to help prevent osteoporosis.
MHT can help treat a variety of symptoms commonly experienced during the three stages of menopause: perimenopause, menopause, and postmenopause. Each stage is associated with varying degrees of hormonal fluctuations and its own set of symptoms.
MHT can reduce the frequency and severity of these symptoms by helping to stabilize hormone levels. Estrogen, in particular, can be very effective at relieving hot flashes and improving sleep quality. Additionally, it can help prevent bone thinning (osteoporosis) that can occur due to lower estrogen levels.
It can also help maintain vaginal health and elasticity and may help improve sexual function. HRT may also help stabilize moods, reduce irritability, and improve skin texture and elasticity.
Its effectiveness may vary from person to person, though. You can talk with your healthcare professional to get an assessment of your symptoms, health history, and medications to see whether HRT could be a good option for you.
Stages of menopause:
Common symptoms*
Perimenopause
From after menstruation starts to around 40. Hot flashes, night sweats, mood swings, irregular periods
Menopause
Around ages 40 to 45. More intense hot flashes, vaginal dryness, sleep disturbances
Postmenopause
Around 50 and older. Symptoms may worsen; vaginal dryness, urinary incontinence, low libido
*Note that these are only some symptoms of the stages of menopause; symptoms can vary by individual and may include some not listed here.
Talk with a doctor
HRT is not suitable for everyone. While it can offer significant relief for many, it does come with potential risks for complications and serious side effects, particularly when used long-term. HRT is not recommended for people with certain health conditions, such as a history of breast cancer, blood clots, or liver disease.
It is essential to have a candid discussion with a doctor about the benefits and risks for complications before starting HRT. Your doctor can help determine whether this is the right option based on your personal health history and symptom severity. They may suggest alternative treatments if not.
Always follow up regularly with your prescriber to ensure the therapy is working as intended and to monitor for any side effects.
• book or change appointment
• prescription renewal
• unlimited messaging to care professional
• menopause-related content
• coaching support
• meditations
HRT vs. HT … what’s the difference?
Though the terms are often used interchangeably, hormone therapy (HT) and hormone replacement therapy (HRT) aren’t exactly the same.
HT broadly refers to the use of hormones as a medical treatment, including for
HRT is also commonly used to describe a form of gender-affirming care for transgender and nonbinary people. This is when regular doses of estrogen or testosterone are used to induce desired changes to secondary sex characteristics.
HRT has three major focuses: estrogen therapy, estrogen and progesterone therapy, and bioidentical hormone replacement therapy (BHRT).
It’s wise to discuss with a healthcare professional to determine the best treatment for your symptoms and preexisting conditions.
Estrogen therapy
- administered in various forms
- gel
- orally
- spray
- transdermal patch
- commonly used for managing menopause symptoms:
- hot flashes
- night sweats
- vaginal dryness
- oral estrogen may affect liver function and the chance of clotting, especially in smokers or immunocompromised folx
- transdermal options bypass the liver, which reduces clotting and liver-related side effects
Estrogen and progesterone therapy
- recommended for people with a uterus to prevent endometrial chances of cancer
- available in oral pills, patches, and intrauterine devices (IUDs)
- reduces menopausal symptoms while offering protection against endometrial cancer
- long-term use may increase the chances of blood clots, breast cancer, and stroke
Bioidentical hormone replacement therapy (BHRT)
- involves hormones identical to those naturally produced by the body
- lab-curated and sourced from plants like soy or yams
- available in
- creams
- gels
- pills
- FDA does not approve compounded BHRT due to concerns about safety, efficacy, and quality control
- compounded BHRT could lead to improper dosing, contamination, or inconsistent hormone levels
- consult a healthcare professional for FDA-approved options tested for effectiveness and safety
The choice between oral and transdermal estrogen depends on various factors like individual preferences, doctor recommendations, and health considerations.
Studies show that transdermal estrogen
These are two of the most common ways to administer MHT:
- Systemic hormone therapy administers hormones throughout the body to manage menopausal signs and symptoms using pills, patches, gels, or sprays, ideal for mental and physical symptom relief.
- Local hormone therapy targets specific areas like the vagina or urinary tract to relieve symptoms such as dryness, irritation, and bladder incontinence, delivered through creams, rings, or tablets.
The cost of MHT varies by type, dosage, method of delivery, and whether it’s branded or generic. When MHT is prescribed by a doctor for menopause symptom relief, most insurance providers will cover the cost of these treatments. Medicaid typically covers these treatments for symptoms of menopause.
Prescription MHT pills can cost anywhere between $130 to $240 per month without insurance. Most doctors’ offices and pharmacies — including online services — take insurance for MHT. With insurance, the average copay is $30.
- MHT helps manage moderate to severe menopausal symptoms in all stages
- effective for natural or surgically induced menopause (after total hysterectomy)
- those looking to prevent bone loss due to estrogen decrease.
- combination therapy for uterus protection
- estrogen-only for people without a uterus
Though MHT can provide relief for many symptoms of menopause, you must consider the
- people who smoke
- folx who have a history of certain cancers
- people with cardiovascular issues
BHRT vs. HRT
Bioidentical hormone replacement therapy (BHRT) is not FDA-approved, has limited evidence supporting its benefits over traditional HRT, and is not recommended by most doctors.
Hormone replacement therapy (HRT), on the other hand, is approved and regulated by the FDA. It is also recommended by leading medical authorities and has decades of research supporting its efficacy in easing menopause-related symptoms and preventing osteoporosis.
Pros
- effective at relieving common symptoms like hot flashes, night sweats, sleep problems, vaginal dryness, and mood swings
- is not considered safe if you have certain health conditions, including a
history of heart disease - increases the risk of uterine cancer if you still have your uterus and don’t also take progestin
Cons
- can increase
the risk of breast cancer (the chance increases the longer you take it) - is not considered safe if you have certain health conditions, including a
history of heart disease - increases the risk of uterine cancer if you still have your uterus and don’t also take progestin
MHT isn’t right for everyone, and it isn’t the only treatment for managing symptoms of menopause.
Alternative therapies include:
- cutting down on alcohol
- reducing caffeine intake
- getting regular exercise
- managing stress with techniques like:
- mindfulness meditation
- cognitive behavioral therapy (CBT)
Otherwise, there is no over-the-counter replacement for MHT. You can talk with a healthcare professional to tailor a plan that works for your body, your hormones, and your symptoms.
There is no minimum time requirement for MHT, though on average it is used for 2 to 5 years. Because the associated risk of complications increase over time, some doctors only prescribe it for a maximum of 5 years.
Yes, hormone therapy has been proven to be an effective treatment for easing many of the common symptoms associated with menopause.
Some doctors are cautious about prescribing MHT because of the increased risk of serious conditions like breast cancer and blood clots.
Though it is a common misconception that MHT causes weight gain, this has not been proven. Though research is limited, current available evidence has found that HRT may help reduce or prevent weight gain typically associated with aging.
Common signs of low estrogen include irregular periods, mood swings, hot flashes, breast tenderness, vaginal dryness, and pain during sex.
If you have not seen a reduction in menopause symptoms (reduced severity, frequency, or both) after 3 months of MHT, it may not be working and you should follow up with a doctor.
When MHT is prescribed by a doctor for menopause symptom relief, most insurance providers will cover the cost of these treatments. Medicaid typically covers these treatments for symptoms of menopause.
You can check with your insurance provider for the most accurate answer.
Hormone replacement therapy comes in two categories: transdermal or systemic, and within each category, options include gel, creams, patches, pills, or sprays. There are overarching types, including estrogen therapy, estrogen and progesterone therapy, and some Bioidentical hormone replacement therapy (BHRT) that are largely not FDA-approved.
Some lifestyle changes might also encourage estrogen production. Ultimately, it’s vital to collaborate with a physician to determine what’s right for you, especially if you smoke, have cardiovascular challenges, have had a hysterectomy, and consider other considerations.