What is HRT? Hormone replacement therapy is prescription treatment that supplies estrogen, usually with a progestin, to relieve the symptoms of menopause and perimenopause. It is the most effective treatment for hot flashes and night sweats, and it also treats vaginal dryness and helps protect bone. It is not right for everyone, and the type, form and dose are chosen with a clinician.
What is HRT used for?
Around menopause the ovaries make much less estrogen and progesterone. MedlinePlus, from the U.S. National Library of Medicine, lists the symptoms this can cause: hot flashes, night sweats, mood changes, vaginal dryness and pain during sex.
The American College of Obstetricians and Gynecologists (ACOG) describes what HRT does for them:
- systemic estrogen “has been shown to be the best treatment for hot flashes and night sweats”;
- systemic and local estrogen both relieve vaginal dryness;
- systemic estrogen protects against the bone loss that occurs early in menopause.
Doctors now often call it menopausal hormone therapy, or simply hormone therapy. The terms mean the same thing. If you are unsure whether your symptoms fit, see our guide to the symptoms of low estrogen.
Types of HRT
ACOG describes two types, depending on whether you take one hormone or two.
Estrogen only
Estrogen is the main hormone in HRT. Estrogen on its own is generally for women who have had a hysterectomy.
Estrogen plus progestin (combination therapy)
If you still have a uterus, you also need a progestin. Estrogen alone causes the lining of the uterus to thicken, which raises the risk of uterine cancer. Adding progestin reduces that risk. This is called combined hormone therapy or hormone combination therapy.
Combined therapy can be taken in two ways:
- continuous-combined: estrogen and progestin every day;
- cyclic: estrogen every day, with progestin added for 10 to 14 days each month.
What about testosterone?
Testosterone is sometimes added to HRT for women. The Endocrine Society notes that there is no approved testosterone product dosed for women in the United States. Testosterone therapy for men is a separate treatment with its own criteria, covered in our guide to the symptoms of low testosterone.
Systemic and local HRT
How the hormone is given matters as much as which hormone it is.
- Systemic therapy releases estrogen into the bloodstream. It comes as pills, skin patches, gels and sprays, and it is what treats hot flashes and night sweats.
- Local therapy is a vaginal ring, tablet or cream that releases a small dose into the vaginal tissue. It is used when vaginal dryness is the only symptom. The Menopause Society notes that very little reaches the bloodstream, so the risks are far lower.
Who should not take HRT?
ACOG says systemic hormone therapy is usually not recommended if you have ever had:
- breast or endometrial cancer;
- a stroke or heart attack;
- blood clots;
- liver disease.
It is also not for use in pregnancy, and MedlinePlus adds unexplained vaginal bleeding to the list. Our post Is HRT safe? covers the risks and benefits in detail.
Side effects of HRT
ACOG lists these possible side effects:
- vaginal spotting or bleeding, which usually stops within six months;
- temporary breast soreness;
- bloating;
- headaches.
The Menopause Society says hormone therapy is not associated with weight gain, and that lowering the dose or changing the form can reduce side effects.
When to start and how long to take it
The Menopause Society says that, for most women, hormone therapy helps control moderate to severe symptoms when started within 10 years of menopause or before age 60.
There is no fixed end date. ACOG advises reviewing the decision with your clinician every year, based on your symptoms, risks and benefits. The FDA advises using hormone therapy at the lowest dose that helps.
Bioidentical hormones
“Bioidentical” means a hormone with the same structure as the one your body makes. Many FDA-approved HRT products are bioidentical. Custom-compounded versions are a different matter, and the FDA and professional societies recommend approved products over them. See our guide to bioidentical hormone therapy.
Alternatives to HRT
ACOG lists options for women who cannot or prefer not to take hormones:
- over-the-counter vaginal moisturizers and lubricants;
- non-hormonal prescription medicines for hot flashes, including certain antidepressants, gabapentin and clonidine;
- medicines for pain during sex.
It also cautions that few plant and herbal supplements have been studied for safety or effectiveness.
Frequently asked questions
What is HRT in simple terms?
It is prescribed estrogen, usually with a progestin, taken to relieve menopause symptoms such as hot flashes and vaginal dryness.
What is the difference between HRT and hormone combination therapy?
Combination therapy is one type of HRT. It means estrogen plus a progestin, which is needed if you still have a uterus.
Do I need blood tests before starting?
Your clinician decides based on your history and symptoms. Our post on labs for hormone therapy explains what may be checked.
Next step
You can read about hormone therapy at Beauté Medical Aesthetics, or book a consultation to discuss your symptoms and options.
Pregnenolone, a hormone that is also sold as a supplement, is a separate subject. See what pregnenolone is and what the evidence says.
Sources
- American College of Obstetricians and Gynecologists. Hormone Therapy for Menopause. Patient FAQ.
- The Menopause Society. Menopause Topics: Hormone Therapy.
- MedlinePlus, U.S. National Library of Medicine. Hormone Therapy for Menopause.
- U.S. Food and Drug Administration, Office of Women’s Health. Menopause.
- Endocrine Society. Compounded Bioidentical Hormone Therapy. Position statement, 2019.
Double Board Certified Nurse Practitioner
Beauté Medical Aesthetics
