Menopause and its precursor—perimenopause—are phases every woman experiences, and the hormonal shifts can have wide-ranging effects: hot flashes, mood swings, sleep disruptions, changes in bone density, and even risks for cardiovascular health.
Hormone Therapy for Women, often called Hormone Replacement Therapy (HRT), is a treatment approach designed to reduce symptoms and protect long-term health. But like any medical intervention, it has trade-offs.
This guide will walk you through what HRT is, how it works (including bioidentical options), its benefits and risks, and what to expect if you decide to explore hormone therapy.
Our team at Curativ offers a full range of wellness services so you can care for every aspect of your health in one place. With personalized plans, regular check-ins, and seamless guidance, we help you stay balanced, feel your best, and explore all the treatments that support your long-term well-being.
What Is Hormone Therapy (HRT)?
Hormone Replacement Therapy, or HRT, is a treatment that helps replace or supplement hormones—mainly estrogen and progesterone, and sometimes a small amount of testosterone—that naturally decline as women approach and go through menopause.
This hormonal shift usually begins during perimenopause, the transition leading up to menopause when estrogen levels start to rise and fall unpredictably.
Menopause itself is officially reached once it’s been 12 months since a woman’s last period, a stage when the ovaries produce far less estrogen and progesterone.
HRT works to rebalance these hormones, easing symptoms like hot flashes, night sweats, mood changes, and vaginal dryness. Beyond symptom relief, it may also help protect against some of the longer-term effects of low hormone levels, such as bone loss and changes in heart health.
Who is HRT For?
- Women in perimenopause or menopause (specially when menopause has been stablished less than 10 years ago) .
- Have moderate to severe symptoms (hot flashes, sleep disruption, vaginal symptoms) affecting quality of life
- Are found via screening to have no high risk for hormone-sensitive cancers, thrombosis, or cardiovascular disease
- Wish to prevent bone loss due to early menopause or osteopenia/osteoporosis
- Women in perimenopause and menopause, even those without noticeable symptoms, can gain multiple benefits from supporting brain, cardiovascular, bladder, bone, and muscle health.
How Hormone Therapy Works
Hormone Therapy is designed to replace the hormones—mainly estrogen and sometimes progesterone—that naturally decline during perimenopause and menopause.
When these hormone levels drop, it can trigger a wide range of changes:
- Hot flashes
- Night sweats
- Mood swings
- Sleep disturbances
- Skin changes
- Hair loss
- Weight gain
- Fatigue
- Vaginal dryness
- Gastrointestinal symptomS
- Bone loss
By gently restoring hormones to healthier levels, HRT helps the body regain balance and ease many of these symptoms.
Estrogen is usually the centerpiece of treatment. It works to cool hot flashes, protect bones from thinning, improve vaginal and urinary health, and even support better sleep and mood.
The goal isn’t to flood the body with hormones, but to carefully replace what’s missing. Whether it’s taken as a patch, pill, gel, or cream, HRT is tailored to each woman’s needs, with doses and methods adjusted to provide relief while keeping treatment as safe as possible.
Ways to Take HRT
- Oral tablets: Easy to take, but because they pass through the liver first, they may carry a slightly higher risk of blood clots or cardiovascular issues
- Patches, gels, or sprays: Absorbed through the skin, these bypass the liver and usually keep hormone levels steadier, which may lower clot risk.
- Vaginal creams, rings, or tablets: Designed to treat local issues like dryness, discomfort, or urinary urgency with very little hormone entering the bloodstream.
- Implants (pellets): Small pellets placed under the skin that slowly release hormones over several months, though this option is less common.
Types of Hormone Therapy for Women
Hormone replacement therapy (HRT) can be broadly divided into two main types: synthetic and bioidentical hormones.
Synthetic Hormones
Synthetic hormones are made from chemical compounds and do not share the same molecular structure as the body’s natural hormones. Because of this, the body must metabolize them into an active form once administered.
Bioidentical Hormones
Bioidentical hormones are derived from natural, mostly plant-based sources and are molecularly identical to the hormones produced in the human body.
There are two types of bioidentical hormones:
- FDA-approved bioidentical hormones: Manufactured by pharmaceutical companies under strict regulations. They are standardized medications with fixed doses and formulations.
- Compounded bioidentical hormones: Custom-made in specialized pharmacies, allowing healthcare providers to personalize doses, combinations, and delivery methods according to each patient’s needs. However, because these formulations vary, they are less strictly regulated than FDA-approved versions.
Delivery Systems for Hormone Therapy
Estrogen
Estrogen replacement therapy can be systemic or local, depending on the symptoms and treatment goals.
Systemic estrogen
Absorbed into the bloodstream through capsules, patches, gels, sprays, vaginal rings, or injections. These forms relieve whole-body symptoms but can carry a higher risk of side effects.
- FDA-approved options: capsules, patches, gels, sprays, vaginal rings, and injections.
- Compounded options: creams, buccal tablets (absorbed through the gums), and pellets (tiny implants inserted under the skin every 4–5 months).
Local estrogen
Primarily used to relieve vaginal dryness, urinary discomfort, and atrophy. These forms act directly on local tissues and carry less systemic risk.
Available as creams, vaginal rings, or suppositories — both compounded and FDA-approved.
Progesterone
Progesterone plays a crucial role in HRT for women in peri- and postmenopause.
- For women with a uterus, progesterone must be combined with estrogen to prevent the endometrial thickening caused by estrogen alone.
- It also helps relieve hot flashes, mood swings, headaches, vaginal dryness, and night sweats.
- Even women without a uterus may benefit from progesterone, as it has been shown to improve sleep quality.
Available forms include:
- Oral: micronized progesterone (bioidentical and FDA-approved) or synthetic progestins (often used with estrogens).
- Other options: creams, patches, vaginal gels, injections, or IUDs (intrauterine devices).
Testosterone
Currently, there are no FDA-approved testosterone formulations for women, as existing products are dosed for men. However, compounded testosterone can be prescribed in low, customized doses to support sexual function, muscle tone, bone health, and energy levels during menopause.
Delivery methods include:
- Creams
- Pellets (small implants inserted under the skin every few months)
Hormone Therapy Benefits
Menopause happens to every woman, but the symptoms can be tough to handle. Hot flashes, sleepless nights, and mood swings can make daily life harder.
Hormone replacement therapy (HRT) can help reduce these problems and protect your health when used with a doctor’s guidance.
Cooling Hot Flashes and Night Sweats
Sudden heat or waking up sweaty is one of the most common menopause issues. Estrogen is one of the best ways to make these flashes less frequent and less intense. Some women also take progesterone to keep hormones more balanced.
Better Sleep and Moods
When hormones are steadier, sleep often improves. Many women say they fall asleep faster, wake up less, and feel more rested in the morning. Better sleep can also mean fewer mood swings and more energy during the day.
Vaginal and Urinary Comfort
Dryness, irritation, or a sudden need to pee can show up after menopause. A small amount of estrogen applied locally—like a cream, tablet, or ring—can hydrate tissues, ease discomfort during sex, and reduce urinary problems.
Stronger Bones
After menopause, bones can lose density quickly, raising the risk of osteoporosis. HRT slows bone loss, helping bones stay stronger and lowering the chance of fractures.
Support for Heart and Metabolism
Starting hormone therapy around the time menopause begins may help cholesterol levels and overall heart health. Results vary from person to person, so it’s important to talk with a healthcare provider.
Other Small Benefits
Some women notice softer skin, steadier energy, and an overall lift in well-being. Early research is also looking at possible memory benefits, but the science is still ongoing.
Common Symptoms of Perimenopause & Menopause
To understand what HRT is aiming to relieve, it helps to recognize the range of symptoms many women face. These include:
- Hot flashes and night sweats
- Sleep disturbances (insomnia, waking frequently)
- Vaginal dryness, thinning of genital tissues
- Reduced libido or sexual discomfort
- Mood swings, irritability, anxiety, or depression
- Memory fog or difficulty concentrating
- Joint stiffness or pains
- Changes in body metabolism—weight gain, shifts in fat distribution
- Bone density loss (osteoporosis)
- Changes in lipid profile, risk of cardiovascular disease
Not everyone gets all these symptoms, and severity can vary widely.
Is Hormone Therapy Safe?
Hormone therapy can be a safe and effective way to ease menopause symptoms—when it’s personalized and monitored by a trusted healthcare provider. Studies show that for many healthy women, starting HRT before age 60 or within about 10 years of menopause offers strong symptom relief with a good safety record.
Key Things to Know
- Timing matters: Beginning treatment closer to the start of menopause is linked to fewer risks for heart disease, stroke, and blood clots than starting years later.
- Type and delivery: Lower-dose treatments and non-oral options—like skin patches, gels, or vaginal creams—tend to carry fewer risks than higher-dose pills.
- Your health history: Conditions such as breast cancer, a history of blood clots, or heart problems play a big role in deciding if HRT is the right choice for you.
Working with a knowledgeable provider ensures you get the right plan for your body, the right dose, and regular check-ins to keep therapy safe and effective.
Risks & Side Effects of Hormone Therapy
No treatment is risk-free. The decision to use HRT should be made in consultation with a healthcare provider, taking into account individual risk factors. Some risks and side effects include:
- Breast tenderness, swelling
- Bloating, fluid retention
- Spotting or breakthrough bleeding (especially with combined regimens)
- Increased risk of certain cancers: particularly breast cancer, and possibly ovarian cancer in some regimens
- Increased risk of blood clots, especially with oral estrogen (higher risk in women who smoke or have clot risk factors)
- Possible increased risk of stroke, depending on dose, age, and method of delivery
- Gallbladder disease risk may increase
- Heart disease risk is nuanced—depends heavily on timing of initiation, health of blood vessels, individual risk profile
Who should avoid HRT?
- Those that currently had or have any type of cancer that is sensible to estrogen.
- History of blood clots (deep vein thrombosis, pulmonary embolism)
- Untreated or poorly controlled cardiovascular disease or stroke risk
- Liver disease
- Very late in menopause (>10-20 years past menopause onset), where risks may begin to outweigh benefits in some profiles
- Hypersensibility to any component of the HRT
- Possible or confirmed pregnancy
- Abnormal vaginal bleeding with no diagnoses
What to Expect from HRT
Starting hormone therapy is a process, but it’s not as intimidating as it might seem. Here’s how it usually goes.
Before You Start
First comes a chat with your doctor. They’ll ask about your symptoms, health history, and any family risks. You might have a checkup or a few basic tests so they can be sure HRT is a good fit and figure out the right dose.
Getting Started
If you decide to go ahead, you’ll begin with a low dose—pill, patch, gel, or cream—so your body can get used to it. Some changes, like fewer hot flashes or better sleep, can show up in a couple of weeks, but for others it might take a bit longer. Your doctor will usually check in after a month or two to see how you’re doing.
While You’re On It
Expect regular checkups, especially in the first year. These visits are just to make sure everything’s working as it should and to tweak the dose if you need it. They might check blood pressure or do simple blood work.
Down the Road
Once things are steady, you’ll only need a yearly review. Together with your doctor, you’ll decide whether to keep going, lower the dose, or stop. Some women stay on HRT for a few years, others longer.
The Bottom Line
Menopause is a nor mal part of life, but the symptoms don’t have to control how you feel every day. Hot flashes, mood swings, sleep changes, and bone loss can all be managed with the right plan—and hormone therapy is one of the most effective tools when used safely and under expert guidance.
By restoring balance, HRT can ease discomfort, protect long-term health, and help you enjoy this next stage of life with more energy and confidence.
At Curativ, we’re here to guide you through every step. Our team provides personalized hormone plans, regular check-ins, and ongoing support to make sure your treatment is safe and effective. With expert care and healthy lifestyle habits, you can navigate menopause with comfort, regain your sense of well-being, and feel like yourself again.