Ultimate Guide to Hormone Replacement Therapy in Menopause

Age management
Jan Trobisch

Jan Trobisch

Ultimate Guide to Hormone Replacement Therapy

You’re blistering hot when everyone else says they’re freezing, you wake up in the middle of the night covered in sweat, you seem to lie awake at night more than you sleep, you have serious mood swings and you’re noticing your monthly visitor is acting a little strange. You can’t help but wonder if you’re heading for menopause.

Menopause, often referred to as “the change,” happens to all women as they age, generally in the late 40s and early 50s. It sets in when the ovaries stop producing estrogen. Your body slows the production of other reproductive hormones, such as progesterone, too. When these hormones aren’t present, menstruation ceases.

In addition to hot flashes, night sweats, disrupted sleep and irregular menstrual periods, other side effects can also occur during perimenopause and menopause:

  • Vaginal dryness
  • Weight gain
  • Slowed metabolism
  • Dry skin
  • Thinning hair
  • Brain fog
  • Mood swings
  • Decreased breast fullness

Some lucky women won’t experience any symptoms, other than less-frequent periods, and eventually, no period at all. However, many women do develop undesirable side effects, which can be debilitating and start years before menopause occurs (during perimenopause) and last long after this change of life is complete.

If you’re going through menopause, your doctor may have suggested hormone replacement therapy (HRT) as a way to help you cope with the symptoms. However, before agreeing, you likely have a lot of questions.

This guide to hormone replacement therapy answers a lot of your questions and arms you with information to decide if HRT is the right option for you. Here’s what to know about hormone replacement therapy in women.

What Is Hormone Replacement Therapy for Menopause?

What exactly is hormone replacement therapy for menopause? Essentially, it’s a form of treatment designed to supplement your body’s hormone levels. During perimenopause and menopause, your hormone levels, specifically estrogen and progesterone, significantly decrease. With HRT, the treatment replaces the hormones your body no longer produces.

What is Hormone Replacement Therapy

HRT involves two main types of hormones — estrogen and progestogen:

  • Estrogen, also known as oestrogen, is the primary female reproductive hormone. Before menopause, your ovaries produce this hormone. Estrogen is responsible for regulating the reproductive system, as well as other sexual characteristics unique to females.
  • Progestogen, a synthetic form of progesterone, is another sex hormone produced by the ovaries before menopause. It plays a crucial role in pregnancy, and it also regulates the menstrual cycle.

How does HRT work? Well, with hormone replacement therapy, you take both of these hormones or just estrogen. Most women take a combination of estrogen and progestogen.

Estrogen and progesterone do several things for the female body. Primarily, these hormones thicken the lining of the uterus, preparing it for the implantation of an egg. In other words, they largely assist in preparing your body for pregnancy. However, these female reproductive hormones also aid in processing calcium, promoting healthy cholesterol levels and boosting the health of the vagina.

When Is HRT Useful?

When the body stops producing estrogen and progesterone, as a result of menopause or removal of your ovaries, you can experience a variety of symptoms, including hot flashes, mood swings, sleep interruptions, night sweats and pain during intercourse. The primary goal of HRT is to reduce these and other menopausal symptoms.

Also, after menopause, women are at an increased risk of developing brittle bones and bone loss. Calcium processing is necessary for strong, healthy bones. Hormone replacement therapy can reduce the risk of developing osteoporosis.

You can begin hormone replacement therapy as soon as you start exhibiting signs of menopause. However, your doctor may not recommend HRT unless your side effects cause you discomfort or interrupt your life. Additionally, your physician will likely put you on the lowest dose possible if you both decide HRT therapy is right for you.  Typically, therapy stops after one to three years, the amount of time it usually takes menopausal side effects to withdraw but may be continued indefinitely.

How Long Does HRT Last

If you’re experiencing hot flashes, mood swings, night sweats, your sleep is interrupted or experience any other undesirable side effects, talk to your doctor to find out if HRT is an option you should consider.

Why You Should Consider HRT in Menopause

If you have developed menopausal symptoms, you’re probably wondering if HRT therapy is right for you.

To determine if HRT is an option you’d like to investigate, it’s helpful to know the benefits this treatment can provide. The advantages, as do the disadvantages, vary from woman to woman, and they are dependent on the type of HRT you’re taking.

Many women who’ve taken hormone replacement therapy report it successfully helps to ease the side effects of menopause. However, hormone replacement therapy is not for everyone.it’

Who Should Consider Hormone Replacement Therapy?

If you’re going through menopause and you’re experiencing moderate or severe side effects or osteoporosis runs in your family, HRT is something you might want to consider and work with your physician to determine if hormone replacement therapy can benefit you.

Women who use HRT can see positive results. Some of the most notable improvements include:

  • Balanced mood
  • Healthier sleep habits
  • Reduced hot flashes and night sweats
  • Better sex drive
  • Stronger and healthier bones
  • Increased muscle mass

Your medical history, the side effects you are experiencing and the type and amount of HRT you’re taking are some of the factors that will affect the results, which vary from person to person. When combined with proper nutrition, exercise and a balanced lifestyle, HRT can positively impact your body and your mind as you make the transition into menopause.

Who Shouldn’t Consider Hormone Replacement Therapy?

Who Should Get Hormone Replacement Therapy

Though HRT is effective for many women, it’s not suitable for everyone. If you’re pregnant or you’re thinking about becoming pregnant, you shouldn’t use hormone replacement therapy. Also, if you have a history of any of the following, HRT is not right for you:

  • Heart disease
  • Uncontrolled high blood pressure or hypertension
  • Blood clots
  • Stroke
  • Severe migraines
  • Breast, endometrial or ovarian cancer

If your menopause is symptomless, you’ll typically not a candidate for HRT.

Timeline of Hormone Replacement Therapy

HRT first became available in the 1940’s and became more broadly used in the 1960s. For years, hormone replacement therapy was the go-to treatment for women who were suffering menopausal symptoms. Doctors prescribed hormones to women who had side effects of “the change.”


In 2002, however, things changed when the Women’s Health Initiative (WHI) announced the results of an extensive HRT study.

This study, the first-ever long-term analysis of the effects of HRT on postmenopausal women, revealed that estrogen and combined estrogen and progestin HRT lead to an increased risk of heart disease, breast cancer, blood clots and stroke. As a result of these findings, panic set in, and the number of women using HRT dropped significantly.


In 2004, another WHI study confirmed that estrogen therapy leads to an increased risk of dementia and stroke, further lowering the number of women who used HRT.

In spite of this information, you shouldn’t write off HRT altogether. As experts delved deeper into the results of the WHI studies, they discovered the data wasn’t as extreme as it first appeared to be. Researchers noted the study included women who were more than a decade older than the average woman using HRT, which was likely the reason for the greater risk of adverse effects of this therapy. The risks highlighted in the WHI study were small.


In September 2017, researchers published a new report, which represented the longest follow-up of the original hormone therapy study and evaluated data from the Women’s Health Initiative. Led by Dr. JoAnn Manson at Brigham and Women’s Hospital, the discovery of the most recent study published in JAMA found that hormone therapy isn’t as risky of treatment for menopausal symptoms as once thought.

Risks of HRT

The study showed that menopausal hormone therapy given to patients for five to seven years had no association with risk of long-term mortality compared to those given a placebo.  The rates of death among women from any causes was similar for women receiving some hormone therapy and for those taking a placebo.

More than 27,000 women participated in the study and received either a placebo, estrogen or a combination of estrogen and progestin.

Are you confused? Don’t be! Here’s a rundown of hormone replacement therapy pros and cons for age management:

Pros of Hormone Replacement Therapy in Menopause

The advantages of HRT largely outweigh the risks for many women who begin using it younger than the age of 60.

HRT Menopause Symptom Relief

HRT may help to:

  • Reduce a multitude of moderate to severe menopausal symptoms, including hot flashes, night sweats, mood swings, sleep issues, brain fog and vaginal dryness.
  • Restore your energy and provide you with a more youthful appearance.
  • Reduce the risk of osteoporosis. However, it shouldn’t be used solely to prevent bone loss.
  • Prevent falls and improve balance.
  • Reduce your risk of developing coronary heart disease, as well as heart attack and heart failure, if you’re below the age of 60, you are healthy, and you have recently started menopause.
  • Protect you against cataracts and macular degeneration.
  • Reduce the risk of fractures in postmenopausal women because of the bone-strengthening it provides.
  • Offer protection against urinary tract infections and urinary incontinence.
  • Reduce your risk of colorectal cancer, specifically when taking a combination of estrogen and progesterone.
  • Impact collagen production positively and improve the elasticity, thickness and hydration of the skin. It may also help to improve the healing of skin wounds.
  • Reduce the long-term risk of dementia and Alzheimer’s disease.
  • Reduce the pain, as it eases the fluctuations of hormones, which causes migraines — if you’re experiencing this type of headache because of menopause.

The potential benefits of progesterone also extend to the protection from breast cancer, uterine cancer, ovarian cysts, heart disease, osteoporosis, stroke and fibrocystic disease.

Cons of Hormone Replacement Therapy

The risks of hormone replacement therapy primarily affect postmenopausal women who begin using it over the age of 60, or who use it as a means of treating osteoporosis alone.

Keeping in mind the most recent September 2017 study published in JAMA noted above that purports hormone therapy isn’t believed to be as risky as it once was, the potential risks of HRT documented in the past have included:

  • A risk of developing blood clots. Oral HRT presents a more of a risk than other types of hormone replacement forms of delivery.
  • An increased risk of ischemic stroke, but not hemorrhagic stroke. The risk is greatest in women who are taking estrogen-only or combined HRT orally, and those who are taking high doses.
  • An increased risk of breast cancer, though the research on this is arguable. Some studies have failed to find a link between HRT and breast cancer, and those that have revealed this form of cancer was minimal, causing about one more case per 1,000 women a year. Those who could be affected include lean women and women who begin HRT late in menopause.
  • A risk of developing endometrial, or womb, cancer in women who are taking estrogen-only HRT and have a uterus. Taking estrogen on its own can increase the risk of developing endometrial cancer. Taking progestogen along with estrogen can reduce this risk. Women who have had a hysterectomy, or surgical menopause, can take estrogen alone, as they no longer have a uterus, so endometrial cancer is not a concern.
  • A risk of developing ovarian cancer, though, like breast cancer, the evidence of this is conflicting.

Always speak to your doctor to determine if these risks apply to you.

Weighing Risks and Benefits of HRT

There are risks and benefits of HRT, so to weigh the two to determine whether it’s the right option for you. Every woman is unique. You should measure the discomfort you’re experiencing as a result of menopause against your concerns about HRT.

HRT Discomfort

You can also take into consideration earlier studies of hormone replacement therapy while knowing there’s a recent study that may contradict findings from earlier research.

Experts define risk as the chance something will go wrong, not that something will go wrong. The risks associated with HRT are lower in younger women and those who start treatment soon after beginning menopause.

Talk to your doctor, review your medical history and discuss the discomfort you’re experiencing. Remember there are several hormone replacement therapy options, and your doctor can make the best recommendation to reduce your risk of developing adverse effects. The lower the dose and the sooner you begin therapy, the less risk.

If you’re considering HRT, but you’re concerned about the risks, there are ways you can lower them. For example,

  • If you have a family history of breast cancer, a mammogram will give you a better understanding of the health of your breasts.
  • If blood clots run in your family, a thrombophilia screening could be helpful.

Though there is extensive research on HRT, there is still a lot to learn. While studies have offered some clarity, they don’t accurately address all of the concerns of each woman. Is HRT worth it for women? Only after consulting with your doctor and considering your situation can you determine if it’s the right option for you.

Types of Hormone Replacement Therapy

Hormone replacement therapy can be taken in a variety of ways and is available in a multitude of preparations. Review the most common HRT options below.

  • Tablets are available for both combined and estrogen-only HRT. Typically, a pill is taken once a day. Many women opt for this method because of its ease. There is an increased risk of developing some of the complications of HRT, including blood clots. Overall, the risk of these side effects is still small.
  • Skin patches. These are another popular way to take HRT. Combined and estrogen-only patches are available, and you apply them to your skin and replace them after a given period. Skin patches don’t increase the risk of HRT side effects, such as blood clots and indigestion, so if you’re concerned about complications, this may be the best option for you.
  • Estrogen gel. If you opt for this method, you’ll apply a gel to your skin once a day, and your body absorbs the estrogen. There is no increased risk of developing blood clots, and it’s an easy application. However, if you have not had a hysterectomy, you’ll have to take a form of progesterone to reduce your chances of developing endometrial cancer.
  • Vaginal creams and rings. These applications are used for estrogen-only HRT and can help to ease vaginal dryness and painful intercourse, however, it doesn’t help with other menopausal symptoms, such as hot flashes and mood swings.

HRT Tablets

There are also two different treatment regimens available, including cyclical and continuous HRT.

Cyclical (also known as sequential) HRT is usually recommended for women who are taking combined estrogen and progestogen and who are experiencing symptoms of menopause but still menstruate. There are two cyclical HRT options available:

  • Monthly, which involves you taking estrogen daily and progestogen only during the last 14 days of the menstrual cycle. Physicians recommend this method for women who still have regular periods.
  • Three-monthly, where you take estrogen every day and progestogen around the last 14 days of the menstrual cycle every three months. Physicians suggest this option typically for women who are experiencing irregular periods, though they should have a period at least once every three months.

Continuous hormone replacement therapy involves you taking both estrogen and progestogen, or just estrogen, on a daily basis. Typically, physicians recommend this regimen for postmenopausal women (women who have not had their period for a year or more.)

Types of HRT

Alternatives to HRT

If you’re not able to take HRT, or you’re concerned about any potential risks, there are alternative options that can help to relieve your menopausal symptoms.

Lifestyle Changes

Making changes to your lifestyle can help to ease the undesirable side effects of menopause. Actions to consider include:

  • Getting regular exercise
  • Eating a well-balanced, nutritious diet
  • Wearing loose, breathable clothing, especially while sleeping
  • Sleeping in a cool, well-ventilated space
  • Reducing caffeine intake
  • Using a vaginal lubricant to ease dryness
  • Not smoking

Menopause Lifestyle Changes


Two types of antidepressants have been found to relieve hot flashes caused by menopause: serotonin-noradrenaline reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs).


A prescription medication like combined HRT, Tibolone can help to ease some of the most common side effects of menopause, including hot flashes, mood swings and low sex drive. However, this alternative may not be as effective as HRT for all women.

Bioidentical Hormones

These “natural” hormones are derived from plants and are said to be identical to human hormones. Bioidentical hormones are the treatment of choice at Synergy Wellness Center due to their proven safety record.

Should I Get Hormone Replacement Therapy?

Hormone replacement therapy has been proven to be an effective way to reduce the side effects of menopause and improve your health and happiness. Though there may be potential risks, for many women, they largely outweigh the benefits.

If you’re experiencing moderate or severe menopausal symptoms and you would like to find out what to know about hormone replacement therapy for women, please contact us at Synergy Wellness in Bakersfield, Calif. today to arrange a consultation. We look forward to discussing our hormone replacement therapy procedures for age management with you. Our phone number is 661-878-9100.

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