Hot flashes, mood changes, low energy. Is this just part of the transition?
As hormone levels begin to fluctuate during (peri)menopause, many people may experience significant symptoms that impact their daily life, intimacy, and overall well-being, with estimates showing more than 80% of women affected.
Common symptoms include:
Hot flashes and night sweats
Irregular or absent periods
Brain fog, difficulty concentrating, or problems with word finding
Mood swing, anxiety, or depressive moods
Heart palpitations, racing heartbeat, or changes in blood pressure
Changes to skin and hair
Vaginal dryness or painful sex
Low libido, sleep disturbances, or fatigue
Bone, muscle, or metabolic changes
What is Hormone Therapy?
Hormone therapies (HT) are prescription medications that alleviate menopausal symptoms by restoring levels of female hormones, such as estrogen, progesterone, or testosterone, that naturally decline during the menopause transition.
The two main types of hormone therapy include systemic therapy and localized therapy.
Systemic therapy includes estrogens (like those the body produces naturally), progestogens (such as progesterone or similar compounds), and increasingly, testosterone. Another option combines conjugated estrogens with a selective estrogen receptor modulator (SERM) to protect the uterus without using a progestogen. Women who have had a hysterectomy can use estrogen alone, while those with a uterus need a progestogen or estrogen-SERM combination. Systemic therapies are considered the gold-standard treatment for hot flashes and night sweats, and for protection against bone loss and fractures.
Localized therapy is applied directly to the vagina, vulva, or vestibule. Because almost no amount of these hormones enters the bloodstream, it effectively improves tissue health with a lower risk of systemic side effects. Localized therapies help restore tissue health in the vulva, vagina, vestibule, and urinary tract, relieving dryness, irritation, and discomfort associated with genitourinary syndrome of menopause (GSM).
What Forms are Hormone Therapies Available In?
Systemic therapies are available as pills, creams, vaginal rings, patches, sprays, or gels, providing a stable stream of hormones throughout the body.
Localized therapies provide targeted, low-dose hormone treatment to the vagina, vulva, or vestibule via creams, gels, vaginal rings, tablets, or suppositories.
Bioidentical vs. Synthetic Hormones: What’s the Difference?
Bioidentical hormones are chemically identical to the hormones naturally produced by the body. Synthetic hormones have a different chemical structure than those naturally produced by the body, although they can deliver similar biological effects. Both bioidentical and synthetic hormones are produced in a laboratory.
Bioidentical hormones can be compounded or found in FDA-approved commercially available prescriptions. The choice on type, route of administration, and dose of hormone therapy should be decided by you and your provider.
Is Hormone Therapy Safe?
Hormone therapy has had a complex and often controversial history.
Much of the concern around its safety emerged in 2002, when media headlines highlighted findings from the Women’s Health Initiative (WHI), a large clinical research study. The study reported potential risks, including a 41% increase in strokes, 26% increase in breast cancer, 29% increase in heart attacks, and more than double the risk of blood clots. In response, many women stopped hormone therapy abruptly, and prescriptions for postmenopausal women plummeted—from 112 million in 2001 to 32 million in 2008, a 70% decrease.
Subsequent analyses have revealed that the WHI study had significant flaws, and the reported results were misrepresented. Since then, a growing body of research has provided a more nuanced understanding of the true benefits and risks of hormone therapy.
Notably, there has been no evidence to date linking vaginal estrogen to increased risk of breast cancer, heart disease, stroke, dementia, or blood clots. Yet, it continues to carry a black box warning, based on outdated studies of systemic hormone therapy in older women.
Is Hormone Therapy Right for Me?
There’s no one-size-fits-all answer when it comes to starting or stopping hormone therapy. Research offers guidance on when to start, with the most benefit seen when hormone therapy is initiated closer to menopause, but there is no data that defines a set age or time when therapy should end.
When we think about women’s health and longevity, hormone therapy is not just about easing hot flashes or night sweats: it plays a critical role in addressing bothersome symptoms as well as supporting long-term health. Instead of asking “What happens if I take hormones?” it’s just as important to consider “What happens if I don’t?”
Hormone therapy has been associated with potential benefits, including:
- Protection of bone health by reducing the risk of osteoporotic fractures
- Lower all-cause mortality, improving overall survival
- May reduce the risk of dementia, including Alzheimer’s disease
- Cardiovascular protection and supporting long-term heart health
Hormone therapy is not appropriate for everyone. Its risks and benefits vary depending on factors such as type, dose, duration of use, route of administration, and timing of initiation. For many women, though, hormone therapy can be a powerful tool to support healthy aging, improve quality of life, and help prevent chronic conditions.
Why Choose HerMD?
For the appropriate candidate, the benefits of taking hormone therapy should outweigh the risks. To determine the appropriate candidate for treatment with hormone therapy, a HerMD healthcare clinician will conduct a thorough review of your personal and family health history, the severity of symptoms you are experiencing, calculate your specific risk for developing certain medical conditions, prior use of hormone therapy, and your desire to start treatment with hormone therapy. This approach ensures your clinical outcomes are maximized and any potential risks are minimized.
The HerMD Difference:
- Longer appointments so your questions are never rushed
- Compassionate experts who truly listen and validate your concerns
- Providers trained in the biopsychosocial model, a multidisciplinary approach that considers the unique interplay between your biology (like hormones and genetics), psychology (such as mood, stress, and mindset), and social factors (including relationships, environment, and lifestyle). This approach helps us create a care plan that’s personalized and designed to maximize your health outcomes.
- Evidence-based hormone therapies, tailored to your needs
- Custom-compounded options available through HerMD Pharmacy
- A virtual experience that seamlessly fits your lifestyle
Whether you’re navigating the early changes of perimenopause or the transitions of menopause, you deserve care that supports you every step of the way and helps you feel your best.