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  • Hannah Lindström

The 101 on hormonal replacement therapy

Updated: Jul 26, 2022

Hormone replacement therapy (HRT) in menopause has been a very debated subject for the last 30-40 years or so.

In the 90’s several reports showed that there could be an increased risk of cardiovascular disease and breast cancer when being on HRT. Since then, the view of hormone therapy has fluctuated from euphoria to panic.

And among the general public, hormone therapy has become increasingly controversial. In recent years, however, there has been new knowledge that has been crucial for the understanding of some contradictory results between previous observational studies and later randomized prospective studies. This has led to a more nuanced picture of the effects of hormone replacement therapy. At the end of the day, it is everyone's own choice of how to tackle menopause. Menopause is not an illness or a disease, but a period of life where you can need some extra support.

Some find HRT to be the only thing that helps them get a night of sleep and manage the day, but many women prefer to first look at lifestyle changes and adapt to this new phase of life.

What is hormonal replacement therapy?

Hormone Replacement Therapy is one of the most effective medical treatments for menopause symptoms, due to its immediate fix to the fluctuating hormones. Replacing the low levels of estrogen and progesterone does not only relieves symptoms but also wards off some health conditions that affect postmenopausal women, such as osteoporosis.

It is common to do a combined HRT - meaning both estrogen and progesterone replacement, and is most commonly used in women who still have their uterus, as taking estrogen alone can increase your risk for uterine cancer. Or, for women who have had a hysterectomy (a surgery that removes the uterus) tend to only need estrogen, as they do not need progesterone to prevent cancers of the uterus.

The type of HRT that is recommended for you will be based on your medical and family history, symptoms, and if you still have periods.

What are these hormones made of?

The 2 main hormones used in HRT are:

  • estrogen – types used include estradiol, estrone, and estriol

  • progestogen – either a synthetic version of the hormone progesterone (such as dydrogesterone, medroxyprogesterone, norethisterone, and levonorgestrel), or a version called micronized progesterone (sometimes called body identical, or natural) that is chemically identical to the human hormone.

Natural estrogen comes from plants and animals and is usually in the form of estradiol, estrone, and estriol (which are various forms of estrogen found in the body). Sources of natural estrogen include soybeans, yams, and urine from pregnant horses. Combined HRT also contains progesterone, which is usually synthetic. Women who are still having periods often take progesterone for two weeks and then stop so that they can have a period. Once a woman is postmenopausal, it is recommended to take progesterone daily to avoid bleeding after menopause.

How is HRT taken?

HRT can be taken in different formats, such as

  • Oral tablets

  • Patches

  • Gels

  • Vaginal Rings

  • Creams

  • Implants

  • Pessaries

Some studies have shown that certain routes are preferable over others, depending on why you are on HRT and your risk for certain side effects. For women who are struggling mostly with vaginal symptoms, local estrogen-only is usually preferred to relieve dryness, pain with sex, and frequent infections. Women can also use rings, vaginal creams, and pessaries to treat symptoms in the vagina.

Are there any side effects?

Like any medication, there are side effects to HRT. The most common are:

  • Breast tenderness

  • Bloating

  • Water retention

  • Headache

  • Nausea

  • Stomach pains/issues

  • Vaginal Bleeding

The risk with HRT is that it may increase your risk for certain cancers and adverse events such as blood clots, especially in women with certain risk factors.

While HRT can be an excellent therapy for managing menopause symptoms, it can take time to figure out the right dose and combination of hormones that work best for you. What is important to keep in mind is to not try to mix and juggle the doses yourself. Do your research and talk to your doctor. Make sure you are in control and get help from your doctor to manage your doses.

Are there any benefits?

HRT is the most effective treatment there is for hot flashes and vaginal dryness, as well as many other menopause symptoms. Simply due to the body feeling like it is back again on the flow of hormones, you were before menopause.

HRT is a good defense for chronic health conditions that may be associated with lower estrogen levels, such as osteoporosis and heart disease.

If your symptoms are mostly related to vaginal discomfort, low-dose vaginal estrogen is exceptionally helpful with few side effects, which you can find on most convenience drug stores.


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