Treatment Options — Hormone Therapy
9 min · Read
What hormone therapy is, who it's for, and how to think about the synthetic vs bioidentical question.
The landscape of menopause treatment has evolved significantly. Understanding your options — and the evidence behind them — puts you in a stronger position to have informed conversations with your healthcare provider.
Hormone therapy: the gold standard for many symptoms
Menopausal Hormone Therapy (MHT, also called HRT) remains the most effective treatment for vasomotor symptoms such as hot flashes and night sweats. It also helps with vaginal dryness, sleep disruption linked to night sweats, and bone density preservation.
Perimenopause vs. post-menopause: different needs
- Perimenopause: Birth control pills or the hormonal IUD may be used. These manage irregular periods, prevent pregnancy (still possible during perimenopause), and help with symptoms. They contain higher hormone doses than MHT.
- Post-menopause: Menopausal hormone therapy uses lower doses of hormones to replace what the body no longer produces. It does not prevent pregnancy and is not the same as birth control.
Types of hormone therapy
- Estrogen Therapy (ET): For women who have had a hysterectomy. Estrogen alone — no progestogen needed. Available as pills, patches, gels, creams, or sprays.
- Estrogen + Progestogen Therapy (EPT): For women with a uterus. Progestogen is added to protect the uterine lining from overgrowth. Can be combined pills or separate medications.
Synthetic vs. bioidentical hormones
This distinction causes significant confusion. Here is a clear breakdown:
- Synthetic hormones: Chemically manufactured. FDA-approved and regulated. Standardized dosing with extensive safety research. Examples: Premarin, Prempro.
- FDA-approved bioidentical hormones: Molecularly identical to hormones naturally produced in the body. Also FDA-approved, regulated, and well-studied. Examples: estradiol patches, micronized progesterone (Prometrium).
- Compounded bioidentical hormones: Custom-made by compounding pharmacies. Not FDA-approved. Variable quality and dosing. Not necessarily safer — and have less safety data.
'Natural' or 'bioidentical' does not automatically mean safer or better. FDA-approved hormone therapies — whether synthetic or bioidentical — have the most robust safety data.
Is hormone therapy right for you?
The decision is personal and depends on your symptom burden, health history, family history, and preferences. Current guidance from major menopause societies is that for healthy women under 60, or within 10 years of menopause onset, the benefits of hormone therapy generally outweigh the risks for managing moderate-to-severe symptoms.
Hormone therapy is not appropriate for everyone — for example, for women with a history of certain hormone-sensitive cancers, blood clots, or stroke. Your provider is your best resource for individualized guidance.
Watch
A clear, evidence-based Q&A addressing the most common questions and misconceptions about hormone therapy. Puts the WHI study legacy in context with current evidence. Empowers participants to have better-informed conversations with their providers.
Reflect
What questions do you have about hormone therapy that you have never had the opportunity to ask a knowledgeable provider?
Tip: highlight any passage to save it to your notes board in the Log.