Hormone Replacement Therapy can help reduce moderate to severe symptoms of perimenopause and menopause for those experiencing them. It is a form of Hormone Therapy (HT), which refers to a treatment that blocks, adds, or removes hormones to have a beneficial medical impact for treating a variety of things (e.g., breast cancer, prostate cancer, thyroid conditions, growth syndromes, fertility treatments, gender affirming care).
As its name suggests, HRT works by adding specific hormones that the body naturally makes less of as people age and experience perimenopause and menopause.
The Need for HRT
When it comes to perimenopause and menopause, many people automatically think of the dreaded hot flash. What is often portrayed as comical on TV or stage can be debilitating to experience in real life. Hot flashes are more than just a momentary discomfort—they can really impact a person’s daily quality of life.
But perimenopause and menopause can bring more than just hot flashes. There are actually around 30 different symptoms a person can experience…and, of course, no two people will experience this transitional phase the same way, making it challenging to prepare for and to educate people on.
Some other symptoms of perimenopause and menopause include:
- Night sweats
- Joint/muscle pain
- Insomnia/sleep disturbances
- Memory changes
- Mood changes
- Anxiety
- Depression
- Sadness
- Vaginal dryness
- Bladder control issues
- Breast changes
- Weight gain
- Skin changes
- Higher frequency of vaginal infections
- Higher frequency of urinary tract infections
- Decreased sex drive
- Increase in waistline
- Loss of muscle mass/increase in fat tissues
- Thinning of hair/loss of hair
- Loss of bone mineral density
More information on perimenopause and menopause can be found here .
Overview of the Hormones
Before we dive into the types of HRT, it’s important to understand how it works, which means reviewing the hormones involved.
Estrogen: Found naturally in cisgender women, estrogen is associated with more than just reproductive health—estrogen also assists in cognitive abilities, bone health, and cardiovascular health, among other things.
Progesterone: The main function of progesterone is to prepare the body for pregnancy, by helping to create a welcoming environment for fertilization.
As people age, their bodies gradually stop producing estrogen and progesterone . Hormone Replacement Therapy can offset perimenopausal and menopausal symptoms by artificially inserting one or both hormones into the body.
“The ovaries earlier in life are producing these hormones on their own, and then as people age into their 40s and 50s, that’s when the ovaries either have a reduced amount of hormone production or the hormones they are producing are being secreted in a disorganized way, causing a lot of symptoms,” explains Dr. Michele Murray, an Island physician who works with Sexual Health, Options, & Reproductive Services ( SHORS). “Finally, in menopause, that’s when the ovaries are no longer producing these hormones, and many patients will have a lot of symptoms associated with that, that can impact their life in many different ways.”
When these symptoms start to impact your quality of life, that’s when it’s time to have a chat with a primary healthcare provider.
Types of HRT
When it comes to HRT, you have two options: estrogen only or combined (estrogen + progesterone). Your primary healthcare provider can help you determine which option is best for you.
Generally, estrogen-only HRT is recommended for people who no longer have a uterus. Those with a uterus are more commonly prescribed a combination form of HRT. This is because progesterone can help reduce the risk of uterine cancer, which increases with estrogen use.
In terms of how long a person requires HRT, Dr. Murray explains that “most people wean themselves off hormone replacement therapy, with the average being 4-5 years during the transition period. But some people experience symptoms beyond the 5 years, so this is an ongoing discussion for each individual.”
Forms of HRT
There are many options for HRT, including:
- Orally (a pill)
- Patch
- Gel
- Ring
- Cream
- Vaginal tablets
- Spray
What you opt to try will depend on the advice of your primary healthcare provider, previous medical history, lifestyle, and personal preference.
Considerations
For younger patients (i.e., under the age of 60), HRT is generally a safe option with few risks. For older patients or for those with a personal history of cancer associated with estrogen (e.g., breast cancer, uterine cancer, ovarian cancer), the risk is higher with HRT. This doesn’t mean these people can’t benefit from HRT—it just means having a discussion with your primary healthcare provider to weigh these risks against the severity of symptoms.
“As we age, the risk of cancer increases for everybody,” explains Dr. Murray. “We generally don’t prescribe to folks over the age of 60 for that reason— although each case is unique to the individual. Some people in their 60s with significant quality of life symptoms choose HRT after weighing the risks. Similarly, it’s the same with cardiovascular disease (heart attack & stroke)—these conditions increase with age, but for younger people (40s–50s), it’s generally safe for most patients.”
One specific form of HRT that is safe for everyone, shares Dr. Murray, is topical vaginal estrogen. The dose is low, it has a gradual effect, and it can be a game changer for symptom control, especially for vaginal symptoms like dryness. People can stay on this course of treatment indefinitely.
How do you know when it’s time to speak to a medical professional about HRT? When your symptoms become intolerable or interfere with your quality of life, says Dr. Murray. Hormone testing, once used to assess a person’s hormonal baseline, is no longer recommended because hormones are constantly in flux—one small snapshot in time doesn’t really tell you what is going on. It’s more important and more helpful to note symptoms.
Debunking Myths
There are a few myths pertaining to HRT that Dr. Murray was all too happy to help clear up.
- Menopause symptoms = hot flashes. We know that there are many symptoms associated with perimenopause and menopause symptoms, not just hot flashes, including irregular bleeding, brain fog/memory problems, and mood changes (plus all the symptoms listed above). Some of these other symptoms may cause more of an impact than hot flashes. It’s all unique to the individual experience.
- Menopause only starts after 50. Some people experience menopause before age 40 or during their 40s. Some people will immediately go into menopause due to medical/surgical procedures, cancer treatments, and autoimmune conditions that can cause the ovaries to stop producing hormones.
- HRT is dangerous for all. This notion stemmed from a study conducted in the early 2000s that linked HRT to an increased risk of both breast cancer and cardiovascular disease. Twenty years later, we’ve learned from this research. One important note: The population of people involved in the study was much older (average age 63) than who HRT is recommended for today (under 60). Additionally, today, we have access to more specific estrogens and we tailor the dose to be the lowest possible dose for an individual. We also have more options in terms of how these hormones enter the body, bypassing the liver and lessoning the risk of clots. In short: Today we have safer forms and lower doses (leading to less risk).
- HRT is the only therapy that works. Lifestyle changes do help, too! For those unable to try HRT or for those who would like to try lifestyle changes first, some things to try include reducing/quitting smoking, reducing/quitting alcohol, eating healthy food, being physically active, and paying attention to sleep quality. Antidepressants can also be prescribed to help with symptoms.
Accessing HRT
“I hope that as conversation moves into the public area and that we have more access to information these days, that there’s more awareness about options around women’s healthcare,” says Dr. Murray. “I think it’s important to remember that this is a normal phase of life—it doesn’t necessarily mean that there is something wrong with somebody, it doesn’t necessarily mean that there is a medical issue that needs to be fixed…but if symptoms are really impacting a person’s quality of life, that’s when it’s time to really think about what the pros and cons [of HRT] are for that individual patient.”
Anyone looking to explore HRT options should first consult with their primary healthcare provider. For those who do not have a primary healthcare provider, individuals can access care via virtually, walk-in clinics or the Sexual Health, Options & Reproductive Services (SHORS) clinic.
Published date: May 2025
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