Hormone Replacement Therapy: Are You Familiar with All the Options?

Did you know there are different types of hormone replacement therapy (HRT)? From oestrogen, progestogen, and even testosterone (in some cases) to various forms like tablets, patches, gels, sprays, vaginal rings, pessaries, and creams—there’s a lot to consider! Our women’s health expert, Dr. Sherry Ross, breaks down all the options, pros & cons.

Menopause can bring a range of disruptive symptoms, but hormone replacement therapy (HRT) offers a safe and effective way to manage them for many women. Hot flashes, night sweats, insomnia, fatigue, anxiety, depression, brain fog, heart palpitations, and vaginal dryness are just some of the challenges that HRT can help alleviate. Additionally, it can reduce the risk of bone loss and fractures.

However, HRT is not suitable for everyone, particularly those with a history of breast, ovarian, or endometrial cancer, blood clots, stroke, heart disease, liver disease, or untreated high blood pressure.

That’s why is important to discuss your options with a menopause specialist. When prescribed and monitored by a healthcare provider, the benefits of HRT often outweigh the risks, especially for women under 60 or within 10 years of menopause.

The key is an individualized approach, using the lowest effective dose for the shortest necessary duration to balance symptom relief with long-term health considerations.

Understanding the Different Types of Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is not a “one size fits all” treatments – the type and dosage given will vary according to your needs.  With various options available, from estrogen-only to combined therapy and different methods of administration, women can find a solution that best suits their health and lifestyle.

Here are the most common types of hormone replacement therapy (HRT) and how they are administered.

Estrogen and Progesterone Hormone Replacement Therapy

When it comes to managing menopause symptoms, hormone replacement therapy (HRT) offers a tailored approach to feeling your best. Estrogen, the key player in HRT, can be taken in pill form or absorbed through the skin via patches, gels, creams, or sprays. For women who have had a hysterectomy, estrogen-only therapy is an option. However, those with a uterus typically require progesterone as well to balance estrogen’s effects and protect the uterine lining. Like estrogen, progesterone is available in oral or transdermal forms, such as patches and creams.

There are two main ways to take HRT: continuously or cyclically. Continuous therapy involves taking hormones daily, eliminating the need for a scheduled period. On the other hand, cyclic therapy mimics the body’s natural rhythm, incorporating a planned monthly bleed. While having a period on HRT isn’t medically necessary, some women prefer the familiarity of a cyclical pattern. Ultimately, the choice depends on personal comfort and lifestyle preferences.

For those concerned about safety, FDA-approved estrogen and progesterone therapies prescribed by Western doctors have been rigorously tested in medical studies, proving their effectiveness and reliability.

Compounding or “Natural” Bioidentical Estrogen and Progesterone HRT

Compounded or a “natural” bioidentical HRT include creams, drops and pellets, have not been tested in clinical trials and are not FDA approved, in the same manner as traditional HRT. They are marketed as being “more natural, safer and better” for your body but there are no medical studies to support these claims. It’s true that compounded HRT can be made from plant products such as soy and yams, but they still need chemical processing to become active in the body.

In truth, many traditional estrogen and progesterone pills, patches, gels, creams and sprays are also bioidentical to our body’s makeup.  It’s important to remember that just because hormones are referred to as “bioidentical”, “compounded” or “natural”, doesn’t mean they are safer to use.

Low Dose Hormonal Contraception

For women easing into menopause, low-dose hormonal contraception offers another option for symptom relief. Unlike traditional hormone replacement therapy (HRT), birth control pills contain a higher dose of estrogen and progesterone, making them effective at managing disruptive symptoms like hot flashes, irregular periods, and mood swings during perimenopause and menopause.

However, hormonal birth control isn’t suitable for everyone. Women over 35 who smoke, have high blood pressure, or are at risk for blood clots or strokes should explore other options.

Different Ways to Take HRT: Exploring Your Options

Oral HRT (Tablets)
One of the most common ways to take HRT, oral tablets contain either estrogen alone or a combination of estrogen and progestogen. 

Transdermal HRT (Patches, Gels, and Sprays)
Patches, gels, and sprays deliver hormones through the skin, offering a safer alternative to oral HRT for women at risk of blood clots. HRT patches are about the size of a large postage stamp and adhere to the skin, continuously releasing hormones into the bloodstream. They need to be replaced twice a week without breaks between applications. HRT gel, applied once daily, absorbs through the skin and enters the bloodstream like patches. Many prefer it for its ease of use, lack of frequent changes, lower risk of skin irritation, and generally fewer risks compared to HRT tablets. These methods are convenient, reduce the risk of liver metabolism, and provide a steady hormone release.

Vaginal HRT (Creams, Rings, and Pessaries)
For women experiencing vaginal dryness, painful intercourse, or urinary issues, local estrogen therapy can be applied directly to the vaginal area using creams, rings, or pessaries. Since it delivers low doses of estrogen directly to the affected tissues, it carries fewer systemic risks.

Finding the Right HRT for You

Menopause is a natural part of life, but suffering through its symptoms doesn’t have to be. Every woman’s journey is unique, and what works for one person may not work for another. The most important step is to stay informed, consult with a trusted healthcare provider, and choose an HRT plan that aligns with your needs, health risks, and lifestyle.