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. This means that the dose and type of HRT can be altered to suit your individual health needs and risk factors for other conditions.

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 needs and lifestyle. Understanding these options and working with a healthcare professional ensures safe and effective symptom management during menopause and beyond.

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

Estrogen and Progesterone Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) can be a game-changer for managing menopause symptoms. Estrogen can be taken orally or applied transdermally through patches, gels, creams, or sprays. Women who have had a hysterectomy can use estrogen-only therapy, while those with a uterus typically need progesterone as well. Progesterone is available in oral or transdermal forms, such as patches or creams, to balance estrogen’s effects and protect the uterus.

HRT can be taken continuously, where hormones are taken daily to avoid a medically induced period, or cyclically, which mimics a natural cycle and includes a scheduled “period.” While there’s no proven health benefit to having a period on HRT, some women prefer the cyclical approach for its familiar rhythm. Ultimately, the best option depends on individual needs and personal preferences.

Estrogen and progesterone hormonal therapy that Western doctors prescribe are approved by the FDA (an independent and trusted group that regulates medication prescribed by medical doctors for patient safety) and have been properly tested in reliable medical studies, proving their safety and efficacy.

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

Low dose hormonal contraception is another alternative treatment as you ease into menopause. Hormonal birth control contains a higher amount of estrogen and progesterone than HRT but works well to control disruptive symptoms of perimenopause and menopause. Hormonal birth control is not for women with high blood pressure, women who smoke over the age of 35y or are at risk for blood clots or strokes.

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.