If you’ve been following along, we’ve been talking about menopause hormone therapy lately.
In this blog, we will break down some of the most common types of menopause hormone therapy and how they may be used.
Catch up on our other menopause hormone therapy blogs here:
Menopause Hormone Therapy: A Primer
Removing the Black Box Label on Menopause Hormone Therapy: What does it mean?
Quick refresh: What is Menopause Hormone Therapy?
Menopause hormone therapy (MHT) refers to the use of hormones, usually and primarily estrogen, with or without progesterone, to help alleviate symptoms associated with menopause, including:
- Hot flashes and night sweats
- Sleep disruption
- Vaginal dryness and discomfort
- Mood changes
- Bone loss
- Quality of life
Estrogen Therapy
During menopause, estrogen levels drop. This drop in estrogen significantly impacts the symptoms of menopause, including insulin resistance. More on that here.
Who is it for?
Estrogen-only therapy is typically prescribed for individuals who do not have a uterus, as unopposed estrogen can increase the risk of endometrial hyperplasia. If you have a uterus, you need to take progesterone with estrogen to protect against the uterine lining becoming too thick and to protect against endometrial cancer.
There are several forms of estrogen that now exist.
They include:
- Oral tablets
- Transdermal patches
- Topical gels or sprays
- Vaginal creams, tablets, or rings
Some things to note about the different forms of estrogen:
- Transdermal estrogen (patch, gel) bypasses the liver and may be preferred for those with metabolic risk factors
- Lower doses can still typically be effective and may be better tolerated
Combined Estrogen + Progesterone Therapy
As mentioned above, for individuals with a uterus, progesterone is added to protect the endometrial lining.
Types of progesterone:
- Micronized progesterone (bioidentical)
- Synthetic progestins
Dosing approaches:
- Continuous combined: estrogen + progesterone daily
- Cyclic: estrogen daily, progesterone added for part of the month
Transdermal vs Oral Therapy
One of the most important distinctions in modern MHT is how the hormone is delivered.
Transdermal (patch, gel, spray):
- Bypasses first-pass liver metabolism
- Lower impact on triglycerides and clotting factors
- Often preferred for individuals with:
- Insulin resistance
- Migraine history
- Higher cardiovascular risk
Oral:
- Convenient
- May impact liver-mediated pathways more significantly
Local (Vaginal) Estrogen Therapy
This form of estrogen therapy is used specifically for genitourinary symptoms of menopause, such as vaginal dryness, pain with intercourse, urinary urgency or recurrent UTIs.
Forms:
- Vaginal creams
- Tablets
- Rings
Something to note is that local estrogen is minimally absorbed systemically, making it a potentially safe and effective option for individuals who may not be candidates for systemic (whole body) hormone therapy.
Bioidentical Hormone Therapy: What Does That Mean?
The term “bioidentical” is often misunderstood. Bioidentical indicates hormones that are chemically identical to those produced by the human body.
Examples include:
- Estradiol
- Micronized progesterone
These are available in FDA-regulated, standardized formulations.
Important distinction: Custom-compounded “bioidentical” hormones are not the same as FDA-approved products and lack consistent dosing and safety data. We recommend discussing with your healthcare provider and obtaining approved medications.
Timing Matters: The “Window of Opportunity”
Emerging evidence supports that starting hormone therapy within 10 years of menopause onset or before the age of 60 is associated with a more favorable benefit-risk profile.
This concept helps explain why early interpretations of the Women’s Health Initiative led to confusion, many participants were older and further from menopause onset. See our blog on Removing the Black Box Warning on MHT and what that means.
Who is a Candidate for MHT?
As we’ve discussed so far, MHT is not one-size-fits-all, but it may be appropriate for certain individuals.
Potential candidates:
- Moderate to severe vasomotor symptoms
- Early menopause or premature ovarian insufficiency
- Increased risk for osteoporosis
Requires careful consideration in:
- History of breast cancer
- Prior thromboembolic events
- Certain cardiovascular conditions
Bringing It All Together
Menopause hormone therapy is not simply “estrogen or not.” It is a highly individualized intervention that considers the “spectrum of risk,” including:
- Symptom profile
- Medical history
- Timing relative to menopause
- Personal preferences
For many, it can be a powerful tool, not just for symptom relief, but for improving long-term health and quality of life.
If you’re navigating menopause symptoms or supporting patients who are, understanding the different types of hormone therapy is essential to making thoughtful, evidence-based decisions.
As always, a careful discussion with your healthcare provider should be had prior to initiation of any type of hormone therapy. The team at LCWNS is available to support your decision making and support your lifestyle alongside the use of MHT.
References:
Faubion SS, Crandall CJ, Davis L, et al. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028.
Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368. doi:10.1001/jama.2013.278040
