Hormone Replacement Therapy: What Women Should Know

What are hormones?

Hormones are chemical messengers produced by glands (for example, the ovaries) that regulate many body functions including temperature control, mood, bone density, and reproductive tissues. During the menopausal transition, levels of estrogen and progesterone fall, and some women experience symptoms that affect daily life. Hormone replacement therapy typically aims to restore more stable hormone levels using one or more preparations—commonly estrogen alone or estrogen combined with a progestogen. The type and dose are selected based on whether a woman has a uterus, symptom profile, medical history, and personal preferences.

How does therapy work?

Therapy delivers hormones through several routes: oral tablets, transdermal patches, gels, creams, vaginal rings, or injections. Transdermal and low-dose formulations can reduce first-pass liver effects and may have different risk profiles than oral preparations. Estrogen relieves vasomotor symptoms and improves vaginal tissues, while adding progestogen protects the uterine lining in women with an intact uterus. Treatment goals include symptom control, improved quality of life, and prevention of bone loss when appropriate. Duration and dosing are tailored and typically reassessed periodically.

Health benefits and risks

Evidence supports HRT’s effectiveness for common menopausal symptoms and for reducing bone loss and fracture risk. Benefits and risks vary with age, timing of initiation, type of hormones used, and individual health factors. Known risks can include an increased chance of blood clots (venous thromboembolism) and, in some formulations and durations, a small increase in breast cancer risk. Cardiovascular effects differ by age and time since menopause; starting HRT closer to the menopausal transition appears to have a different risk profile than starting later. Side effects can include breast tenderness, spotting, bloating, and mood changes. Decisions should weigh symptom severity, personal risk factors, and monitoring plans.

HRT during menopause

Menopause is the natural end of menstrual cycles and is defined after 12 months without a period. Perimenopause (the transition) often brings fluctuating hormones and symptoms that HRT can target. For vasomotor symptoms (hot flashes, night sweats) and genitourinary syndrome (vaginal dryness, urinary symptoms), HRT is among the most effective treatments. Local low-dose vaginal estrogen can relieve urogenital symptoms with lower systemic exposure. For prevention of osteoporosis, HRT can be considered when other risk-reduction strategies are insufficient or contraindicated. Regular reassessment of risks and benefits is advised, and duration is individualized.

Considerations for women

Before starting HRT, clinicians typically review medical history, family history (including breast cancer and cardiovascular disease), and current medications. Contraindications commonly include active or recent breast cancer, active blood clots, unexplained vaginal bleeding, and certain liver diseases. For women with a uterus, combined therapy (estrogen plus progestogen) is usually recommended to reduce the risk of endometrial hyperplasia. Monitoring plans may include symptom review, blood pressure checks, and adherence to recommended cancer screening such as mammography. Shared decision-making helps balance symptom relief with safety concerns and personal priorities.

Finding local services and follow-up

Care for HRT can be provided by primary care clinicians, gynecologists, endocrinologists, or specialized menopause clinics, and many services now offer telemedicine consultations. When seeking local services, look for clinicians experienced in menopausal management and hormone therapy who can provide baseline assessment, discuss alternatives, and arrange monitoring. Follow-up typically occurs several weeks after initiation to assess symptom control and side effects, then periodically (for example annually) to review ongoing need, adjust dose, and update screening. Accessibility and service options vary by location and healthcare system.

Conclusion

Hormone replacement therapy is a clinically established option for managing menopausal symptoms and addressing certain longer-term health concerns like bone loss. Its use requires individualized assessment of benefits and risks, choice of formulation and route, and ongoing monitoring. Conversations with a qualified healthcare professional can clarify whether HRT aligns with a woman’s health profile and goals, and help plan safe, evidence-informed treatment.