Hormone Replacement Therapy for Menopause

Written by WebMD Editorial Contributor, Marijke Vroomen Durning, RN
Medically Reviewed by Zilpah Sheikh, MD on January 14, 2025
10 min read

HRT is a possible treatment for menopause symptoms. Your doctor may also refer to the treatment as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy.

During menopause, your ovaries stop producing the hormones estrogen and progesterone. The drop in estrogen can cause uncomfortable symptoms known as vasomotor symptoms, like hot flashes. Your may have other symptoms too, such as vaginal dryness.

If you're looking for relief from menopause symptoms, knowing the pros and cons of HRT can help you decide whether it's right for you.

Not all women need HRT to treat some of the unpleasant or uncomfortable symptoms of menopause, but many do benefit from it. If you're having any of these signs, it might be worth talking to your health care professional about whether HRT is right for you:

  • Moderate-to-severe hot flashes. Mild hot flashes make you feel hot but don't make you sweat. Although they're annoying, they don't need treatment. Moderate hot flashes make you feel hot and sweaty. Severe hot flashes make you feel so uncomfortable that you have to stop what you're doing.
  • Vaginal dryness, itching, or burning. You might also have pain or discomfort while having intercourse.
  • Overall body aches and joint and muscle pain
  • Insomnia
  • Low energy
  • Moodiness or feeling like you can't control your body or emotions
  • Issues with memory loss and cognitive challenges

HRT can also help you if you are at a high or higher risk of:

If you're having symptoms of menopause after a hysterectomy (surgery to remove the uterus) or a hysterectomy with bilateral salpingoophorectomy (surgery to remove the uterus, fallopian tubes, and ovaries), doctors may suggest a low dose of estrogen. Estrogen comes in different forms. The daily pill and patch are the most popular, but the hormone also is available in the form of a vaginal ring, gel, or spray.

Estrogen pill

Pills are the most common treatment for menopausal symptoms. Among the many forms of pills available are conjugated estrogens (Cenestin, Estrace, Estratab, Femtrace, Ogen, and Premarin) or estrogens-bazedoxifene (Duavee). Follow your doctor's instructions for dosing. Most estrogen pills are taken once a day without food. Some have more complicated dosing schedules.

Estrogen patch

The patch is worn on the skin, on your abdomen (belly). Depending on the dose, you might replace the patch every few days or only once a week. Examples are Alora, Climara, Estraderm, and Vivelle-Dot. Combination estrogen and progestin patches — like Climara Pro and Combipatch — are also available. Menostar has a lower dose of estrogen than other patches, and it's only used for reducing the risk of osteoporosis. It doesn't help with other menopause symptoms.

Topical estrogen

Creams, gels, and sprays offer other ways of getting estrogen into your system. Examples include gels (like Divigel and EstroGel), creams (like Estrasorb), and sprays (like Evamist). As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. How you apply these creams vary, although they're usually used once a day. For example, EstroGel is applied on one arm, from the wrist to the shoulder. Estrasorb is applied to the legs. Evamist is applied to the arm.

Vaginal estrogen

Vaginal estrogen comes in the form of cream, vaginal rings, or vaginal estrogen tablets. In general, you might use this form of estrogen if you're troubled specifically by vaginal dryness, itchiness, and burning or pain during intercourse. Examples are vaginal tablets (Vagifem), creams (Estrace or Premarin), and insertable rings (Estring or Femring). Dosing schedules vary, depending on the product. Most vaginal rings need to be replaced every three months. If you use vaginal tablets, you might need to use them daily for a couple of weeks; after that, you only need to use them twice a week. Creams might be used daily, several times a week, or according to a different schedule.

Often when people think about HRT, they think of estrogen. But if you still have a uterus and your doctor wants you to try HRT, you will need combination HRT, which includes estrogen and another hormone, progesterone (also called progestin).

Taking progesterone with estrogen lowers your risk of cancer of the endometrium, the lining of the uterus, compared with taking estrogen alone.

While generally used as a form of birth control, progesterone can help treat some menopausal symptoms too.

Oral progestins

Taken in pill form, progestin medications include medroxyprogesterone acetate (Provera) and the synthetic progestin pills (norethindrone and norgestrel). Many experts now treat the majority of their menopausal patients with natural progesterone rather than synthetic progestins. Research suggests that natural progesterone may not have a negative effect on lipids and is a good choice if you have high cholesterol levels. In addition, natural progesterone might have other advantages when compared with medroxyprogesterone acetate.

Intrauterine progestin

Low-dose intrauterine devices (IUDs) with levonorgestrel are sold under the brand names Liletta, Kyleena, Mirena, and Skyla. In the U.S., these are approved for pregnancy prevention and bleeding control. They're sometimes used "off-label" along with estrogen. If you have one of these IUDs when you enter perimenopause, your doctor may suggest that you keep it in until perimenopause is complete to help with uneven periods.

While HRT doesn't help everyone, it may:

You may have read some articles about HRT being dangerous, but research shows that the benefits can be greater than the risks for many. All medications have some risks though, and it's important to understand what they are. For some women, HRT may raise their risks of:

Your risks may be lower if you:

  • Start HRT within 10 years of menopause or before age 60
  • Take the lowest dose that works for you for the shortest possible time
  • Take progesterone or progestin if you still have your uterus
  • Ask about other forms of HRT besides pills, like patches, gels, mists, vaginal creams, vaginal suppositories, or vaginal rings
  • Get regular mammograms and pelvic exams

You might have heard that HRT can help you lose weight. Unfortunately, that's not the case, at least not directly. HRT doesn't cause weight loss. But it might help with some weight issues indirectly.

If you're losing sleep because of insomnia or severe hot flashes, eating well and exercising may be the last things you want to do. But if HRT helps lessen your hot flashes and helps your sleep overall, you might be more inclined to follow healthier lifestyle choices. This then can lead to weight loss or prevent further weight gain.

Another thing that HRT might do is redistribute the fat in your abdomen. After menopause, women often start getting more belly fat called visceral fat. This type of fat is more dangerous to your health than the fat that lies just under your skin. It surrounds your stomach, liver, and intestines. Some studies suggest that HRT might redistribute some of the visceral fat, but it's not yet been proven for sure.

Not everyone can take HRT. If you have any of these conditions, you may want to avoid HRT:

  • History of blood clots
  • Cancer (such as breast, uterine, or ovarian)
  • Heart, liver, or gallbladder disease
  • Heart attack
  • Known or suspected pregnancy
  • Stroke
  • Unexplained vaginal bleeding

Do you smoke? Your doctor may encourage you to stop before prescribing HRT.

All medications, including HRT, cause side effects in some people. Call your doctor if you have any of these:

Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.

Here are some questions to ask:

  • Based on my medical history, is there any reason I shouldn't use HRT?
  • Do you think it could help my symptoms, especially hot flashes, sleep issues possibly relating to night sweats, or vasomotor symptoms?
  • Are there treatments I should consider for vaginal dryness? (Vaginal moisturizers may help vaginal dryness, for example.)
  • Do you think I'll have side effects from HRT? (Be sure to tell your doctor if you had any issues with taking birth control pills.)
  • Does my family medical history make me a good or bad candidate for HRT? (If your mom had osteoporosis, HRT will help lower your risks of it. But if your mom had breast cancer, you'll want to talk about that with your doctor.)
  • What type of HRT might be best for me?

BHRT is a treatment that uses bioidentical hormones to help at times when your hormones are unbalanced or too low, like during menopause.

Bioidentical hormones are hormones that come from plants and processed to act similarly to human hormones. Those most often used are estrogen, testosterone, and progesterone.

Some are made by drug companies and approved by the FDA, but others can be compounded (custom made) by a pharmacist after your doctor writes a prescription of what should be included.

Many people feel that bioidentical hormones are a natural HRT, but it's important to be very careful when using so-called natural products because not everything that's natural is necessarily safe. In addition, once the plant is processed to produce the hormones, the product is not in its natural form anymore.

If you can't or don't want to take HRT to help manage your menopause symptoms, you might be interested in looking for alternative treatments to manage hot flashes. Don't stop taking your HRT if you're already taking it and replace it with something else without checking with your doctor first though.

  • Fezolinetant. This drug was approved by the FDA in 2023 to treat moderate-to-severe hot flashes. It isn't a hormone though.
  • Antidepressants. Selective serotonin receptor inhibitors are often used to help treat hot flashes. One antidepressant, paroxetine (Brisdelle), has been FDA approved for this. Other antidepressants that may help include venlafaxine (Effexor) and desvenlafaxine (Pristiq).
  • Gabapentin (Neurontin) and pregabalin (Lyrica). Usually prescribed to manage seizures.
  • Oxybutynin (Ditropan). Used to treat urinary incontinence.
  • Clonidine (Catapres). Usually prescribed to treat high blood pressure, but the extended formula can also treat ADHD.
  • Plant-derived estrogens (phytoestrogens). Some foods like soybeans, chickpeas, and lentils contain phytoestrogens, which might help manage hot flashes. Health food stores may sell supplements.
  • Herbs. Black cohosh and vitamin E might help with hot flashes. Others, like ginseng, might help with mood swings.

Other options

If you'd rather avoid taking any medications or supplements to manage menopause symptoms, you might want to try one of these:

  • Cognitive behavioral therapy (CBT). Menopause symptoms aren't in your mind, but CBT can help you adapt to the symptoms, like hot flashes, so you react differently when they happen.
  • Mindfulness meditation. Mindful meditating can help you slow down and live in the moment. Like CBT, it won't lower the number of hot flashes, but it might help you manage them better.
  • Hypnosis. This type of treatment is recommended by the National Menopause Society to help reduce how often you have hot flashes and how severe they are.
  • Acupuncture. This treatment may help reduce how often you have hot flashes and how severe they are, but the research doesn't yet prove that it helps.

HRT is a common treatment for menopause symptoms. You can take estrogen only or, if you have your uterus, estrogen and progesterone. Not everyone can take HRT though, so if you're interested in seeing if it will manage your menopause symptoms, it's important to speak with your health care professional to see if it's safe for you.

When is HRT no longer recommended?

HRT is no longer recommended when you don't have symptoms or if you develop a condition that could make it dangerous to continue, like blood clots.

How do you tell if you need HRT?

If your menopause symptoms are severe enough to interfere with your quality of life, or if you are at a high risk of conditions like osteoporosis, your doctor can help you decide if you need HRT.

Does HRT cause weight gain?

HRT could cause some bloating, but it's not known to cause weight gain.

Does HRT cause cancer?

HRT doesn't cause cancer, but some types can raise your risk of some types, like breast cancer.

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