HRT for Menopause
Menopausal hormone therapy for hot flashes, night sweats, sleep disruption, and genitourinary symptoms. Best evidence is for bothersome symptoms, especially when started nearer to menopause. Not a default anti-aging prescription.
Overview
HRT for menopause is the clinic name for menopausal hormone therapy (MHT): estradiol for vasomotor symptoms, with a progestogen if the uterus is present, plus local vaginal estrogen when the problem is dryness or urinary symptoms. The job is symptom control and, when indicated, bone. It is not a proof that every woman 45+ should be “optimized.”
What usually helps
Hot flashes and night sweats respond well to systemic estrogen in appropriate candidates. Sleep often improves when night sweats stop; progesterone at night can add sedation. Genitourinary syndrome of menopause is a local estrogen job more than a pellet job. Timing matters: NAMS supports MHT for bothersome symptoms in selected women, with more caution the further you are from menopause and the more vascular risk you carry. WHI’s oral CEE+MPA results in older women are not a photocopy of a 52-year-old on a transdermal patch.
What it will not do
It will not reliably prevent dementia. It is not first-line prevention of heart disease. It does not replace treating depression, iron deficiency, or sleep apnea. Breast-cancer history, unexplained bleeding, prior VTE, and active liver disease are reasons to stop the sales pitch and get a real consult. See estrogen, progesterone, and women’s hormone health.
Benefits
Best-studied use of estrogen is bothersome hot flashes and night sweats
Vaginal estrogen treats GSM without pretending to be a full-body anti-aging drip
Transdermal estradiol plus micronized progesterone is a common modern pairing
Bone benefit is real when MHT is indicated—not a license to skip DEXA thinking
You can often start with labeled products instead of a pellet mill
The Procedure
1
Name the symptoms
2
Risk screen
3
Systemic vs local
4
Reassess
Preparation
Last menstrual period, hysterectomy status, mammogram dates, clot/cancer history, and a bleeding diary. Bring the actual symptom that is ruining sleep—not a longevity checklist.
Recovery & Aftercare
Flashes often ease over weeks. Spotting can happen at start; persistent or heavy bleeding is not “normal HRT” until someone looks.
Risks & Considerations
Breast tenderness, bleeding, VTE/stroke (higher with some oral estrogens), gallbladder disease, and missed endometrial protection if estrogen is unopposed. Pellets add an off-switch problem.
Frequently Asked Questions
References
[1]
NAMS 2022 hormone therapy position statement (Menopause, 2022).
https://doi.org/10.1097/GME.0000000000002028[2]
Rossouw J.E. et al. WHI estrogen plus progestin (JAMA, 2002).
https://doi.org/10.1001/jama.288.3.321[3]
Canonico M. et al. Transdermal vs oral HRT and VTE (BMJ, 2008).
https://doi.org/10.1136/bmj.39510.537191.BE[4]
ACOG. Compounded bioidentical menopausal hormone therapy.
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2012/08/compounded-bioidentical-menopausal-hormone-therapy
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