Menopause hormone therapy: benefits, risks, and what to know

At menopause, the body's levels of estrogen and, in most women, progesterone fall, which drives many of the symptoms people notice. Menopause hormone therapy replaces some of those hormones to relieve symptoms. Women who still have a uterus are generally given progesterone along with estrogen to protect the uterine lining. For independent background, see MedlinePlus — Hormone Therapy for Menopause.

The evidence is strongest for a few things. Hormone therapy is the most effective treatment for hot flashes and night sweats, it is first-line for the vaginal and urinary symptoms of menopause (often with a low-dose local option), and it helps prevent the bone loss that speeds up after menopause. Some people also notice modest improvements in sleep and mood. It is not used to prevent heart disease, and results vary from person to person.

Benefit and risk depend on your age, how long since menopause, the dose, the type, and how it is taken. In general, starting within about ten years of menopause and using the lowest effective dose for the shortest time needed is the safer approach, and a skin (transdermal) route at a low dose is often favored when clot risk is a concern. Longer use of combined estrogen-plus-progesterone therapy is associated with a higher breast-cancer risk, and hormone therapy can raise the risk of blood clots and stroke in some people. Your provider weighs these against your symptoms and history.

This is the part worth understanding clearly. FDA-approved menopause hormone therapies have been tested and reviewed for safety, effectiveness, and quality. Compounded "bioidentical" hormones are not FDA-approved. The FDA-commissioned review by the National Academies of Sciences, Engineering, and Medicine found limited high-quality evidence for compounded versions, and major medical groups advise that compounded bioidentical hormones should not be used routinely when FDA-approved options exist. Compounded preparations are also not monitored by the FDA for dose or purity, which can vary. Compounded does not mean "safer" or "more natural." It has a role only when a provider identifies a specific reason an approved product will not work for you. See our guide to compounded medications.

Eligibility is a medical decision made by a licensed provider, not by a questionnaire alone. The provider considers your symptoms, your age and time since menopause, and your history, including any history of certain cancers, blood clots, or heart or liver conditions. Menopause hormone therapy is not appropriate for everyone. The only way to know is a provider evaluation.

Menopause care is coming soon on Panterra and is not yet orderable. When it opens, it will be priced per refill, all-in, with no membership required to be a patient, and that price will include the medication, the provider, follow-ups, and shipping. The treatment page will show pricing when it is available.

See the treatment pages: Menopause care (Hygeia) and Hormone balance care (Hygeia).

1. You complete a health intake online, including your symptoms and history.
2. A licensed U.S. provider reviews your information.
3. If hormone therapy is appropriate for you, the provider issues a prescription.
4. Your treatment ships to you, and follow-ups are included in the price.

If treatment is not appropriate, the provider will tell you and may suggest other options. A prescription is never guaranteed.

Prescription required. Menopause hormone therapy is available only with a prescription from a licensed provider after an evaluation.

FDA-approved options are generally recommended first. Compounded "bioidentical" hormones are not FDA-approved, and are not monitored by the FDA for dose, purity, or quality. They are not safer or more natural than approved products.

Not for everyone. Tell your provider about your full history, including any cancer, blood-clot, or heart conditions. This page does not list every risk.

This is education, not medical advice. It does not replace a conversation with your provider. For a medical emergency, call 911.

Authoritative background: MedlinePlus — Hormone Therapy for Menopause and FDA — NASEM study on compounded bioidentical hormone therapy.