If you’ve been hearing a lot about hormone replacement therapy (HRT) lately, you’re not imagining it. As perimenopause and menopause continues to become a more mainstream topic, women are exploring the option of using HRT as a way to help ease them through the transition. Many women using it swear by it, reporting that it helps combat symptoms like hot flashes, night sweats, and vaginal dryness. For others, questions remain around potential risks and side effects. The chatter on HRT is often extreme, with it either being presented as a cure-all for aging, or something to avoid altogether.
Why HRT is back in the conversation
Hormone replacement therapy first became popular in the 1960s. By the late 1990s, nearly 15 million women in the U.S. were taking an estrogen-based menopausal treatment. This made it the most commonly prescribed treatment in the country at the time.
That changed rapidly, however, after the Women’s Health Initiative, which is a large, long-term U.S. study designed to evaluate the risks and benefits of hormone therapy published early findings in 2002. The research raised concerns about risks like breast cancer, heart attacks, stroke, and blood clots as a side effect of the treatment. Within six months of the study’s release, women using HRT dropped by 50%. It’s since fallen from nearly 1 in 4 women in HRT’s prime to around 5% using it in 2020
Studies have since challenged the findings of that 2002 assessment, exposing several critical flaws. The original research, for instance, looked at women with an average age of 63, making them around 10 years post-menopause and a demographic already vulnerable to cardiovascular conditions. It also only evaluated one delivery method: a daily combo pill of estrogen and progesterone in lieu of the many forms available today such as patches and creams.
More recent research has found hormone replacement therapy to be a highly effective and generally safe way for women to treat moderate-to-severe side effects of menopause. With a study published in 2024 deeming the benefits outweighing the risks.
Updated research paired with a better understanding of menopause as being a system-wide biological shift instead of just a reproductive change, is bringing hormone replacement therapy back into the mainstream conversation. Pair that with celebrities like Halle Berry, Michelle Obama, and Drew Barrymore speaking openly about the game-changing effects HRT has had on their lives, and more women are beginning to inquire about it.
What hormones actually do in the body
The human body is made up of many different hormones that each perform key functions in a woman’s body.
Estrogen: Estrogen is a sex hormone that is necessary for reproductive and sexual health by thickening the uterine lining and promoting the maturation of egg follicles. It also plays a role in:
- Brain function: Estrogen helps regulate brain chemicals that affect mood, focus, and memory.
- Bone health: Helps maintain bone strength by regulating the balance between bone formation and breakdown. Declining levels are linked to accelerated bone loss.
- Cardiovascular function: Supports blood vessel health and helps keep cholesterol levels in a healthy range.
- Metabolism and body composition: Influences how the body uses energy and where fat is stored.
- Skin and connective tissue: Plays a role in helping skin stay firm, hydrated, and more elastic.
Progesterone: Like estrogen, progesterone plays a role in reproductive health, mainly in preparing the uterus for pregnancy. It also assists with:
- Sleep and nervous system: Helps the brain use a neurotransmitter called GABA to reduce nerve activity, which helps you wind down to make it easier to relax and fall asleep.
- Mood: Plays a role in emotional regulation and how the brain processes stress.
- Reproductive balance: Controls the buildup of the uterine lining and helps support it for a potential pregnancy.
Testosterone: We’re quick to associate testosterone with men but it’s also an important hormone for women’s health. It’s present in smaller amounts in women but still plays an important role in:
- Sex drive: Contributes to a woman’s desire for sex
- Bone and muscle health: Helps support muscle strength and plays a role in maintaining bone density
- Mood and energy: Plays a role in energy and how you feel overall
- Menstrual cycle and fertility: Supports healthy ovarian function and the early stages of egg development
Hormonal changes during perimenopause and menopause
Starting with perimenopause and throughout the menopause transition, women go through many hormonal changes. These affect more than just reproductive health, taking a toll on various systems across the body. During this time:
- Estrogen levels become more unpredictable and fluctuate between extreme highs and lows during perimenopause. Then during menopause, they decline.
- Progesterone begins to decline earlier and more steadily during perimenopause, as ovulation becomes less frequent.
- Testosterone decreases gradually with age, with changes being less abrupt than estrogen and progesterone.
These hormonal shifts lead to an array of new symptoms such as:
- Vasomotor symptoms: 70% to 80% of women experience hot flashes and/or night sweats during this time.
- Sleep disruption: Hormonal changes and night sweats can interfere with sleep. Statistics show that around 50% of women report sleep disturbances during menopause.
- Metabolic shifts: Menopausal hormonal changes can impact metabolism, fat distribution, and heart health.
- Bone density loss: Decreasing estrogen levels affect bone health, and bone loss can happen especially fast in the first 5 to 7 years after menopause.
What HRT does on biological level
Hormone replacement therapy works by replacing or supplementing hormones that decline during menopause, including estrogen and progesterone. By helping to stabilize hormone levels, HRT can help to alleviate symptoms across multiple systems in the body. It usually takes a few weeks before results appear and these effects may include:
A reduction of hot flashes and night sweats: Hormone therapy is considered the most effective treatment for vasomotor symptoms, reducing vasomotor symptoms by as much as 90%.
Improved sleep issues from menopause: HRT can improve sleep quality in some women by reducing symptoms that can interfere with sleep, like reducing night sweats.
Reduced vaginal dryness: Estrogen supplements can help to reduce vaginal dryness and irritation.
An elevated mood: Research has suggested that HRT may improve mood symptoms related to menopause.
Bone density maintenance: Reduces the risk of osteoporosis by slowing bone breakdown that occurs as estrogen levels decline.
Supported cardiovascular health: Can support cholesterol levels and blood vessel function, with effects that vary depending on timing, formulation, and individual risk factors.
Managed body composition: Some studies suggest that HRT may help reduce weight gain in the belly and help preserve muscle mass, with effects that vary.
Related: Why you should be tracking your body composition
What HRT does not do
While hormone replacement therapy has shown to have many benefits in helping to ease menopausal symptoms, it does have its limits.
It’s not a guarantee against aging: HRT may help with certain symptoms and biological changes in the body due to menopause. It can slow specific changes, such as bone loss, but doesn’t stop or reverse the overall aging process.
It’s not a universal solution: HRT is not recommended for everyone. The decision on whether to use it should be made with your doctor, looking at your individual health history and risk factors. Experts warn that hormone replacement therapy may also not be ideal for certain demographics. This includes:
- Women with a history of breast, ovarian, or womb cancer
- Those with a history of blood clots—this may not be a deal breaker but could cause your physician to prescribe a different medium of treatment such as gels or patches over oral tablets
- Women who have liver disease
- Women with a history of untreated high blood pressure. This needs to be treated before starting HRT.
- Those who are pregnant
It does not eliminate all menopause-related changes: While HRT has been shown to help alleviate some symptoms that appear throughout menopause, it does not address every change associated with the transition.
Its effects vary significantly between individuals: Studies show that the results of HRT vary based on a person’s individual health history, age, time of initiation, and formulation.
Risks, trade-offs, and evolving science
Hormone replacement therapy has been widely studied throughout the years. As more research has become available, our understanding of its risks and benefits have evolved over time.
Earlier studies, like the Women’s Health Initiative, have raised concerns about some potential side effects of using HRT. This included an increased risk of breast cancer, stroke, and blood clots associated with certain forms of hormone therapy. Recent research, however, has provided a more nuanced view. Experts are now taking into consideration factors like the age that someone begins treatment, individual health history and risk factors, and the HRT formulation—whether it’s a pill, gel, cream, etc.
Current evidence supports the “timing hypothesis,” which suggests that starting HRT within 10 years of menopause, which is typically before age 60 may be associated with more favorable outcomes for heart and bone health. Starting later may be linked to higher risks of stroke and blood clots and may not provide the same potential benefits.
The way HRT hormones are delivered can also affect how they interact with the body. Transdermal options, like patches or gels, for instance, have been linked to a lower potential risk of blood clots compared to oral forms in some women.
At the same time, it’s important to note that HRT is not completely risk free. Some studies have linked certain formulations, particularly combined estrogen-progestin therapies with an increased risk of breast cancer. Others have found oral estrogen and progesterone to come with a higher risk of thrombotic events such as blood clots. These risks are not uniform and can vary due to a woman’s personal health history, the type of hormones used, and duration of therapy. Thus if you’re considering HRT, it’s important to discuss your health background with your physician to find the right fit for you.
The push to feel better during menopause
The conversation around hormone replacement therapy is shifting. Doctors now have a much better understanding of the biology behind menopause, recognizing it as a system-wide transition that affects the whole body, not just reproductive health. Earlier concerns about HRT’s risks have been reevaluated, bringing a more balanced view to the table and leading to more conversations about age of use, individual risk factors, and formulation.
As more women openly discuss their experience with menopause, there is a growing push for a smoother transition that comes with fewer disruptive symptoms like hot flashes and sleep disruption. And as the healthcare model shifts from reactive to proactive, people are striving to not just live longer but to maintain their quality of life over time.
Women are also interested in understanding how menopausal hormonal shifts may be reflected in their bodies. Prenuvo offers a Whole Body Scan, Body Composition Analysis, Advanced Heart Health Scan, Advanced Brain Health Scan, and advanced lab testing that can help provide insight into areas influenced by these changes, including:
- Body composition: Changes in muscle mass and fat distribution, including visceral fat
- Cardiovascular health: Markers related to heart and vascular function
- Bone and structural health: Indicators of bone density and musculoskeletal changes
- Brain health: Structural markers associated with cognitive health
Related: The 3 stages of menopause—and how they affect your health
Thinking about HRT? Check in on how hormonal changes are showing up in your body. To learn more about the benefits of whole body MRI, body composition tracking, and advanced blood panels, book a call with a member of our Patient Services Team.
