Journal / Women's Health Initiative

Hormone Replacement for Menopause – Is it Safe?

Dr. Green
Nancy L. Belcher

Medically reviewed by Dr. Green OB/GYN Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated October 08, 2021

Hormone Replacement for Menopause – Is it Safe?

What Do You Need To Know About Hormone Replacement Therapy?

Hormone replacement for menopause or simply ‘hormone replacement therapy’  (HRT) is the most studied and effective form of treatment for menopause symptoms, especially hot flashes and night sweats. Scientists have yet to unearth a more effective remedy for menopause symptoms. Hormone replacement therapy gives the body the estrogen, progesterone, and testosterone it desires in order to improve the profound mind-body shifts that occur during menopause and perimenopause. 

In the months or years leading up to perimenopause and menopause, you might start experiencing the effects of hormonal fluctuation such as hot flashes, anxiety, weight gain, low libido, vaginal dryness, and insomnia. When you decide that you want to reduce these symptoms, healthcare providers can prescribe bioidentical hormones, or hormone therapy. The main hormone often discussed in HRT for menopause is estrogen. However, progesterone and testosterone must be included in the hormone replacement discussion. But what is Hormone Replacement Therapy?

Hormone replacement therapy shouldn’t be complicated or scary. It simply restores the estrogen, progesterone, and testosterone that women gradually start producing at lower levels as they age. HRT is an incredibly effective, natural remedy for your menopause symptoms. But our societal norms stigmatize aging and menopause. Even the discussions about hormonal fluctuations are considered taboo. Additionally, because some outdated research continues to get amplified on the internet, there is unnecessary fear associated with taking control of your menopause journey and trying hormone replacement therapy. 

It is estimated that only one in four, or 25%, of the women who could/would benefit from hormone replacement therapy, will actually try it. We understand. After reading some of the false reports about HRT we recognize how women might be scared by hormone therapy when they hear these inaccurate, negative reports. Talking to friends, older relatives and reading these antiquated journal articles only make the fears more real.2 

It doesn’t have to be this way, but the disinformation continues. Winona aims to help you make choices that reflect your hopes – and not your fears.

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Hormone Replacement for Menopause – How Is It Safe?

A very common question women have is whether or not hormone replacement therapy (HRT) for menopause is safe. The short answer is that hormone replacement for menopause is extremely safe for the majority of women. If this is true, why is there so much scary stuff out there regarding the risks of HRT? The answer is, “it’s complicated.” To understand where all the false information about the risks of menopause HRT comes from, we must look at the history of the use of hormone therapy.

Before 2002, hormone replacement was recommended for almost all women from the time they approached menopause until the day they died. Scientists believed that hormone replacement therapy was good for everyone, and for the entire second half of their life. In retrospect, we were probably overusing hormone replacement. 

In 2002, the Women’s Health Initiative (WHI) study results were released and turned everything that we thought we knew about hormone replacement therapy completely upside down. The WHI study reported that like most medications, there are risks and benefits to hormone replacement therapy and we should be careful who we prescribed it for.

We still agree with this summary. But, the Women’s Health Initiative’s additional results made huge headlines and, unfortunately, caused panic among post-menopausal women. People became very afraid of hormone replacement therapy because of the idea that adding back your body’s natural estrogen, progesterone, and testosterone hormones carried a risk. This huge overreaction to the WHI study caused hundreds of thousands of women to suffer needlessly from unjustified fear of HRT for decades.

When the data from the WHI study was examined critically, it turned out that the actual risk of something bad happening (a poor medical outcome) from the hormone replacement therapy (HRT) medicines was only 19 out of 10,000 women. That is not zero, but a very small risk. Not only was the risk small, but the hormones that were used are now considered “old fashioned” and out-of-date. Winona does not sell those hormones.

Since the WHI study was conducted, there have been much safer types of estrogen, progesterone, and testosterone hormones developed that have a much lower risk. At Winona, we do not offer the “old fashioned” hormones used in the Women’s Health Initiative study.

We use only the safest hormones available. Furthermore, the old WHI study only used oral forms of progesterone and estrogen hormones (tablets). Today we offer new delivery systems, like patches and creams, that offer an alternative way of getting your hormones that can further decrease any risk in some women. Winona offers all of these methods: creams, patches, and tablets.

So, even when women were taking these older hormones, the risks associated with hormone replacement were low. Today, 30 years since the beginning of the WHI, we use great screening and safer choices of estrogen, progesterone, and testosterone hormones. The risk of using these new hormones is extremely low. 

The knowledge scientists have gained over the past six decades, together with advances in research techniques, have allowed us to develop more personalized hormone strategies to prevent and treat conditions when our bodies create less estrogen, progesterone, and testosterone.1 Shipped by Winona’s private pharmacies, it comes as a pill or cream. 

Winona provides estrogen, progesterone, and testosterone that is chemically identical to the kind made by women’s ovaries, and is described as “bioidentical.” Hormones’ job is to bind to and stimulate receptors that are found inside most human cells. In your body, these bioidentical hormones will bind to receptors and signal the same effects in your body that you were able to produce before perimenopause and menopause. These bioidentical compounds are originally produced from plant hormones.

Hormone replacement for menopause can profoundly improve one’s quality of life and prevent diseases including cancers, stroke, heart problems and so much more. It is a shame that so many women have missed out on this huge benefit due to fears that come from a misunderstanding of the actual scientific data. Let’s change the future, and change what menopause looks like!

HRT for Menopause Therapy

Hormone replacement therapy uses bioidentical hormones and can directly contribute to longevity, yes living longer, and lead to a significant improvement in your quality of life.11 Taking hormone replacement therapy early in menopause can promote memory, concentration, and cognition.

Research shows that progesterone supplementation can improve brain function as well as nervous system health. In combination, the hormones estrogen, progesterone, and testosterone can also help protect against long terms health risks like cardiovascular disease, stroke, cancers, and Type 2 Diabetes.

Once a woman hits her mid to late ’30s, she can enter perimenopause, and her levels of estrogen, progesterone, and testosterone production will start to decline. Once she reaches menopause, circulating hormone levels are way off –  in fact, her progesterone levels are so low that they are similar to levels normally seen in men.1

Progesterone is an often overlooked hormone, but it might surprise you to hear that progesterone acts as a natural antidepressant and can enhance your mood and relieve anxiety. It actually stimulates the brain’s ‘feel-good,’ center. So it makes sense then that when progesterone levels drop with menopause, anxiety can become a major menopause problem.5 Researchers have shown that replacing progesterone appears to be the most potent anti-anxiety hormone for menopausal women.6,7 

While there are many causes of anxiety – your kids, your job, or something else  – a progesterone hormone deficiency is the main factor leading to moodiness, brain fog, and depression during menopause. When excessive anxiety occurs daily, it can become disabling. When progesterone levels are restored to normal with bioidentical progesterone HRT medication, women have noticed anxiety relief, decreased irritability, and less nervous tension.5,6,7

Estrogen and progesterone also help with the sleep problems often associated with menopause. After hot flashes, the next most troublesome symptoms of menopause are insomnia or interrupted sleep. Researchers found that taking progesterone daily at bedtime improved the quality of deep sleep.9 Not only will progesterone make you sleepy but it can reduce the severity of night sweats, which can awaken women from an otherwise sound sleep.9

Anti-Aging and HRT

Who doesn’t want to live longer and age gracefully? But, if we want to live longer we should also try to look and feel good doing it, right? While we can’t reverse the aging process, we can slow it down. Hormone replacement therapy is regarded as a cornerstone of anti-aging efforts.10

If hormone replacement therapy is not used at menopause, women can expect to live about ⅓ -½ of their lives in a state of sex-hormone deficiency (not enough estrogen, progesterone, or testosterone). That is a huge problem because the long-term repercussions include an increased risk of cancer, stroke, heart disease, dementia, and more!

When people talk about anti-aging they often think about skin aging – which is a real problem – but we are also talking about decreases in muscle, bone density, sexual desire, and intellectual activity which can lead to heart problems, mood disorders osteoporosis, painful sex, cognitive decline, and dementia. Bio-identical hormones can give you back the many benefits of estrogen, progesterone, and testosterone. 

Estrogen and progesterone also have direct effects on another hormone, insulin. Insulin can impact both weight loss and longevity. If you produce too much insulin you can actually speed up the aging process. Estrogen and progesterone can reverse insulin’s effects and slow the signs of aging that you may be noticing. By helping to control your stress levels, progesterone can again be considered an anti-aging hormone.

Although many think of it as a ‘male’ hormone, testosterone is also an important female hormone that plays a critical role in women’s health.4 Testosterone helps to maintain normal metabolic function, muscle and bone strength, urogenital health, mood, and cognitive function.4 A deficiency in testosterone can also lead to low sexual desire, arousal, and trouble reaching orgasm. 

Tiredness, depression, headaches, cognitive problems, osteoporosis, and lean body tissue loss are additional complications from low testosterone.4 Testosterone levels peak in a woman’s ’20s and start to drop years before perimenopause. By menopause, most women’s levels are half of their peak levels of testosterone.5 Winona offers DHEA, a testosterone precursor, to gently yet effectively replace the testosterone that is missing in menopausal women.

Estrogen, progesterone, and testosterone can improve sleep, protect memory and cognitive functions, and even reduce the incidence of breast, uterus, ovarian, cervical, & colon cancers. 2,3,11

Personalized hormone treatments. For you.

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Benefits of  Hormone Replacement Therapy:

  1. Sleep: HRT helps with the sleep problems so often associated with menopause. 

  2. Bone: Hormone replacement therapy can prevent the bone loss that is accelerated at menopause. With HRT, fewer women have a bone fracture due to weaker bones and the evidence of estrogen treatment to prevent bone loss is excellent. 

  3. Stoke: Starting HRT within 5 years of menopause does not increase the risk of stroke as previously reported in outdated research. Patches and creams are safer than pills, and vaginal estrogen can lower the risk of stroke.

  4. Weight Gain/Loss: HRT can help with weight loss by increasing your lean muscle mass and your metabolism. It can also help with sleep leading to decreased food cravings.

  5. Vagina: Hormone replacement therapy lessens vaginal dryness, pain, and discomfort during intercourse.

  6. Bladder: HRT strengthens the muscles of the bladder which can reduce the frequency of urinary tract infections, and the risk of incontinence and other bladder problems.

  7. Hot Flashes (Vasomotor): Hormone replacement therapy is the most effective way known to reduce the frequency and the intensity of hot flashes and sweats that can significantly reduce the quality of life for many menopausal women.

  8. Anxiety: HRT has been shown to decrease anxiety.

  9. Mood & Depression: HRT can curtail the frequency and severity of mood swings and decrease depression.

  10. Brain: Concentration, memory, and focus are improved with hormone replacement therapy, and early research indicates that estrogen treatment may decrease the risk of dementia if provided at perimenopause or menopause stages. 

  11. Skin: Elasticity, thickness, and moisture levels in the skin are increased with hormone replacement therapy which results in the reduction of common skin changes associated with aging such as wrinkles or sagging. 

  12. Heart Problems: Recent studies using Winona type of HRT (micronized) progesterone provides additional protection from heart disease. 

  13. Breast, Uterine, & Colon Cancer: Recent studies using the type of Winona HRT (micronized) estrogen, progesterone, and testosterone can reduce the risk of certain cancers. Fewer women develop colon and uterine cancer when they are on HRT than those who are not on HRT.

  14. Diabetes: Fewer women develop Type 2 diabetes when on hormone replacement therapy possibly due to the weight control, and insulin regulation that HRT provides.

  15. Mortality: Fewer women die during the 5 years they are on hormone replacement therapy than women who are not taking HRT.

Risks of Estrogen Treatment:

  1. Breast: If there is a personal history, or very strong family history, of breast cancer women should not take estrogen therapy. However, it is very important to understand the actual risk.

  2. Endometrium: If there is a personal history, or very strong family history, of endometrial cancer women should not take estrogen. There was no increased risk of endometrial cancer with hormone replacement therapy in recent studies but, it is important to understand the risk.

  3. Stroke: The likelihood of having a stroke can be reduced by using transdermal patches or creams rather than oral estrogen replacement (tablets).

  4. Pulmonary Embolism: The risk of pulmonary emboli is reduced by using a transdermal patch or creams rather than oral estrogen replacement (tablets).


Our current knowledge of estrogen, progesterone, and testosterone hormone replacement for perimenopause and menopause is that it is extremely safe. Winona takes safety very seriously. We use only the safest hormones and tailor the delivery system to the individual needs of each woman.

We will ask a series of health questions to make sure you are a good candidate for hormone therapy. A women’s health specialist will work with each individual patient to tailor a treatment that is both safe and effective.

While menopause is a normal phase of life, there are ways to treat the often-chronic symptoms that result from menopause. Winona encourages women to try various treatment options whether it is hormone replacement therapy, diet, or lifestyle changes (or all three) to identify what works best for them. Remember, menopause is a positive beginning, with the opportunity to take preventive action against major health risks associated with the decreasing hormones associated with menopause.

Whether experiencing severe or minor symptoms, women can embrace their evolving bodies by providing the nutrients their body needs like estrogen, progesterone, and testosterone. Bioidentical hormones used in HRT can enable them to move through this sometimes precarious phase with grace and wellness. Let the Winona women’s health care experts work with you to replace the missing ingredients to help you feel, and stay, young and healthy.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”