How Does Hormone Replacement Therapy Work?

Hormone replacement therapy (HRT) helps manage menopausal symptoms by restoring hormone levels that naturally decline during this stage. It comes in different types, including therapies containing a single hormone or a combination of hormones. The choice of therapy depends on individual needs and health factors, such as a history of hysterectomy.⁽¹⁾

HRT also comes in various forms, ranging from oral tablets and transdermal patches to vaginal creams. This flexibility allows for personalized care tailored to specific symptoms and preferences.⁽¹⁾

While HRT offers substantial benefits — such as symptom relief and improved bone health — it may not be suitable for everyone. There may be an increased risk of certain conditions based on the individual’s medical history.⁽¹⁾

This article discusses how HRT works, its types, benefits, potential risks, and key considerations for safe and effective use. A thorough understanding of these aspects helps individuals make informed decisions about managing menopause.

Types of Hormone Replacement Therapy (HRT)

HRT is available in different types and forms and can contain synthetic or bioidentical hormones.

Different Hormones in HRT

HRT uses various hormones to manage menopausal symptoms and improve overall health. 

Estrogen

Estrogen is a key hormone in HRT and plays a central role in managing a wide range of menopausal symptoms. It helps regulate body temperature, effectively reducing hot flashes and night sweats. Estrogen also helps maintain the health of vaginal tissues by alleviating dryness and discomfort. Beyond symptom relief, it supports bone density, reduces the risk of osteoporosis, and promotes skin elasticity and cardiovascular health.⁽¹⁾

Progesterone

Progesterone is primarily used alongside estrogen in women who still have a uterus. This combination is essential because unopposed estrogen (estrogen without progesterone) can lead to an overgrowth of the uterine lining (endometrial hyperplasia), increasing the risk of endometrial cancer. Progesterone helps balance this effect by maintaining the health of the uterine lining.⁽¹⁾ 

Testosterone

Testosterone can help improve symptoms such as low libido, reduced energy, and decreased muscle strength. However, there are no FDA-approved testosterone therapies specifically for menopause. Instead, dehydroepiandrosterone (DHEA), a hormone precursor, may be recommended to naturally support testosterone levels. DHEA is converted into testosterone and estrogen in the body, and supplementation can help restore hormonal balance as DHEA levels decline with age.⁽¹⁾⁽²⁾

Different Ways To Take HRT

HRT is delivered as either systemic therapy or local therapy.

Systemic HRT

Systemic HRT delivers hormones throughout the body via the bloodstream, making it effective for managing widespread menopausal symptoms like hot flashes, night sweats, and bone loss. This type of therapy is ideal for addressing systemic issues caused by declining hormone levels. Below are common methods of systemic HRT:

• Oral tablets

• Patches

• Gels 

• Creams (estrogen, estrogen with progesterone)

Local HRT

Local HRT targets specific areas, such as the vagina, to treat localized symptoms like dryness, itching, or discomfort during intercourse. This form of therapy is designed to minimize systemic absorption, making it a safer option for individuals who may not be suitable candidates for systemic HRT. The following are examples of local HRT options:

• Vaginal creams

• Vaginal rings

• Vaginal tablets

Types of Hormones Used in HRT

HRT can also be categorized based on the types of hormones it uses. These classifications highlight the origin and structure of the hormones, offering options that can be tailored to individual needs and preferences:⁽¹⁾

Synthetic Hormones

Synthetic hormones are created in laboratories and designed to mimic the effects of natural hormones. They have similar but not identical molecular structures to the hormones produced by the body.

Bioidentical Hormones

Bioidentical hormones are derived from plant sources and are chemically identical to the hormones naturally produced by the body. Because of their structural similarity, bioidentical hormones align more closely with the body’s biological processes, making them more compatible for some individuals. They are often perceived as a more "natural" option and, in certain cases, may be associated with fewer adverse effects.

How does HRT work? 

As menopause approaches, the ovaries gradually shrink and stop producing key hormones like estrogen, progesterone, and testosterone. This decline leads to hormonal imbalances that are responsible for common menopausal symptoms such as hot flashes, night sweats, mood swings, and vaginal dryness.⁽¹⁾

HRT works by replenishing these lost hormones, helping restore balance in the body. By supplementing estrogen and, in some cases, progesterone or DHEA, HRT addresses the underlying cause of menopausal symptoms rather than just managing them.⁽¹⁾

Hormones act as chemical messengers, traveling through the bloodstream to different parts of the body. They bind to specific receptors found in various tissues, including the brain, bones, heart, and skin.

When hormones bind to their receptors, they trigger a cascade of biological processes, including the following:⁽¹⁾ 

• Vasomotor Symptoms: HRT alleviates hot flashes and night sweats by influencing the neurokinin B signaling pathway in the hypothalamus. This area of the brain regulates body temperature. 

• Vaginal Health: It can improve hydration and elasticity in vaginal tissues, helping to alleviate dryness and discomfort.

• Bone Health: By acting on bone cells, HRT may slow down bone loss and lower the risk of fractures.

• Mood and Sleep: HRT may support neurotransmitter activity, which could improve mood stability and promote better sleep.

How long does it take for hormone therapy to work?

The time it takes for HRT to show results varies from person to person. However, most individuals begin to notice improvements within a few months of starting treatment. It’s important to remember that each body responds differently, and the timeline can depend on factors like the type of HRT, dosage, and individual health needs.⁽¹⁾ 

Does HRT work for everyone?

HRT can be highly effective for many individuals, but it’s not recommended for those with certain medical conditions. A thorough review of the patient’s health history is essential to determine whether HRT is appropriate. In specific cases, local options may offer a safer alternative.

HRT is generally not recommended for individuals with the following conditions:⁽¹⁾

• Breast cancer

• Endometrial or ovarian cancer

• Stroke

• Blood clots

• Liver disease (In some cases, localized HRT may be a safer alternative, as it bypasses the liver’s metabolism.)

Discovering if HRT is the Right Treatment

HRT is a valuable option for many individuals experiencing menopausal symptoms. By replenishing declining hormone levels, HRT can provide relief from symptoms such as hot flashes, night sweats, and mood swings while also supporting bone health and overall well-being.

However, HRT is not a one-size-fits-all solution. It requires a personalized approach, taking into account individual symptoms, preferences, and medical history. Working closely with a healthcare provider ensures that the benefits of HRT are maximized while potential risks are minimized.

Understanding the different types, delivery methods, and considerations for HRT empowers individuals to make informed decisions about their menopausal care.

Take our quick quiz to find out if hormone replacement therapy could be the right option for managing your menopausal symptoms.