Journal / Hormone Replacement Therapy

Complete Guide to How Hormone Replacement Therapy Works

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Complete Guide to How Hormone Replacement Therapy Works

Hormone Replacement Therapy

Medical science is capable of delivering answers, and how hormone replacement therapy works are one of them. Hormone replacement therapy (HRT) is a medical treatment that can help you get your solutions when ambushed by aging and menopause. There are many benefits of hormone replacement to treat aging and symptoms of menopause. Let’s look at how hormone replacement works, the benefits of hormone replacement therapy, and the types of hormone replacement therapy available.

With age, you can start experiencing symptoms of hormonal fluctuation such as hot flashes, low libido, vaginal dryness, and insomnia and you may need HRT or low estrogen treatment. To reduce aging symptoms, natural hormone replacement for menopause can be prescribed by healthcare providers. HRT is the most studied and effective form of treatment to date for hot flashes and night sweats. Scientists have yet to unearth a more effective remedy for menopause symptoms than HRT which helps improve the profound mind-body shifts that occur during menopause.1,2

Estrogen, progesterone, and testosterone used as HRT treatments can improve sleep, protect memory and cognitive functions, and even reduce the incidence of breast, uterine, ovarian, cervical, and colon cancers. In combination, these hormones can also reduce hot flashes, night sweats, anxiety, vaginal changes, weight gain, and many other side effects of aging.6-9

Women in their 30’s, 40’s, and 50’s will stop producing as much estrogen, progesterone, and testosterone as they did in their 20s. While the drop in hormones is normal, estrogen levels eventually will drop by 90% and testosterone by 50% of what was produced previously. That’s a lot for your body to handle, but HRT can return your equilibrium. 

There is much for you to enjoy and accomplish in the decades before, during, and after menopause. Who doesn’t want to live longer and age gracefully? But if we want to live longer, we should do it in a healthy way that prevents chronic disease. HRT can allow us to look and feel our best as we age.3-9 While we can’t reverse the aging process, we can slow it down. 

The benefits of HRT are regarded as a cornerstone of anti-aging efforts.10 Currently, women can expect to live about ⅓ -½ of their lives in a state of estrogen, progesterone, and testosterone deficiency if they don’t take HRT. Sagging skin as well as decreased muscle and bone density, suppressed sexual desire, slowed brain function, and painful sex are all associated with aging due to decreased hormones. 

HRT, when done correctly, uses bio-identical hormones that can directly contribute to longevity, and lead to a significant improvement in your quality of life.5-10 By giving the body the estrogen, progesterone, and testosterone it desires you can improve the profound mind-body shifts that occur as you age. You may hear about HRT side effects, and we will discuss them in this review but, HRT is safe when prescribed by a physician.5

Hormones And Menopause

Women who are typically accomplished and capable in so many areas of their lives, often stumble into menopause –  their second hormonally disruptive stage (puberty being the first). The phrase “Scientia potentia est” is Latin for “knowledge is power,” and we aim to provide you with the most current, and thoroughly vetted scientific information available to safeguard against menopause misery and reduce the incidence of long-term diseases.1-9

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Bioidentical or “Natural” Hormone

Estrogen, progesterone, and testosterone are called ‘steroid hormones’ and are found in both men and women. These hormones find their specific hormone receptors on the cells inside of your body to regulate normal cell activity. Scientists are able to produce the same hormones from plants, and they are called bioidentical or ‘natural’ hormones.  For example, bioidentical estrogen hormones bind to an estrogen receptor and signal the same effects in your body as the estrogen your ovaries create.

These bioidentical hormones are regularly used throughout women’s lives for contraception, menstrual complications, or to treat menopause symptoms. During perimenopause, your body slows down the manufacture of its own hormones. This natural decrease in hormones occurs in a very irregular fashion and can cause many complications. Most women don’t recognize that perimenopausal hormone fluctuations are what is causing their sudden changes in mood, weight, sleep, skin and so much more.

Hormone replacement for menopause shouldn’t be complicated or scary. After all, it is an incredibly effective natural remedy for menopause symptoms that simply restores the hormones that women are producing at lower levels as they age. 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 HRT. The main hormones involved in hormone replacement therapy are estrogen, progesterone, and testosterone.

Estrogen Therapy Use

The estrogen hormone is found in both men and women. For women, estrogen plays an important role in managing the reproductive system, but it also protects your bones, improves heart health, helps with vaginal dryness, painful intercourse, and helps your skin heal from bruises and injury. 

Your estrogen production will naturally slow as you get older. As estrogen levels fall, you will start having symptoms of menopause. As estrogen levels drop, HRT can help replace your estrogen levels and ease symptoms. Most commonly, these symptoms include:

  • Hot flashes

  • Mood disorders and anxiety

  • Vaginal dryness

  • Weight gain

  • Brain Fog

  • Muscle and joint pain

  • Painful intercourse

  • Difficulty sleeping

  • Dry, wrinkly skin

  • Excessive sweating

  • Heart palpitations

  • Urinary problems and UTIs

Taking hormone replacement therapy early can improve memory, concentration, and cognition. It may also help protect against long-term health risks like heart disease, stroke, cancers, Type 2 Diabetes, and more.2-6Estrogen therapy can be provided in the form of a pill, patch, cream, and vaginal cream.

Benefits of Hormone Replacement Therapy

  1. Vagina: Lessens vaginal dryness, pain, vaginal itching, and discomfort during intercourse.  HRT can improve vaginal atrophy (thinning of lining).

  2. Improve sleep by decreasing anxiety, night sweats, and insomnia.

  3. Sex: Make sex less painful, more enjoyable, and increase libido.

  4. Bladder: Reduces urinary tract infections, and risk of incontinence and other bladder problems.

  5. Weight Loss: Counterweight gain, and assist in weight loss.

  6. Hot Flashes (Vasomotor): Reduce the frequency and intensity of hot flashes and sweats.

  7. Mood: Curtail the frequency and severity of mood swings and decrease depression.

  8. Brain: Improve concentration and focus, may reduce risk of Alzheimer’s disease and dementia.

  9. Anti-Aging & Skin: Increases skin collagen content, thickness, elasticity, and moisture levels which results in the reduction of skin changes associated with aging such as wrinkles or sagging. 

  10. Heart Disease: Protection from heart disease.

  11. Breast Cancer: Reduced risk of invasive breast cancer.

  12. Colon cancer: Lower the risks of colorectal cancer.

  13. Diabetes: Decrease the development of Type 2 diabetes.

  14. Mortality: Improve life expectancy in women during the 5 years of HRT.

  15. Healing: Enhance wound healing, and reduce the incidence of wound complications.

  16. Stroke: Lower stroke risk.

  17. Muscles: Maintain and enhance muscles, and strength. Decrease muscle aches and pains.

  18. Migraines: Diminish migraine symptoms.

  19. Bone: Prevent bone loss that is accelerated at menopause. Fewer bone fractures with HRT. 

  20. Wellness: Improve long-term disease prevention. HRT promotes a better quality of life. 


Progesterone Therapy Use

Once a woman hits her mid to late 30’s progesterone production starts to decline and perimenopause begins. Once she reaches menopause, circulating progesterone levels are so low that they are similar to levels seen in men. Research shows that progesterone supplementation can improve brain function as well as breast, cardiovascular, and nervous system health and decrease the risk of uterine cancer.  

Progesterone acts as a natural antidepressant and can enhance your mood and relieve anxiety. It actually stimulates the brain’s ‘feel-good,’ center. Progesterone nicknames include ‘miracle hormone,’  ‘the great sedator,’ and  ‘happy cream.’  So it makes sense then that when progesterone levels drop with menopause, anxiety can become a major menopause symptom.8

While there are many causes of anxiety – your kids, your job, or something else  – progesterone hormone deficiency is the main factor leading to moodiness, brain fog, and depression during menopause. Researchers have shown that progesterone appears to be the most potent anti-anxiety hormone for menopausal women.15-20

Progesterone also helps with the sleep problems so often associated with menopause. Researchers found that taking progesterone daily at bedtime improved the quality of deep sleep. Not only will it make you sleepy but progesterone can reduce the severity of night sweats, which can awaken women from an otherwise sound sleep.15-20

During menopause, many people describe a fogginess in their thinking, and memory problems. Progesterone may protect against cognitive decline if HRT starts early in the menopause process. Specifically, progesterone improved visual and verbal memory for people in menopause.16

After hot flashes, the next most troublesome symptom of menopause is delayed or interrupted sleep. Researchers found that taking progesterone at bedtime improved the quality of deep sleep. Not only will it make you sleepy, but progesterone can reduce the severity of night sweats, which can awaken women from an otherwise sound sleep.15-20

Progesterone is a hormone that deserves to be noticed outside of its role with estrogen. Estrogen and progesterone do not have to be prescribed together. Some believe that progesterone should only be prescribed together with estrogen and only if a woman still has her uterus. However, the protective benefits of progesterone are realized throughout the entire body, and not just the uterus. 

Benefits of Progesterone Supplementation (as related to women 40+):

  • Eases anxiety, stress, and has a calming effect on both the mind and the body.

  • Improves mood. Depleted progesterone can cause mood swings and depression. 

  • Promotes memory. Progesterone stimulates brain processes and the nervous system.

  • Enhances sleep. Take before bed to help resume normal sleep cycles; it has a sedative effect.

  • Helps regulate estrogen. If progesterone levels are low, this can throw off estrogen too. 

  • Helps Prevent Diabetes. Progesterone and estrogen work together to balance the release of insulin and if thrown off you can have an increased risk for Insulin Resistance or Diabetes.

  • Protects from Cancer: Progesterone prevents overgrowth of certain types of cells and can help protect against some cancers including those of the breast or the uterus

  • Reduces weight gain and helps the metabolism by contributing to the use of fat for energy.

  • Prevents Heart Disease. Progesterone assists in preventing plaque from forming on arterial walls and lowers triglycerides.

  • Bone formation. Essential for bone growth and loss of Ca

  • Thyroid Gland. Assists in the proper function of the thyroid gland

  • Anti-Aging. Can help to slow down the aging process

  • Improves libido/ sex drive

  • Reduces  migraines

  • Reduces inflammation and joint pain

Personalized hormone treatments. For you.

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Personalized hormone treatments. For you.

Testosterone Uses

Testosterone therapy is not a men’s only club. We see lots of low testosterone (T) treatments, or “Low T treatment,” clinics – but the emphasis is on men. Testosterone replacement therapy (TRT) can be a way for both men and women to replace your lost testosterone. Testosterone levels peak in a woman’s ’20s and start to drop years before perimenopause. By menopause, most women’s levels are half of the peak levels.22

Because it is typically a slow decline, women can be wooed into complacency about feeling – terrible. Tiredness, depression, headaches, cognitive problems, osteoporosis, and lean body tissue loss are additional complications from low testosterone.21Unfortunately, women and even their healthcare providers often don’t recognize that their exhaustion, aching bones, weight gain (~ over 20 lbs), brain fog, and painful sex are caused by low estrogen, progesterone, and testosterone.  TRT can help relieve these testosterone-related symptoms quickly and safely.21-25

While it may seem like an unlikely treatment for menopause, TRT is used safely and effectively as one of the natural remedies for menopause symptoms.  Research has shown that giving testosterone (T) supplements may ease hot flashes, sleep problems, irritability, and fatigue. T treatment can be a beacon of hope for many women who feel blindsided when they step into peri- and menopause.21-24

Symptoms of Low Testosterone in Women include:

  • Low sexual desire, arousal, orgasm,

  • Reduction in general quality of life, 

  • Tiredness & Fatigue,

  • Mood Changes & Depression, 

  • Headaches, 

  • Hair thinning

  • Skin dryer and thin

  • Weight Gain,

  • Cognitive problems, 

  • Loss of muscle mass,

  • Osteoporosis,

  • Changes in breast tissue,

  • Vaginal dryness

Here is a full list of the roles testosterone can play in a woman’s health:

  • Energy & Metabolism

  • Urogenital Health

  • Mood and Quality of Life

  • Brain Health & Cognitive function

  • Muscle health and strength

  • Bone health and strength

  • Breast health

  • Sexual arousal, libido & orgasm

  • Vaginal health, decrease vaginal atrophy

  • Fat distribution & reduction

  • Red blood cell production

  • Anti-Aging

  • May help cardiovascular health14

Ways of Taking HRT Therapy/Types of HRT

Winona physicians are devoted to understanding your health concerns and symptoms. We use scientific-based protocols to treat the root cause of hormonal imbalances. Bioidentical hormones can be administered as oral micronized tablets or creams. 

Our products are natural estrogen or progesterone,  made from yams from the variety Diascorea uilosa. When extracted from these sources, they are considered bioidentical to the progesterone and estrogen a woman’s body makes. Traditional table yams you find in the market won’t offer the same benefits.

Creams: Natural estrogen and progesterone are available as a cream. The body absorbs creams well, making them more available in the bloodstream. Winona’s creams are easy to use – just apply a dime-sized amount of cream onto the inside of the wrists, arms, stomach, or thighs. 

Patches: Hormonal or transdermal skin patches are used as an estrogen hormone delivery system to treat particular symptoms of menopause such as hot flashes and vaginal dryness, burning, and irritation. The patches are called transdermal (“trans” meaning “through” and “dermal” referring to the dermis or skin). The body absorbs the hormones from patches well, making them more available in the bloodstream.

Pills: Natural progesterone and estrogen pills are also available. However, the liver breaks down hormones quickly, so less becomes available to the bloodstream. A person would have to take more oral hormones than they would if they chose to apply the estrogen or progesterone cream. When estrogen and progesterone are taken together, it’s often in pill or cream form. Progesterone is in a micronized form, which is easily metabolized in the body. 

DHEA pills or Dehydroepiandrosterone (also known as androstenolone) is a chemical that can be broken down to become testosterone. DHEA, a steroid precursor (also called prohormone), is a natural substance that your body can convert into testosterone.

Winona offers DHEA, a testosterone precursor, to gently yet effectively replace the testosterone that can be missing in the menopausal woman. Women deserve the right to choose to replace testosterone, but there are currently no testosterone products for female use licensed in the US. So, some women will try to use products licensed for men, but there is a better way to have your testosterone replaced. Taking DHEA is a preferable method to add T overusing products designed for men and cutting the dose. Taking a man’s prescription is not legal and could lead to taking too much testosterone.  

DHEA is naturally produced in your adrenal glands, ovaries, and brain.5 By providing DHEA to women who are low in T, they can increase their T levels by adding DHEA which converts to T.  We use DHEA, sometimes in combination with anastrozole, to gently and safely return testosterone to normal levels. DHEA is a testosterone precursor that the body naturally breaks down into a combination of estrogen and testosterone. 

Anastrozole is a medication that can block the conversion of DHEA to estrogen. By adding anastrozole, more of the DHEA ends up as testosterone. This can give a slightly higher testosterone boost for women that need a bit more testosterone.21-34

Personalized hormone treatments. For you.

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Personalized hormone treatments. For you.

HRT Is Not For Everyone 

Some health conditions place women at higher risks for diseases associated with hormone therapy. However, Winona physicians will go over your health history in detail before prescribing bioidentical hormones. The benefits of hormone replacement therapy may help you, but your doctor may decide if HRT is right for you. HRT isn’t right for you if you have or have had:

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

  • Endometrial and Ovarian Cancer: If there is a personal history, or very strong family history, of endometrial or ovarian cancer, women should not take estrogen. 

  • Stroke: This can likely be reduced by using transdermal patches or creams rather than oral estrogen replacement.

  • Blood Clots: The risk is reduced by using a transdermal patch or creams rather than oral estrogen replacement.

  • Unexplained vaginal bleeding

  • Liver disease

  • You also shouldn’t use HRT if there’s any chance you might be pregnant.

Side Effects

The North American Menopause Society (NAMS) released guidelines in 2017 saying that for most women with bothersome menopausal symptoms, the benefits of hormone therapy outweigh the risks in women less than 60 years old or within 10 years of being menopausal. Furthermore, for women who use transdermal estrogen (a patch or cream) instead of oral estrogen, there is even less risk. 

Currently, the Food and Drug Administration (FDA) approves the use of estrogen and progesterone hormone therapy medications for treating hot flashes and vaginal dryness and preventing osteoporosis. Other benefits of hormone therapy may include help with negative mood changes, better sleep quality, and alleviating “brain fog.” The most common side effects of the hormones associated with HRT include:


  • bloating.

  • breast tenderness or swelling.

  • swelling in other parts of the body.

  • leg cramps.

  • headaches.

  • indigestion.

  • initial vaginal bleeding.


  • headache.

  • breast tenderness or pain.

  • upset stomach.

  • diarrhea.

  • constipation.

  • tiredness.

  • muscle, joint, or bone pain.


  • Increased body hair at the site of the application is occasionally a problem if cream on the same location and too thick (uncommon)

  • Alopecia, male pattern hair loss (uncommon)

  • Acne and greasy skin (uncommon)

  • Deepening of voice (rare)

  • Enlarged clitoris (rare)


Winona helps women to receive better, more up-to-date, and informed guidance about how hormone replacement therapy works and their aging and menopause journey. Gone are the days of facing an exhaustive list of baffling, life-altering symptoms.

While menopause is a normal phase of life, there are ways to treat the often-chronic symptoms that result from it. We encourage you to try various treatment options whether it is Hormone Replacement Therapy, diet, or lifestyle changes (or all three) to identify what works best. Remember, menopause is a positive beginning, with the opportunity to take preventive action against major health risks associated with the decreasing hormones linked 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 as 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.”