Loading…
A general explainer on estrogen, progestogen and testosterone: routes of delivery, how risk is actually discussed, body identical versus compounded, and what remains uncertain.
Hormone therapy replaces the estrogen the ovaries stop producing, and it is the most effective treatment available for hot flashes and night sweats. Whether it suits you depends on your symptoms, your age, how long since your final period, and your medical history. This is a general explainer to help you follow a clinical conversation. It is not prescribing advice, and it deliberately contains no doses.
Two components, sometimes three:
If you have had a hysterectomy, estrogen alone is generally used. If you have a Mirena style intrauterine system, that can provide the progestogen component in some regimens.
| Route | Form | Notes |
|---|---|---|
| Transdermal | Patches, gels, sprays | Absorbed through skin, bypassing the liver. Not associated with the increased clot risk seen with tablets, so often preferred where clot or cardiovascular risk factors exist |
| Oral | Tablets | Convenient and familiar. Carries a higher venous clot risk than transdermal routes |
| Vaginal | Cream, pessary, tablet, ring | Low dose and local. Treats genital and urinary symptoms only, with very little absorbed into the bloodstream |
| Intrauterine | Hormone releasing system | Can supply the progestogen component while also providing contraception |
Vaginal estrogen sits apart from the rest. It is not systemic treatment, it does not generally require a progestogen, and it can usually be used alongside systemic therapy when genital symptoms are not fully controlled.
These terms are used loosely and the difference matters.
Regulated body identical preparations, such as micronised progesterone and estradiol, are structurally identical to human hormones, licensed, quality controlled and available on prescription. Professional bodies generally regard these as preferred options.
Compounded bioidentical hormones are custom mixed by private clinics or pharmacies, often marketed with saliva or blood testing and personalised blends. Major menopause societies do not recommend them: they are not subject to the same regulation, purity and dose consistency are not assured, and endometrial protection cannot be relied upon. If a clinic offers a bespoke compounded regimen, ask whether the products are licensed.
It is not prescribed to prevent cardiovascular disease or dementia, and it is not established as a standalone treatment for clinical depression. Claims about energy, cognition and general wellbeing are considerably less well supported than the marketing suggests.
This is where outdated headlines cause the most harm, in both directions. A few principles that current guidance broadly shares:
Ask for absolute numbers rather than percentages. A relative increase sounds alarming and can describe a very small change in absolute terms.
Some histories do not rule hormone therapy out but do mean the decision should not be routine. Raise these explicitly:
If menopause occurred before forty five, and particularly before forty, hormone therapy is generally recommended at least until the average age of natural menopause. The reasoning extends beyond symptom relief to bone and cardiovascular protection during years you would otherwise spend without estrogen.
Doses used in this group commonly differ from those used for menopause at a typical age, and combined hormonal contraception is sometimes used instead. This is a situation to discuss with a clinician experienced in it.
Expect a review after starting, since it often takes some weeks to judge the effect and initial side effects such as breast tenderness, nausea or irregular bleeding frequently settle. Bleeding patterns depend on the regimen, and unscheduled bleeding should always be reported.
On stopping: current guidance does not impose an arbitrary age limit or maximum duration. Continuation is an individual decision reviewed periodically. Symptoms may return when treatment stops, and there is no strong evidence that tapering is better than stopping directly, though some people prefer to reduce gradually. Do not stop or change treatment on the basis of a news headline without speaking to your prescriber.
Testosterone is used mainly for persistently low sexual desire causing distress, where other contributors have been addressed and estrogen therapy alone has not helped. In many countries no product is licensed for women, so a male preparation is used at a much reduced dose, which is why prescribing is often specialist. Levels are monitored to stay within the female physiological range, and effects take months rather than weeks to assess. Evidence supports benefit for desire specifically; claims about energy, mood and cognition are not well supported.
Honest summaries include the gaps. Long term outcomes for people starting in their forties and continuing for decades are less well characterised than shorter term data. The comparative long term safety of different progestogens continues to be studied. Effects on cognition are not settled, and hormone therapy is not prescribed to prevent dementia. Optimal duration is individual rather than established.
Combined therapy is associated with a small increase in risk related to duration of use, which declines after stopping. Estrogen only therapy carries little or no increase. Ask for absolute numbers against your own baseline rather than relative figures.
For venous clot risk specifically, transdermal preparations are not associated with the increase seen with oral estrogen, which is why they are often preferred where clot or cardiovascular risk factors exist. Suitability still depends on your history.
Current guidance does not set an arbitrary limit. It is an individual decision reviewed periodically, weighing symptoms, benefits and risks.
Generally no, since the purpose is protecting the womb lining. There are occasional exceptions, for example some histories of endometriosis, so confirm with your clinician.
Major menopause societies do not recommend them. They are not regulated to the same standard, dose consistency is not assured, and endometrial protection cannot be relied upon. Regulated body identical preparations are available on prescription.
It is not a weight treatment. Evidence does not support the idea that it causes weight gain either, and some evidence suggests it reduces central fat accumulation. Midlife weight change is driven more by ageing and muscle loss.
Often yes. Systemic therapy does not always resolve genital and urinary symptoms, and adding low dose vaginal estrogen is common practice. Confirm with your prescriber.
No. Menopausal hormone therapy is not contraception. If you are still in perimenopause you need separate contraception until the criteria for stopping are met.
Hormone therapy is the most effective treatment for hot flashes and night sweats, and it protects bone while taken. The route matters for clot risk, the type and duration matter for breast cancer risk, and timing relative to your final period shapes the overall balance. Early menopause is a distinct situation where the reasoning changes. Regulated body identical preparations are preferred over compounded blends. None of this is a substitute for a conversation with a clinician who knows your history, and nothing here should be used to start, stop or change treatment on your own.
Sources verified 10 September 2026. Clinical guidance is updated periodically, and availability of specific treatments differs by country, so check current national guidance. This article is general information and does not replace individual medical advice. It has not been reviewed by a named clinician; where that changes, the reviewer will be named here.
9 printable pages including a symptom checklist, a 30-day symptom tracker, an appointment checklist and questions to ask — delivered to your inbox.