Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) supplies estrogen, progesterone, or both to make up for falling hormone levels. Current guidelines increasingly use the term menopausal hormone therapy (MHT). HRT is used in perimenopause and menopause, and in conditions such as premature ovarian insufficiency (POI).

HRT relieves hot flashes and night sweats (vasomotor symptoms) and slows bone loss. It may also lower the risk of heart and blood vessel disease when it starts early after menopause. Known risks include blood clots in the veins (venous thromboembolism). Estrogen combined with a progestogen also brings a small rise in breast cancer risk. That risk varies with the form of therapy, the length of use, and the timing of the start.¹

Consider the case of a 32-year-old woman with POI whose estrogen remains low. Without treatment, she faces faster bone loss, higher heart risk, and effects on the brain and nerves. POI does not always mean that the ovaries have stopped permanently.

About half of affected women still have ovaries that function on and off. About 5% conceive without treatment.¹ Guidelines recommend hormone replacement in POI until at least the average age of natural menopause. Untreated low estrogen at a young age carries known risks.

HRT in this setting replaces hormones at natural body levels for a proven deficiency. Hormones given to suppress normal reproductive function serve a different goal. They carry a different balance of risk and benefit.

Restorative care in perimenopause and menopause addresses symptoms first with lifestyle, nutrition, and a targeted look at the hormonal picture. It considers whole-body hormone therapy once there is a clear reason and her own risk has been weighed. The route, the form, and the length of use each affect that risk.

Transdermal estrogen, for example, enters the body through the skin. It avoids the first pass through the liver that occurs with pills. This difference affects the risk of blood clots.