Hormone Therapy for Menopause: What Every Midlife Woman Needs to Know

Midlife is full of surprises. Hot flashes in the middle of a meeting. Night sweats that soak your sheets. Mood swings that make you feel like a teenager again. And somewhere along the way, someone mentions HRT aka hormone replacement therapy, and suddenly, the options are overwhelming.

I remember sitting with a client who asked me: “Karen, is vaginal estrogen really HRT? Am I going to regret taking systemic hormones? How do I know if I need testosterone?" 

If you’ve ever asked yourself the same questions, you’re not alone.

The truth is: hormone therapy isn’t one-size-fits-all, and understanding your options is the first step toward feeling like yourself again.

Systemic Hormone Therapy 

Systemic hormone therapy means the hormones you take circulate throughout your entire body, not just in one spot.  

Forms include:

Pills (oral)

Patches (transdermal)

Gels or sprays

Why delivery method matters:

Oral pills go through your liver first, which can slightly increase the risk of blood clots.

Patches or gels deliver hormones directly into the bloodstream, bypassing the liver, which generally lowers that clot risk.

Why clot risk matters:
Hormone therapy can slightly increase the chance of forming a blood clot, especially in women who:

Smoke

Have a history of clots or cardiovascular issues

Are older than 60

It’s not meant to scare you, it’s just one reason why your doctor will personalize your hormone therapy type and dose. Choosing the right delivery method is part of keeping systemic HRT effective and safe for you.

Vaginal Estrogen (Low Dose)

 Targets dryness, discomfort, and intimacy issues

 Minimal absorption into the bloodstream

 Won’t fix hot flashes or night sweats

Pro Tip: Don’t underestimate vaginal estrogen. Localized therapy is highly effective and safer for many women.

Combined Therapy (Estrogen + Progesterone)

Needed if your uterus is intact

Protects uterine lining from estrogen-only therapy

Can be delivered as pills, patches, or IUDs

Even small adjustments, like choosing a different delivery method, can make a big difference in side effects and comfort.

Benefits vs Risks

Benefits:

Symptom relief (hot flashes, night sweats, vaginal discomfort)

Improved sleep and mood

Bone health support

Risks:

 Blood clots, stroke, or breast cancer depending on your health history

Always discuss duration, dose, and personal risk factors with your healthcare provider

Timing & Personalization

Perimenopause, menopause, and post-menopause present different hormone needs

Your symptoms, age, and medical history matter

Personalized plans are safest and most effective

HRT isn’t permanent.  You and your clinician can adjust as your body changes.  Even with HRT, strength training, proper nutrition, and stress management amplify benefits. Muscle preservation and bone health don’t come from hormones alone!