Hormone Replacement Therapy (HRT): What are my options?

Before you read on, please note that this guide is for education purposes only, and is designed to help you navigate your discussion with a licensed health care practitioner. This guide is not intended as a substitute for medical care. 

I am providing you a paired down, less scientific version of this information. If you want to really go down the rabbit hole, let me suggest this fabulous paper made available by the Cleveland Clinic that separates fact from fiction.

Also, do not sweat all of this information. Your qualified healthcare practitioner (HCP) will help you select the best option for your body!

Let’s start with the three primary types of hormone products available for purchase:

• Non-Bioidentical Hormones: Synthetic hormones that are created in a laboratory and are not identical to the hormones naturally produced by the body. Otherwise known as conjugated estrogen and medroxyprogesterone acetate.
•  Bio-Identical Hormones (bHRT): Bio-identical hormones, on the other hand, have a chemical structure that is identical to the hormones produced by the body. Bio-identical hormones are typically made from a plant steroid, Disogenen, which is extracted from soy or wild yams. The majority of FDA approved therapies are bio-identical and they are made in a lab.
•  Compounded Bio-Identical Hormones: These are customized hormones made just for you by a compounding pharmacy. They can combine various hormones, and may come in unique doses and formulations, but they are not FDA approved or regulated.

Are any of the HRT options safer or more natural?

Not really. Anything that says otherwise is just clever marketing. Most regularly prescribed HRT carries the same risks.

In fact, compounded bioidenticals theoretically provide the most risk as they aren’t approved or regulated by the Federal Drug Administration (FDA).

That isn’t to say that there aren’t great compounding pharmacies that can provide customizable doses. There are fabulous companies out there, but the promise of getting a perfect dose for your body from a saliva test is unreliable science. The hormones in your saliva do not mimic the rest of your body,

Plus, if you have prescription insurance, your monthly hormones will be MUCH less expensive if you take an FDA approved alternative that is covered by your plan. 

You do you! No judgment here. Just helping to separate fact from fiction.

If I want FDA approved HRT or bHRT to treat the symptoms of perimenopause/menopause, what are my options?

For this discussion, I am sticking to estrogen and progesterone. Testosterone is not FDA approved for use in women so we won't discuss it on The Fuchsia Tent, but if you are interested, please talk to your qualified HCP.

• Estrogen: Estrogen is a hormone that plays a crucial role in the development and regulation of the female reproductive system. When estrogen drops, hot flashes, night sweats, bone loss, joint pain and all sorts of other symptoms abound.
• Progesterone: Progesterone is a hormone that plays a key role in the female reproductive system and helps protect and regulate the uterine lining in a woman's body.

For those women cleared to take HRT there is a primary decision point:

• If you still have a uterus, you must take both estrogen and progesterone in order to offset the risks of uterine cancer.
• If you have had your uterus removed, you can take estrogen alone.

If you have to take both estrogen and progesterone, they can be taken alone or in combination. In the tables below I will share the main options for each. I will not separate brands since prescription insurance usually dictates the most affordable option. For more on insurance coverage and how to get the most affordable options, check out my coverage page.

Primary Estrogen Only Options

(all symptoms)

**There are several estrogens that are applied vaginally that are only approved to treat vaginal symptoms. I will cover them elsewhere.

Primary Progesterone Only Options

Combined Estrogen and Progesterone Options

While it may seem easier to get both hormones in one delivery system (pill, patch, etc.), doses cannot be individually adjusted which might be a preferable option as hormones tend to fluctuate throughout the menopausal transition.

In addition you can and should always head over to GoodRx.com to avoid overpaying for prescription medications.

Menopause support and community has a new address, join The Fuchsia Tent today!