Menopause brings a variety of physical and emotional changes, many of which stem from declining hormone levels—especially estrogen and progesterone. Hormone therapy (HT) remains one of the most effective treatments for relieving menopausal symptoms. But not all hormone therapy is the same.
This guide breaks down the main types of hormone therapy for menopause, comparing estrogen-only therapy, combined hormone therapy, and bioidentical hormone therapy, to help you determine which one may be right for you.
Why Hormone Therapy?
Menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT), helps alleviate common symptoms like:
- Hot flashes and night sweats
- Vaginal dryness and discomfort
- Mood swings and brain fog
- Sleep disturbances
- Thinning bones (osteoporosis)
By supplementing estrogen (and sometimes progesterone), hormone therapy can restore balance and improve overall well-being. But choosing the right type of hormone therapy depends on several factors, including whether you’ve had a hysterectomy, your health history, and personal preferences.
1. Estrogen-Only Therapy (ET)
What It Is:
Estrogen-only therapy provides estrogen without progesterone and is usually prescribed for women who have had a hysterectomy (surgical removal of the uterus).
Common Forms:
- Oral pills
- Transdermal patches
- Topical gels and sprays
- Vaginal creams, rings, or tablets
Pros:
- Most effective option for treating hot flashes and vaginal dryness
- Reduces risk of osteoporosis
- Simpler regimen with fewer side effects for women without a uterus
Cons:
- Not suitable for women with an intact uterus due to risk of endometrial cancer
- Potential risks of blood clots and stroke (depending on age and delivery method)
Best For:
- Women without a uterus who need relief from moderate to severe menopausal symptoms
2. Combination Therapy (Estrogen + Progestogen)
What It Is:
Combination hormone therapy includes both estrogen and progestogen (a synthetic or natural form of progesterone). It’s prescribed to women who still have their uterus.
Why Progestogen Is Added:
Estrogen stimulates the growth of the uterine lining (endometrium). Progestogen counteracts this and protects against endometrial hyperplasia and endometrial cancer.
Common Forms:
- Oral tablets
- Skin patches
- Cyclical or continuous regimens
Pros:
- Treats vasomotor symptoms (hot flashes, night sweats)
- Reduces risk of uterine complications
- Protects against bone loss
Cons:
- Slightly higher risk of breast cancer with long-term use
- May cause irregular bleeding or spotting initially
- Slight increase in risk of blood clots, stroke, or heart disease in older women
Best For:
- Women with an intact uterus who need full symptom relief and endometrial protection
3. Bioidentical Hormone Therapy (BHT)
What It Is:
Bioidentical hormones are compounds chemically identical to those produced by the human body. They’re derived from plant sources (typically yams or soy) and can include estradiol, estriol, and micronized progesterone.
Types:
- FDA-approved bioidentical hormones (e.g., Estrace®, Prometrium®, Vivelle-Dot®)
- Custom-compounded bioidentical hormones made at specialty pharmacies
Pros:
- Perceived as more “natural” due to identical molecular structure
- May be customized to fit individual hormonal needs
- FDA-approved bioidentical options are available and tested for quality
Cons:
- Compounded bioidentical hormones are not FDA-regulated or standardized
- Limited large-scale studies on safety and effectiveness of compounded versions
- Still carry similar risks to conventional hormones (e.g., clotting, breast cancer)
Best For:
- Women looking for personalized or bioidentical-based treatment
- Those with sensitivities to conventional hormone formulations
- Patients interested in a more “natural” hormone option—preferably using FDA-approved products
Choosing the Right Hormone Therapy: Key Factors to Consider
| Factor | Estrogen-Only | Combination Therapy | Bioidentical Hormones |
|---|---|---|---|
| Uterus Present? | Only if removed | Required if uterus intact | Both (depends on formulation) |
| Symptom Severity | Moderate to severe | Moderate to severe | Mild to severe (customizable) |
| Personalization | Standardized | Standardized | Highly customizable |
| Regulation | FDA-regulated | FDA-regulated | FDA-approved OR compounded |
| Cancer Risk | Low (if uterus removed) | Slightly higher with long-term use | Similar risks to conventional hormones |
Final Thoughts: Which Hormone Therapy Is Right for You?
There’s no universal answer to the “best” hormone therapy—it depends on your individual health, menopausal symptoms, uterine status, and risk factors. Here’s a quick summary:
- ✅ Choose estrogen-only therapy if you’ve had a hysterectomy and need symptom relief.
- ✅ Opt for combination therapy if your uterus is intact and you need full-body symptom management.
- ✅ Consider bioidentical hormone therapy if you’re seeking a more natural or customized option—but favor FDA-approved versions over unregulated compounded ones.
Always consult with a menopause specialist or gynecologist to review your personal and family medical history before starting hormone therapy. Regular monitoring and follow-up are essential to ensure both effectiveness and safety.
