This article is for general education and does not provide a diagnosis or replace individualized medical care.
Why is estrogen used in menopause hormone therapy?
Estrogen is the main hormone used to treat many menopause symptoms. Systemic estrogen can be delivered by pills, patches, gels, or sprays, while local vaginal estrogen is used when vaginal or urinary symptoms are the primary concern.
Why is progesterone or another progestogen sometimes added?
Systemic estrogen can stimulate the lining of the uterus. For patients who still have a uterus, a progestogen is generally added to reduce the risk of endometrial cancer from unopposed estrogen.
Patients who have had a hysterectomy may be able to use estrogen without a progestogen, depending on their individual history.
Are “bioidentical” hormones different?
Some FDA-approved estradiol and micronized progesterone products are chemically identical to hormones produced by the body. The word “bioidentical” does not mean a product must be compounded.
Compounded hormones can be appropriate for a specific need, such as an allergy to an ingredient or unavailable dosage form, but they should not be assumed to be safer or more effective than FDA-approved options.
How is the route selected?
Route depends on the symptom being treated, medical history, convenience, cost, side effects, and risk factors. Oral and transdermal estrogen are not identical from a pharmacologic standpoint, and route choice should be individualized.
For a broader overview, see menopause hormone therapy.
What is micronized progesterone?
Micronized progesterone is an FDA-approved form of progesterone used in some menopause regimens. It is one possible way to provide endometrial protection when systemic estrogen is used in a patient with a uterus. Other progestogen strategies may also be appropriate depending on the clinical situation.
Does everyone need the same dose or schedule?
No. Regimens can be continuous or cyclic, and the appropriate dose and schedule depend on the estrogen regimen, bleeding pattern, uterus status, patient preference, and other clinical factors. This is one reason treatment should be individualized rather than copied from another person’s prescription.
What about local vaginal estrogen?
When low-dose vaginal estrogen is used for isolated vaginal or urinary symptoms, the clinical considerations differ from systemic therapy. Patients should still review their personal history with a clinician, but the treatment goal and degree of systemic exposure are not the same as with a systemic estrogen regimen.
If your main concern is dryness, discomfort with sex, or urinary symptoms, see vaginal and urinary symptoms around menopause.
Sources & clinical references
- Hormone Therapy for Menopause American College of Obstetricians and Gynecologists
- The Menopause Years American College of Obstetricians and Gynecologists
- Menopause U.S. Food and Drug Administration
