What menopause hormone therapy can address
Menopause hormone therapy is most commonly used for bothersome hot flashes, night sweats, and genitourinary symptoms such as vaginal dryness or pain with sexual activity. It can also help prevent bone loss in selected patients.
Symptoms such as poor sleep, fatigue, mood changes, weight changes, and difficulty concentrating may occur during the menopause transition, but they are not always caused by estrogen deficiency alone. A good evaluation looks at the overall clinical picture before deciding that hormone therapy is the right answer.
Systemic hormone therapy is an effective treatment option for appropriate patients with bothersome vasomotor symptoms.
Local or systemic options may be considered for dryness, painful sex, and other genitourinary symptoms of menopause.
Treating night sweats or other menopause symptoms may improve sleep when those symptoms are the main driver.
Estrogen-containing therapy can help prevent postmenopausal bone loss in selected patients when clinically appropriate.
How treatment is individualized
Review menstrual changes, hot flashes, night sweats, sleep, vaginal symptoms, bleeding, mood, cognition, and quality-of-life impact.
Uterus status, pregnancy possibility, cancer history, clotting history, cardiovascular disease, liver disease, migraines, and other conditions can change the treatment plan.
Systemic versus local therapy, transdermal versus oral delivery, and whether progesterone or another progestogen is needed are individualized decisions.
Follow-up focuses on symptom response, adverse effects, bleeding, ongoing need, and whether the regimen remains appropriate.
Hormone therapy options we may discuss
FDA-approved hormone therapies include products that use hormones chemically identical to hormones produced by the body, including estradiol and micronized progesterone. “Bioidentical” does not mean that a medication must be compounded.
Systemic Estradiol
FDA-approved estrogen therapy
Moderate-to-severe hot flashes and night sweats; may also help some genitourinary symptoms and can help prevent bone loss in selected patients.
- FDA-approved estradiol products are available in several routes
- Transdermal options avoid first-pass liver metabolism
- Treatment choice depends on symptoms, history, preferences, and risk factors
- A patient with a uterus generally needs appropriate endometrial protection when using systemic estrogen
Systemic estrogen is not used simply for weight loss, anti-aging, memory enhancement, or general 'optimization.'
Official clinical information
Progesterone / Progestogen
Endometrial protection when needed
Patients with a uterus who use systemic estrogen generally need a progestogen component to reduce the risk of endometrial hyperplasia and cancer.
- FDA-approved micronized progesterone is available
- Regimen depends on the estrogen plan, bleeding pattern, and clinical history
- Choice may be continuous or cyclic depending on the individual plan
- The purpose is not to treat nonspecific 'low progesterone' based on salivary testing
Topical compounded progesterone should not be assumed to provide reliable endometrial protection.
Official clinical information
Low-Dose Vaginal Estrogen
Local therapy for genitourinary symptoms
Vaginal dryness, painful intercourse, and other symptoms of genitourinary syndrome of menopause when local treatment is appropriate.
- FDA-approved local vaginal estrogen options are available
- Designed primarily for local vaginal and vulvar symptoms
- Can be considered even when systemic therapy is not needed
- Product choice depends on symptoms, preferences, medical history, and cost
Persistent postmenopausal bleeding or unexplained bleeding requires appropriate evaluation rather than empiric hormone treatment.
Official clinical information
Vaginal Prasterone (DHEA)
FDA-approved local DHEA option
Moderate-to-severe dyspareunia due to vulvovaginal atrophy / genitourinary syndrome of menopause in appropriate postmenopausal patients.
- Prasterone is DHEA used locally as a vaginal insert
- FDA-approved specifically for moderate-to-severe dyspareunia due to menopause
- This is different from using systemic DHEA for 'adrenal support' or general energy
- Selection depends on symptoms, history, and patient preference
Systemic DHEA should not be marketed as a general treatment for fatigue, mood, metabolism, or 'adrenal optimization.'
Official clinical information
Compounded “bioidentical” hormones are not automatically better
FDA-approved estradiol, micronized progesterone, and other menopausal hormone therapies undergo standardized review for dose, quality, safety, and effectiveness. Custom-compounded products do not go through the same FDA approval process.
Compounding can still be appropriate for a specific patient need — for example, an allergy to an ingredient or a formulation that is not commercially available — but it should not be presented as inherently safer, more effective, or more “natural.”
Estriol deserves particular caution: there are currently no FDA-approved estriol products in the United States, and FDA does not consider estriol proven to be a safer form of estrogen.
What about testosterone for women?
There is currently no FDA-approved testosterone formulation for women in the United States. Some professional guidance supports carefully dosed transdermal testosterone as an off-label option for selected postmenopausal women with hypoactive sexual desire disorder after an appropriate biopsychosocial assessment and informed discussion.
Testosterone should not be marketed as a general treatment for fatigue, brain fog, weight loss, muscle building, mood, or anti-aging. Monitoring is required, and androgenic adverse effects can occur.
Review testosterone guidance ↗Routine hormone “optimization” testing is usually not the goal
Menopause treatment is generally guided by the clinical history, symptoms, age, menstrual pattern, medical history, and treatment goals. Routine salivary or urinary hormone testing is not recommended for selecting or adjusting compounded menopausal hormone therapy.
Blood testing may still be appropriate for specific clinical questions, differential diagnoses, or monitoring of certain therapies. Testing should answer a clinical question rather than simply generate a target number to “optimize.”
What your clinician reviews before treatment
Menstrual history, vasomotor symptoms, sleep, vaginal symptoms, bleeding, and quality-of-life impact.
Whether endometrial protection is needed when systemic estrogen is used.
Breast, endometrial, and other relevant history plus any unexplained vaginal bleeding.
Prior blood clots, stroke, heart disease, blood pressure, smoking, and other relevant risk factors.
Current prescriptions, supplements, liver disease, and potential interactions or contraindications.
Route, dosing, cost, symptom priorities, side effects, bleeding changes, and ongoing reassessment.
Hormone therapy is not appropriate for every patient. Benefits and risks depend on the specific product, route, dose, age, timing, medical history, and treatment goal. A consultation does not guarantee a hormone prescription.