Menopause symptoms may feel unbearable at times. Hormone replacement therapy (HRT) may be able to help manage some of them. Take a look at some places that offer HRT online.
Menopause occurs when people assigned female at birth
These hormonal changes are associated with a variety of symptoms that can range from mild to severe. They commonly include hot flashes, night sweats, trouble sleeping, joint pain, mood changes, vaginal dryness, and pain during sex.
HRT — also called menopausal hormone therapy (MHT) — may help ease these symptoms by
HRT can be particularly helpful with hot flashes and night sweats, two of the most common symptoms associated with menopause. Certain HRT regimens are also approved to help prevent osteoporosis.
HRT can help treat a variety of symptoms commonly experienced during the three stages of menopause: perimenopause, menopause, and postmenopause. Each stage is associated with varying degrees of hormonal fluctuations and its own set of symptoms.
HRT can reduce the frequency and severity of these symptoms by helping to stabilize hormone levels. Estrogen, in particular, can be very effective at relieving hot flashes and improving sleep quality. Additionally, it can help prevent bone thinning (osteoporosis) that can occur due to lower estrogen levels.
It can also help maintain vaginal health and elasticity and may help improve sexual function. HRT may also help stabilize moods and reduce irritability, as well as improve skin texture and elasticity.
Its effectiveness may vary from person to person, though. You can talk with your healthcare professional to get an assessment of your symptoms, health history, and medications to see whether HRT could be a good option for you.
Stages of menopause: Common symptoms*
Perimenopause
hot flashes, night sweats, mood swings, irregular periods
Menopause
more intense hot flashes, vaginal dryness, sleep disturbances
Postmenopause
symptoms may worsen; vaginal dryness, urinary incontinence, low libido
*Note that these are only some symptoms of the stages of menopause; symptoms can vary by individual and may include some not listed here.
Talk with a doctor
HRT is not suitable for everyone. While it can offer significant relief for many, it does come with potential risks and serious side effects, particularly when used long-term. HRT is not recommended for people with certain health conditions, such as a history of breast cancer, blood clots, or liver disease.
It is essential to have a frank discussion with your doctor about the benefits and risks before starting HRT. Your doctor can help determine whether this is the right option based on your personal health history and symptom severity. They may suggest alternative treatments if not.
Always follow up regularly with your prescriber to ensure the therapy is working as intended and to monitor for any side effects.
| Price | Prescriptions available | Insurance coverage | App features | |
|---|---|---|---|---|
| PlushCare for HRT | $19.99 per month | yes, plus discount card available | most major insurances accepted, plus FSA/HSA accepted | unlimited messaging to care professional, book or change appointment, prescription renewal |
| Evernow | from $35 to $49 per month | yes, covered by insurance from local pharmacy | check coverage through online tool, plus FSA/HSA accepted | track progress, unlimited messaging to care professional |
| Stella | $200 for initial visit; $90 for follow-ups | yes, if eligible | none, but FSA/HSA accepted | online community, menopause-related content, coaching support, meditations, and more |
As hormone levels drop during the three stages of menopause, many people experience uncomfortable symptoms like hot flashes, night sweats, mood swings, and vaginal dryness.
HRT works by replacing the hormones that are no longer being produced in sufficient amounts, helping to restore balance in the body and relieve these symptoms. By replenishing estrogen and sometimes progesterone or progestin, HRT can provide significant relief and improve quality of life during menopause.
When starting HRT, it’s important to be aware of the stages and symptoms that may arise. Though some people may experience immediate relief from symptoms like hot flashes and mood swings, for others it may take weeks or even months to feel the full benefits.
Some people also notice changes in their menstrual cycle or experience slight bleeding, especially if they are using a combination of estrogen and progesterone. These changes are typically temporary, but it’s important to keep your doctor informed of any new or unusual symptoms.
Headaches, nausea, and bloating are common early side effects as your body adjusts to new hormone levels. When taking HRT, it is crucial to schedule regular follow-ups with your doctor so they can monitor how your body is responding to the treatment and adjust your dose if needed.
Long-term use of HRT can be associated with serious risks, like increased chances of blood clots, breast cancer, or stroke. So it is especially important to make an appointment with your doctor regularly to help minimize these risks.
HRT vs. HT … what’s the difference?
Though the terms are often used interchangeably, hormone therapy (HT) and hormone replacement therapy (HRT) aren’t exactly the same.
HT broadly refers to the use of hormones as a medical treatment, including for
HRT is also commonly used to describe a form of gender-affirming care for transgender and nonbinary people. This is when regular doses of estrogen or testosterone are used to induce desired changes to secondary sex characteristics.
HRT has three major focuses: estrogen therapy, estrogen and progesterone therapy, and bioidentical hormone replacement therapy (BHRT).
Each treatment has pros and cons, so it’s best to discuss which treatment could work for you and the symptoms you’re experiencing with a healthcare professional. The risks for these treatments could be related to any preexisting conditions you may have or any medications you’re currently taking.
Estrogen therapy
Estrogen therapy can be administered in several forms, including orally or as a transdermal patch, gel, or spray. It is one of the most commonly used treatments for managing menopause symptoms, particularly hot flashes, night sweats, and vaginal dryness.
The most traditional form of estrogen therapy is a daily pill that contains either estradiol (the most common form of estrogen) or conjugated estrogens. Oral estrogen is effective at easing menopausal symptoms, but it can have an effect on liver function and increase the risk of blood clots in some individuals, especially those who smoke or have other risk factors.
Transdermal estrogen includes estrogen delivered through the skin via a patch, gel, or spray. Transdermal options bypass the liver, reducing the risk of blood clots and liver-related side effects that can be associated with oral estrogen.
Patches are typically worn on the skin and replaced weekly or twice weekly, while gels and sprays are applied daily. Many people prefer these methods for their convenience and lower risk profile.
Estrogen and progesterone therapy
For people who still have their uterus, a combination of estrogen and progesterone (or progestin, a synthetic form of progesterone) is typically recommended. Estrogen alone can increase the risk of endometrial cancer (cancer of the lining of the uterus), so progesterone is added to protect the uterus. This combination therapy is available in several forms, including oral pills, patches, and intrauterine devices (IUDs).
This combination therapy can significantly reduce the symptoms of menopause while also providing protection against endometrial cancer. But it’s important to note that taking both estrogen and progesterone can come with risks, including an increased chance of blood clots, breast cancer, and stroke, especially if used for long periods.
Bioidentical hormone replacement therapy (BHRT)
BHRT involves the use of hormones that are chemically identical to those naturally produced by the body. BHRT can be compounded (custom-made) by a pharmacist to fit an individual’s specific needs.
These hormones, which typically come from plant sources such as soy or yam, are intended to mimic the body’s natural hormones more closely than traditional human-made forms of estrogen or progesterone. BHRT can be customized in different forms, such as creams, gels, or pills.
While BHRT has gained popularity due to its natural appeal, it’s important to note that compounded BHRT is not approved by the FDA. This means that these treatments are not subject to the same rigorous standards for safety, effectiveness, and quality control as FDA-approved medications.
In fact, the FDA has raised concerns about the safety and efficacy of compounded BHRTs, and there is limited evidence showing their benefits over conventional HRT.
Because compounded hormones are not regulated, there is a risk of improper dosing, contamination, or inconsistent hormone levels, which can lead to side effects or health complications. For these reasons, most healthcare professionals do not recommend compounded BHRT.
If you are considering hormone therapy, it is important to consult with your healthcare professional about FDA-approved options that have been tested for safety and effectiveness.
The choice between oral and transdermal estrogen depends on variable factors like individual preferences, doctor recommendations, and health considerations. For example, people at a higher risk for blood clots might opt for a transdermal patch or gel.
Studies show that transdermal estrogen
The best way to determine the best method and dosage for your specific health profile and needs is by working closely with your healthcare professional, including being honest and upfront with them about your medical history and lifestyle.
These are two of the most common ways to administer HRT:
- Systemic hormone therapy: Hormones are delivered throughout the entire body, which is typically used to manage more widespread menopausal symptoms like hot flashes, night sweats, and mood changes. Systemic hormone therapy can be delivered through pills, patches, gels, or sprays. It is often recommended for those who need more comprehensive symptom relief.
- Local hormone therapy: By targeting specific areas of the body, like the vagina or urinary tract, local hormone therapy can treat symptoms like vaginal dryness, irritation, and urinary incontinence. Local therapies are available as creams, tablets, or rings, all of which deliver a lower dose of hormones directly to the affected area. People who don’t require systemic treatment but need relief from localized symptoms are often good candidates for local hormone therapy.
The cost of HRT varies by type, dosage, method of delivery, and whether it’s branded or generic. When HRT is prescribed by a doctor for menopause relief, most insurance providers will cover the cost of these treatments. Medicaid typically covers these treatments for menopause.
Prescription HRT pills can cost anywhere between $130 to $240 per month without insurance. Most doctor’s offices and pharmacies — including online services — take insurance for HRT. With insurance, the average cost is a copay of $30.
HRT can benefit people experiencing moderate to severe symptoms of menopause, such as hot flashes, night sweats, mood swings, and vaginal dryness. It can be helpful for all stages of menopause, including perimenopause, menopause, and postmenopause.
HRT can be helpful for both natural menopause or surgical menopause (such as after a hysterectomy). In addition to its effectiveness in managing symptoms, HRT can aid in preventing bone loss caused by decreased estrogen levels.
Combination estrogen and progesterone replacement therapy is only indicated for people who still have their uterus. For people without a uterus, estrogen-only therapy is typically recommended because they do not need progesterone to protect against the risk of endometrial cancer. This is because endometrial cancer is only a concern for those who still have their uterus.
Though HRT can provide relief for many symptoms of menopause, you must consider the
It’s important to carefully weigh the benefits of symptom relief and bone protection against these risks and to work with a doctor to find the most appropriate treatment plan tailored to your health profile. Regular follow-ups are essential to ensure the therapy is working effectively and safely.
BHRT vs. HRT
Bioidentical hormone replacement therapy (BHRT) is not FDA-approved, has limited evidence supporting its benefits over traditional HRT, and is not recommended by most doctors.
Hormone replacement therapy (HRT), on the other hand, is approved and regulated by the FDA. It is also recommended by leading medical authorities and has decades of research supporting its efficacy in easing menopause-related symptoms and preventing osteoporosis.
Pros
- effective at relieving common symptoms like hot flashes, night sweats, sleep problems, vaginal dryness, and mood swings
- helps prevent osteoporosis by increasing levels of estrogen in the body
- is usually covered by insurance
Cons
- can increase
breast cancer risk (the risk increases the longer you take it) - is not considered safe if you have certain health conditions, including a
history of heart disease - increases risk of uterine cancer if you still have your uterus and don’t also take progestin
HRT isn’t right for everyone, and it isn’t the only treatment for managing symptoms of menopause.
Alternative treatments include cutting down on alcohol and caffeine, getting regular exercise, and managing stress with techniques like mindfulness meditation and cognitive behavioral therapy.
Otherwise, there is no over-the-counter replacement for HRT. Talk with your healthcare professional to tailor a plan that works for your body, your hormones, and your symptoms.
There is no minimum time requirement for HRT, though on average it is used for 2 to 5 years. Because the associated risks increase over time, some doctors only prescribe it for a maximum of 5 years.
Yes, hormone therapy has been proven to be an effective treatment for easing many of the common symptoms associated with menopause.
Some doctors are cautious about prescribing HRT because of the increased risk of serious conditions like breast cancer and blood clots.
Though it is a common misconception that HRT causes weight gain, this has not been proven. Though research is limited, current available evidence has found that HRT may help reduce or prevent weight gain typically associated with aging.
Common signs of low estrogen include irregular periods, mood swings, hot flashes, breast tenderness, vaginal dryness, and pain during sex.
If you have not seen a reduction in menopause symptoms (reduced severity, frequency, or both) after 3 months of HRT, it may not be working and you should follow up with your doctor.
When HRT is prescribed by a doctor for menopause relief, most insurance providers will cover the cost of these treatments. Medicaid typically covers these treatments for menopause.
You can check with your insurance provider for the most accurate answer.