Yesterday I sat with another client who told me: "My doctor prescribed HRT. But I don't really understand what it is and how it works."
I hear this almost daily. And it's not the doctors' fault - they simply don't have 45 minutes to explain everything. But I have this time. And as someone who's worked daily with gynecologists for 15+ years, I can translate medical knowledge so you understand it.
What is HRT Actually?
HRT stands for Hormone Replacement Therapy. But the name is somewhat misleading - we don't completely "replace" the hormones, we supplement them.
The Simple Explanation:
Think of your hormones like the water level in a pool. In perimenopause, the water level fluctuates wildly - sometimes too much, sometimes too little. In menopause, the water level continuously drops. HRT adds enough water to keep the pool at a comfortable level.
The Two Main Hormones in HRT
1. Estrogen
Estrogen is the main hormone that declines in menopause. It's responsible for:
- Body temperature regulation (hence hot flashes when it's missing)
- Brain function (hence brain fog when it's missing)
- Mood regulation (hence mood swings when it's missing)
- Bone health (hence osteoporosis risk when it's missing)
- Vaginal health (hence dryness when it's missing)
- And much more...
What most don't know: Modern estrogen in HRT is "body-identical" - meaning it has the exact same molecular structure as the estrogen your ovaries produced. It's synthesized from plants, but chemically it's identical to your own estrogen.
2. Progesterone/Progestogen
If you still have a uterus, you need a progestogen in addition to estrogen. Why?
Estrogen alone causes the uterine lining to grow. Without an opponent, this could long-term lead to uterine cancer. Progestogen protects the uterine lining.
💡 Important: If you've had a hysterectomy (uterus removed), you usually only need estrogen, no progestogen. This significantly simplifies HRT.
How is HRT Administered?
This is where it gets interesting, because you have options:
Estrogen Options:
- Tablets: One pill daily. Simple, but goes through the liver (which slightly increases blood clot risk).
- Patches: Applied to skin 1-2x per week. Doesn't go through the liver.
- Gel: Applied to skin daily. Very flexible dosing.
- Spray: Sprayed on skin daily. Practical and fast.
Insider knowledge: Transdermal (patches, gel, spray) is the better option for most women because it doesn't increase blood clot risk. Gynecologists especially recommend it for:
- Women over 60
- Overweight women
- Smokers
- Women with high blood pressure
- Women with migraines
Progesterone/Progestogen Options:
- Micronized progesterone (Utrogestan): Oral capsule, body-identical. Many women prefer it.
- Synthetic progestogens: Various options, also effective, but not body-identical.
- Mirena coil: Releases local progestogen, protects the uterus AND serves as contraception. Very practical!
The Two HRT Regimens
Sequential Regimen (for perimenopause):
Estrogen EVERY day + progestogen 12-14 days per month. Often leads to a light monthly bleed (like a period). Suitable if you still have occasional periods.
Continuous Regimen (for postmenopause):
Estrogen AND progestogen EVERY day. Usually leads to no bleeding after a few months. Suitable if you haven't had a period for 12+ months.
When Does HRT Work?
This is the question everyone asks me. The honest answer:
- Hot flashes: 2-4 weeks (sometimes faster)
- Sleep: 2-4 weeks
- Mood: 4-6 weeks
- Brain fog: 4-8 weeks
- Vaginal dryness: 4-12 weeks (sometimes longer, may need additional local estrogen)
- Bone health: Months to years (but prevention starts immediately)
💡 Insider tip: Give HRT at least 3 months. Dosing often needs adjustment in the first months. This is normal and not a sign that HRT isn't working!
The Risks - What You Need to Know
This is where it's important you know the facts, not the myths:
Breast Cancer Risk:
- With body-identical estrogen + micronized progesterone: Minimally increased risk (about 1 additional case per 1,000 women over 5 years)
- With synthetic progestogens: Slightly higher risk
- Estrogen only (without uterus): NO increased risk
- For comparison: Being overweight and alcohol increase risk more than HRT!
Blood Clot Risk:
- With transdermal HRT: NO increased risk
- With oral HRT: Slightly increased risk (but still very low)
Heart Risk:
- If you start HRT before 60 or within 10 years of last period: PROTECTION for the heart
- If you start HRT much later: No clear benefit, possibly risk
Confused? Uncertain?
That's completely normal. HRT decisions are complex and individual. I help you make the right decision FOR YOU.
Book Free Clarity CallMy Insider Advice to You
After 15 years in pharma, I can tell you this:
- HRT is not dangerous - the studies that scared you are outdated and were misinterpreted.
- Transdermal is often better than oral - but it depends on your specific situation.
- Body-identical is not necessarily better - but many women prefer it.
- Dosing is individual - what works for your friend may not suit you.
- Patience is important - the first dose is rarely perfect, adjustments are normal.
And most importantly: Don't let fear guide you. HRT is safe for most women and can be life-changing. But it's YOUR decision - nobody should pressure you, either for or against.