Medically reviewed by Briana Walton, MD – updated 06/02/26
The conversation around hormone therapy is changing. Let’s explore the facts.
If you were born a woman, your body has most likely grown accustomed to the (mostly) steady presence of the hormones estrogen and progesterone for decades. Typically, in your 40s, signs of menopause—the end of your menstrual period—appear as estrogen and progesterone levels rise and fall before nearly fading altogether. Adjusting to these changes can be difficult for your body.
During the transition to menopause, known as perimenopause, and after your period stops, symptoms resulting from shifting hormones, such as sleep problems, mood changes, frequent urination, hot flashes and night sweats, can turn life upside down.
As you look for relief, you may wonder if hormone therapy could be an effective solution. This treatment replaces lost estrogen and progesterone with hormone versions in medication form.
Hormone therapy has had a mixed reputation for more than 20 years. Recent research, however, is prompting some physicians to view hormone therapy more favorably. And in 2025, the U.S. Department of Health and Human Services removed the FDA’s “black box” warning from hormone replacement therapy for menopause.
Evolving Attitudes on a Major Menopause Treatment
The origins of many patients’ and medical providers’ concerns about hormone therapy stretch back to the early 2000s.
In 2002 and 2004, researchers halted two clinical trials that were part of the U.S. government-sponsored Women’s Health Initiative (WHI) due to safety concerns. The data collected indicated that estrogen plus progestin—a synthetic form of progesterone—and estrogen alone were associated with health risks in women, particularly older women. For years afterward, many medical providers were reluctant to prescribe hormone therapy, and many patients hesitated to take it.
In a 2024 review of long-term data collected from the WHI, however, researchers found that hormone therapy is effective for treating moderate to severe hot flashes and night sweats in women younger than 60. For women struggling with these symptoms, the benefits of hormone therapy may outweigh the risks.
Findings like those from the 2024 study, along with new types of hormone medications and different approaches to dosing, have many medical providers feeling more comfortable about recommending hormone therapy.
Every woman is different. Talk to your provider about your specific situation.
Benefits of Hormone Therapy
Also known as menopausal hormone therapy and hormone replacement therapy, hormone therapy may improve the health and wellness of menopausal women under 60 in several ways, including:
- Bone protection. Hormone therapy can reduce the risk of bone loss. This can help protect against osteopenia (bone thinning) and osteoporosis (bone loss), two of several post-menopausal conditions that may affect women. Women may also experience improvement in joint health and mobility.
- Reduced risk of certain cancers. You may have a lower risk for certain types of cancer, especially if you start hormone therapy before age 60.
- Symptom relief. Vaginal dryness, hot flashes and night sweats may improve.
Additionally, recent studies have shown that women who start hormone therapy within 10 years of menopause onset may have:
Risks of Hormone Therapy
Hormone therapy may be beneficial, but it’s not without risk. This treatment, for example, doesn’t cause cancer, but it can lead to an increased risk of endometrial, breast cancer and colon cancer depending on the type of therapy, how long you take it or your individual risk factors.
Hormone therapy can also increase your risk for other conditions, including:
- Deep vein thrombosis
- Gallbladder disease
- Stroke
- Urinary incontinence
- Vaginal bleeding
You may have heard that hormone therapy can cause weight gain, but no conclusive evidence demonstrates this. A variety of factors, including hormonal changes, aging and a less active lifestyle, may contribute to weight gain around menopause.
Factors to Consider with Your Medical Provider
Your OB-GYN or primary care provider can help you determine whether the benefits of hormone therapy outweigh the risks for you. Much depends on your unique risk factors.
If, for example, you’ve had a stroke, certain cancers, vaginal bleeding or blood clots in the past, you shouldn’t take hormone therapy due to its links to these conditions.
If you decide to try this treatment, here are some other factors to discuss with your medical provider.
Types of Menopausal Hormone Therapy
Two major types of hormone therapy are available.
- Estrogen-only therapy—also known as estrogen therapy—is an option if you’ve had a hysterectomy (surgery to remove the uterus). By itself, estrogen can increase the risk of endometrial cancer, which is cancer that affects the lining of the uterus. That’s why you’ll only take estrogen alone if you don’t have a uterus.
- Estrogen plus progestin therapy, or combined hormone therapy, is the option of choice if you have a uterus.
Bioidentical Hormones
You may have heard of “bioidentical” hormones, which are often marketed as a more natural or personalized form of hormone therapy. But “natural” does not always mean safer — and bioidentical hormone therapy is not automatically better than FDA-approved hormone therapy.
Some bioidentical hormones are available in FDA-approved forms, while others are custom-mixed by compounding pharmacies. These compounded bioidentical hormones are not FDA-approved, which means they have not gone through the same review for safety, effectiveness, quality and dosing consistency as FDA-approved hormone therapies. The American College of Obstetricians and Gynecologists recommends FDA-approved menopausal hormone therapies over compounded bioidentical hormone therapy when FDA-approved options are available.
Compounded hormones may be helpful in limited situations, such as when someone has an allergy to an ingredient in an FDA-approved medication or needs a form that is not otherwise available. But for most people, FDA-approved hormone therapy offers a more studied and regulated option. Hormone testing — including saliva or blood tests used to “customize” compounded hormone doses — is also not recommended for routine dosing because hormone levels naturally fluctuate and the results may not reliably guide treatment.
If you are considering hormone therapy, talk with your health care provider about your symptoms, health history and goals. Together, you can decide whether hormone therapy is right for you and which option offers the safest, most effective approach.
Forms of Hormone Therapy
Some forms of estrogen therapy enter your bloodstream and spread throughout your body. This is known as systemic therapy and is available as a pill, patch, spray or gel.
You may only need estrogen to target one area of the body, such as the vagina to treat vaginal dryness. In that case, you’ll take local estrogen therapy. A cream, tablet or vaginal ring can deliver this treatment.
If you also need progestin, you can find it in pill form, as a vaginal tablet or gel, or in an intrauterine device.
Side Effects
Tell your medical provider if you experience side effects from menopausal hormone therapy. These side effects may include:
- Bloating
- Breast tenderness
- Headaches
- Spotting or bleeding
Side effects are usually temporary, but your medical provider may need to adjust your dosage if they last longer than normal.
Length of Treatment
Given the potential risks, menopausal hormone therapy isn’t meant to be a long-term treatment. The goal is to find the lowest dose that works for you and take it for the shortest amount of time necessary. The American College of Obstetricians & Gynecologists recommends meeting with your medical provider every year to reevaluate whether to keep taking hormone therapy.
Hormone therapy isn’t the only way to manage menopause symptoms. If the treatment isn’t right for you or you decide to stop taking it, your medical provider can suggest alternatives, including medications that don’t contain hormones.