Hormone therapy

What it is

Hormone therapy replaces the estrogen the ovaries stop making. People who still have a uterus also take a progestogen, because estrogen alone makes the uterine lining grow and raises the risk of uterine cancer. People without a uterus take estrogen alone.¹

It comes in two main kinds:^1,2

Systemic estrogen reaches the whole body, as a pill, skin patch, gel or spray. It treats hot flashes and night sweats.
Local vaginal estrogen is a low dose placed in the vagina as a cream, tablet or ring. It treats vaginal dryness and pain during sex.

Benefits

It's the most effective treatment for hot flashes and night sweats.^1,3
It relieves vaginal dryness.¹
It protects against the fast bone loss of early menopause and helps prevent hip and spine fractures.^1,3

Risks

The risks depend on the type, dose, how long it's used, how it's taken, when it's started, and whether a is used.³ ACOG lists:¹

a small increased risk of stroke and blood clots with both kinds. Patches, sprays and other forms not taken by mouth may carry less risk of clots than pills.
a small increased risk of heart attack and of breast cancer with combined estrogen and progestin
a small increased risk of gallbladder disease, highest with pills

Who it suits

The Menopause Society's position: for people under 60 or within 10 years of their last period, with no reason they shouldn't take it, the benefits outweigh the risks for treating bothersome hot flashes and preventing bone loss. Starting after 60, or more than 10 years after menopause, the balance is less favorable.³ Using it for longer is fine when there's a reason, such as hot flashes that continue, with regular check-ins.³

Myth: Hormone therapy is dangerous and causes breast cancer.

For about two decades this was a common message, so many people still believe it. Experts have since updated their advice. The risks depend on age and timing, and for healthy people under 60 or within 10 years of menopause, the benefits outweigh them.³ In November 2025 the FDA asked drugmakers to remove the boxed warnings about heart disease, breast cancer and dementia from labels. The warning about uterine cancer for estrogen taken alone stays, and the heart and breast cancer risks remain listed in the label's warnings.²

Bioidentical and compounded hormones

"Bioidentical" hormones are made from plant sources, and some are FDA-approved. Compounded versions, mixed by a pharmacy, aren't FDA-approved and don't have to prove their safety, effectiveness or quality. ACOG recommends FDA-approved over compounded hormones.¹

Questions to ask

Is safe for me, given my health and family history?
Would a patch or gel be better than a pill for me?
If I have a uterus, which would I take?
How often should we review whether I still need it?

Recap

Hormone therapy is the most effective treatment for hot flashes and night sweats, and it prevents bone loss and fractures.
For healthy people under 60 or within 10 years of menopause, the benefits outweigh the risks.
People with a uterus need a progestogen with estrogen, to protect against uterine cancer.
Patches, gels and sprays may carry less risk of blood clots than pills.
In 2025 the FDA asked for the boxed warnings about heart disease, breast cancer and dementia to be removed from labels.

Words to know 5

compounded bioidentical hormones	Custom-mixed hormone products made by a pharmacy. They aren't FDA-approved.
hormone therapy (HT)	Taking estrogen, and a progestogen if there's a uterus, to treat menopause symptoms. Also called HRT or menopausal hormone therapy.
local vaginal estrogen	Low-dose estrogen placed in the vagina as a cream, tablet or ring, to treat vaginal symptoms.
progestogen	Progesterone or a lab-made version (progestin). In hormone therapy it protects the uterine lining.
systemic estrogen	Estrogen that reaches the whole body, as a pill, patch, gel or spray.