Hormone Therapy 101

Hormone Therapy 101: A Guide to HRT in Menopause and Perimenopause

Written by: Dr. Madeleine Clark, ND

What Is Hormone Therapy (HRT)?

Hormone therapy — also known as hormone replacement therapy (HRT) — is the targeted prescribing of estrogen, progesterone, and sometimes testosterone. These prescription medications are given at individualized doses to help manage menopause and perimenopause symptoms, improve quality of life, and reduce long-term health risks linked to low estrogen.

When Is Hormone Therapy Used?

HRT is most commonly prescribed during perimenopause or menopause, when estrogen naturally declines as the ovaries stop releasing eggs. This drop can trigger symptoms such as:

  • Hot flashes and night sweats

  • Sleep disturbances

  • Mood changes and brain fog

  • Vaginal dryness and discomfort

Replacing estrogen — and, when needed, progesterone — can help reduce these symptoms and manage health risks associated with low estrogen states.

💡 Related reading: Learn more about depression and anxiety in perimenopause and how hormone therapy may play a role in mood support.

Who Can Benefit from Hormone Therapy?

HRT is considered the gold standard for:

  • Vasomotor symptoms (hot flashes, night sweats)

  • Genitourinary syndrome of menopause (GSM)

  • Prevention of osteoporosis

  • Reducing risk of type II diabetes and possibly dementia

It’s also recommended for:

  • Medically or surgically induced menopause — until the average age of menopause (about 51).

  • Premature ovarian insufficiency (POI) — until the average menopause age, to replace lost estrogen during otherwise protective years.

Types of Hormone Therapy

Estrogen Therapy

  • Reduces hot flashes, improves GSM, prevents osteoporosis, and supports long-term health.

  • Prescribed with progesterone if you have a uterus to protect the uterine lining.

Progesterone Therapy

  • Protects the uterine lining from abnormal cell growth caused by unopposed estrogen.

  • Can improve sleep and reduce anxiety in some patients.

  • Typically taken at night due to its calming effects.

Testosterone Therapy

  • Not currently approved in Canada for perimenopause concerns.

  • May be prescribed off-label for low libido or sexual function concerns by qualified providers (not NDs).

Benefits of Hormone Therapy

  • Relief from hot flashes, night sweats, and GSM symptoms

  • Better sleep quality

  • Improved mood and anxiety symptoms in some patients

  • Protection against osteoporosis and fracture

  • Reduced risk of type II diabetes

  • Possible cognitive benefits when started within the “critical window”

💡 Related reading: For more on estrogen’s role in brain health, see how estrogen shapes mood and cognition.

Risks and Contraindications

Estrogen therapy is not suitable for everyone. It may not be recommended if you have:

  • A history of blood clots, heart attack, or stroke

  • Estrogen-positive cancer

  • Certain liver conditions

  • Uncontrolled high blood pressure

  • Significant smoking history

What About the WHI Trial?

The 2001 Women’s Health Initiative (WHI) trial led to fear about HRT due to an observed increase in breast cancer risk. However, later analysis found that many participants were in their 60s or 70s — well past menopause — and had higher baseline risks.

Current evidence supports starting HRT in women under 60 or within 10 years of menopause for the best safety profile and benefit-to-risk ratio.

How Is Hormone Therapy Taken?

  • Estrogen is often prescribed transdermally (patches or gels) for lower clot risk.

  • Progesterone is typically taken orally at night.

  • Vaginal estrogen may be used for GSM symptoms.

Duration of Treatment

HRT should be re-evaluated regularly with your healthcare provider, assessing:

  • Symptom control

  • Side effect profile

  • Changing health risks over time

Contraception and HRT

HRT is not birth control. Contraception is still required until menopause is confirmed, with options such as IUDs, condoms, tubal ligation, or vasectomy.

Alternatives to Hormone Therapy

For those who can’t take HRT or choose not to, alternatives include:

  • Non-hormonal prescription medications for hot flashes, sleep, mood, and bone health

  • Lifestyle medicine (eat, move, think, rest, connect)

  • Targeted supplementation

  • Acupuncture for symptom relief

Learn more about non-hormonal options for hot flashes and insomnia in midlife.

Is HRT Right for You?

If you’re wondering whether hormone therapy is a fit for your symptoms and health goals, book a complimentary meet-and-greet with Dr. Madeleine Clark, ND MSCP. At Crafted Balance, we combine evidence-based prescribing with lifestyle and nutritional strategies for whole-person menopause care.

Book your appointment to learn more.

perimenopause, hormonal healthMadeleine Clark