What Is HRT? Hormone Replacement Therapy Explained

HRT stands for hormone replacement therapy. In menopause care it means taking medication that replaces some of the hormones - mainly estrogen, and for many women progesterone - that the ovaries produce less of during perimenopause and after menopause. You may also see it called menopausal hormone therapy (MHT) or simply "hormone therapy"; they all refer to the same kind of treatment.

HRT doesn't "reverse" menopause or restore hormones to the levels of your 20s. The aim is more practical: to relieve symptoms that are affecting your quality of life, and in some cases to protect long-term health such as bone density, at the lowest dose that works for you.

Falling and fluctuating estrogen affects many parts of the body, which is why HRT therapy can help with a range of symptoms. The main ones it is used for are:

• Hot flashes and night sweats - HRT is the most effective treatment available for these vasomotor symptoms.
• Sleep disruption - especially when night sweats keep waking you up.
• Vaginal dryness, discomfort and urinary symptoms - known as genitourinary syndrome of menopause (GSM), which tends to persist or worsen over time without treatment.
• Bone protection - systemic estrogen helps prevent the bone loss that speeds up after menopause.

Some women also notice improvements in mood, joint aches or brain fog, but these respond less predictably, and they can have other causes worth checking. Our guide to perimenopause symptoms covers the full picture.

The first big distinction is whether you take estrogen on its own or with a progestogen:

• Estrogen-only HRT - generally used by women who have had a hysterectomy (no uterus).
• Combined HRT - estrogen plus a progestogen (either micronized progesterone or a synthetic progestin). Women who still have a uterus generally need this, because systemic estrogen on its own raises the risk of endometrial (uterine lining) cancer, and the progestogen protects against that.

Combined HRT can be taken cyclically (progestogen for part of each month, usually with a monthly bleed) or continuously (every day, usually aiming for no bleeding). Which schedule makes sense often depends on whether you are still having periods. Our guide to progesterone for menopause explains this in more detail.

HRT is also divided by how much of the body it is meant to reach:

• Systemic HRT circulates through the bloodstream and treats whole-body symptoms like hot flashes. It comes as a pill, a patch, a gel or a spray (and some higher-dose vaginal rings).
• Vaginal (local) estrogen - low-dose creams, tablets or rings - works mainly on vaginal and urinary tissue. Very little reaches the bloodstream, so it treats dryness and related symptoms rather than hot flashes.

The route matters for safety as well as convenience: oral estrogen is associated with a higher risk of blood clots than transdermal forms such as patches and gels. We compare the options in estrogen patch vs pill. Most modern HRT uses estradiol, which is chemically identical to the estrogen your ovaries make - see bioidentical hormones explained for what that label does and doesn't mean.

For many healthy women with bothersome symptoms who start before age 60 or within about 10 years of menopause, major medical societies consider HRT an appropriate option. But it is a real medication with real risks, including blood clots, stroke, breast-cancer considerations with longer use of combined therapy, and endometrial cancer if estrogen is taken without a progestogen by a woman with a uterus. Risk depends on your age, time since menopause, the type, dose and route of hormones, and your personal and family history.

Clinicians are generally cautious about or avoid systemic HRT in women with a history of breast or other estrogen-sensitive cancers, blood clots, stroke or heart attack, unexplained vaginal bleeding, or active liver disease. Some of these women may still be candidates for low-dose vaginal estrogen or non-hormonal treatment - a specialist decision. For the full evidence, including the FDA's 2025-2026 boxed-warning changes, read is HRT safe?

HRT isn't the only way to treat menopause symptoms, and it isn't the right choice for everyone. Other evidence-based options a clinician may discuss include:

• Fezolinetant (Veozah) - a non-hormonal prescription for moderate to severe hot flashes due to menopause, approved in 2023. It carries a boxed warning about rare but serious liver injury, so liver blood tests are part of treatment.
• Elinzanetant (Lynkuet) - another non-hormonal prescription for moderate to severe hot flashes due to menopause, approved by the FDA on October 24, 2025.
• Certain antidepressants (SSRIs/SNRIs) - low-dose paroxetine is FDA-approved for hot flashes, and clinicians use some others off-label.
• Gabapentin - sometimes used off-label, particularly for night sweats.
• Cognitive behavioral therapy (CBT) - has good evidence for helping women cope with hot flashes and sleep problems.
• Vaginal moisturizers and lubricants - first-line, non-prescription options for dryness.

Each of these has its own side effects and suitability questions, so the choice should be made with a clinician who knows your history.

You can get HRT from a primary-care doctor, a gynecologist or a menopause specialist - or from a licensed online HRT provider. Online services differ mainly in how you see the clinician and how you pay: Winona uses a physician-reviewed online intake with no video visit, Gala charges one flat monthly price, and Midi Health offers insurance-billed video visits. Compare all three in our online HRT providers comparison or head-to-heads like Winona vs Gala.

Whichever route you choose, a legitimate provider will take a full health history before prescribing - and should be willing to explain which product, dose and route you're getting and why.

This article is general information, not medical advice. A licensed clinician should decide whether HRT, or any treatment, is right for you.