Understanding Hormone Replacement Therapy (HRT): A Simple, Evidence-Based Guide
Hormone replacement therapy—often called HRT—is one of the most effective ways to treat symptoms of perimenopause and menopause. It’s also one of the most misunderstood. At ICONA, we use HRT thoughtfully, individually, and with modern evidence—not outdated fear or one-size-fits-all plans.
Here’s a clear, approachable guide to what HRT is, who it’s for, and what women can expect.
What HRT Is
HRT replaces the hormones that naturally decline during perimenopause and menopause—primarily estradiol, progesterone, and sometimes testosterone. Because every woman’s biology is different, the type and dose of hormones should be personalized. There is no universal prescription.
Women use HRT for two reasons:
To relieve symptoms (hot flashes, sleep issues, mood changes, vaginal dryness, weight changes, brain fog)
To support long-term health (bone density, heart health, cognitive function)
A Quick Overview of Each Hormone
Estradiol (Estrogen)
Estradiol is the primary estrogen produced by the ovaries. Levels fluctuate in perimenopause, decline sharply in menopause, and remain low long-term. Estradiol supports:
Temperature regulation
Sleep and mood
Bone strength
Heart and brain health
Vaginal and urinary function
Replacing estrogen can dramatically improve quality of life and future health.
Progesterone
If you still have your uterus, progesterone protects the uterine lining when taking estrogen. But it also:
Improves sleep quality
Supports mood stability
Helps calm anxiety
Women without a uterus may still benefit from progesterone depending on symptoms and treatment goals.
Testosterone
Often thought of as a “libido hormone,” testosterone supports far more:
Energy and motivation
Muscle strength
Cognitive clarity
Joint health
Sexual well-being
Testosterone naturally declines with age and can be added when needed.
Who Can Take HRT?
Most healthy women can safely take HRT, and for many, the benefits outweigh the risks. Modern guidelines support the use of body-identical hormones—the same molecular structure your body once produced.
A few important truths:
You can start HRT in perimenopause.
You don’t need to wait for symptoms to be “bad enough.”
There is no set time limit—many women stay on HRT long-term.
HRT can often be used even if you have migraines, high cholesterol, high blood pressure, or a history of clot (with the right formulation and medical supervision).
Women can begin HRT later in life as well.
The right plan simply requires a thoughtful conversation and individualized medical review.
How HRT Is Delivered
There are several ways to take hormones, and the best option depends on your symptoms, medical history, and lifestyle.
Estrogen
Patches, gels, and sprays: absorbed through the skin and preferred for safety; these are body-identical.
Tablets: available but generally used less often because they can slightly increase clot risk in some women.
Progesterone
Most commonly prescribed as a micronized capsule (body-identical).
Can be taken orally or vaginally.
In some cases, a Mirena IUD can provide uterine protection while also offering contraception.
Testosterone
Gels and cream: absorbed through the skin; custom doses can be compounded
Pellets: release hormones at a steady rate; lower-maintenance option that requires fewer daily or weekly treatments
Doses are much lower than those used for men.
Finding the Right Dose
There is no “perfect” dose on day one. Your plan is adjusted based on:
Symptom relief
Side effects
How your body metabolizes the hormones
Lab values when needed
Some women notice improvement within weeks; others need 2–3 months for their body to stabilize. Adjustments are normal and expected.
Benefits of HRT
For most women, the right HRT plan leads to significant improvements in:
Hot flashes and night sweats
Sleep quality
Energy and mood
Concentration and memory
Vaginal comfort and sexual wellness
Joint and muscle discomfort
Beyond symptom relief, HRT also supports long-term health:
Stronger bones and lower osteoporosis risk
Reduced risk of heart disease when started at the right time
Lower risk of type 2 diabetes and colon cancer
Possible cognitive benefits with early use
Understanding the Risks
Risks depend on the type of HRT, your health history, and whether synthetic or body-identical hormones are used. Modern research shows:
Transdermal estrogen (patches, gels, sprays) does not increase clot or stroke risk.
Micronized progesterone has a lower breast-cancer risk profile than synthetic progestins.
For most women under 60 or within 10 years of menopause, HRT is considered safe and effective.
Your clinician will personalize treatment based on your unique risk factors.
What to Expect When You Start
It’s common to experience temporary changes as your body adjusts:
Breast tenderness
Mild bloating
Light or irregular bleeding (especially early in treatment)
Mood shifts or increased emotional sensitivity
Most of these settle within weeks. If something feels off or persistent, we adjust your plan.
A Final Note
HRT is one part of a whole-body strategy for feeling well during midlife and beyond. Nutrition, strength training, sleep, stress management, and sexual wellness all play essential roles.
HRT does not delay menopause, and it is not contraception. It is simply a tool—backed by strong evidence—that helps women feel like themselves again and protects their health long-term.
At ICONA, hormone care isn’t transactional—it’s relational. We take the time to understand your physiology, your lived experience, and your goals so that your plan evolves with you.
Step 1: Your Comprehensive Initial Visit
You’ll meet with one of our experienced providers for a full assessment—symptoms, medical history, lifestyle patterns, and the day-to-day realities that shape how you feel. This is where we start to understand the whole picture, not just the lab values.
Step 2: A Custom, Evidence-Based Plan
There is no template. Based on your evaluation, you’ll receive a personalized treatment plan designed around your body, your needs, and your goals. Every recommendation is intentional, research-informed, and tailored to help you truly feel better.
Step 3: Thoughtful Follow-Up & Refinement
Your body changes—and your plan should too. Follow-up visits give you space to share what’s working, what’s shifting, and what still needs attention so your provider can fine-tune your treatment for better alignment and better results.
Step 4: Ongoing Support & Long-Term Guidance
Hormone care is not a one-time intervention. We stay connected with you every 3 to 6 months to ensure your levels remain optimized, your symptoms improve, and your plan continues to support long-term health and well-being.