• Hormone Replacement Therapy
• Menopause

How to Talk to Your Doctor About HRT

Medically reviewed and edited by Lauren Cramer, PA- C

Published: August 14, 2025
Updated: November 13, 2025
5 mins

Menopause can cause a whirlwind of mood swings, stress, and physical changes in your body. Every day can feel unpredictable, from sudden hot flashes to occasional forgetfulness and fatigue. Women’s health concerns like menopause often go undertreated and leave women feeling unheard and unsupported when finding help with managing life during menopause.

However, new research has shown that hormone replacement therapy (HRT) is one of the most effective treatments for menopause. Still, your primary healthcare provider may be hesitant to bring it up as a treatment option. 

Outdated research has previously cited health concerns about HRT for menopause. Today, new findings have concluded that the benefits outweigh the risks for most women. In fact, the FDA updated its guidance in November 2025, removing the black box warning on estradiol, reflecting its improved safety profile.

Speaking with a qualified healthcare provider about HRT can help you learn more about whether it would be effective for you. The sooner you address low estrogen levels due to perimenopause or menopause, the more likely a woman is to see improvements in quality of life during menopause.

How Does Hormone Replacement Therapy Work?

During the transition to menopause, follicle depletion leads to falling ovarian estradiol production and, over time, the ovaries shrink. The loss of estrogen can dramatically shift health outcomes. Post-menopausal women have an increased risk of developing osteoporosis (bone disease), cardiovascular issues, and neurological complications. 

The HRT process involves replacing any estrogen and progesterone lost during menopause.  Combination therapy is the most common form of HRT today. If a woman has had a hysterectomy and no longer has a uterus, she doesn’t need progesterone with estradiol to protect the uterus. However, progesterone still has benefits for other parts of the body because its receptors are found throughout the body. A healthcare provider can prescribe one or both of the following types of hormone replacement therapy:

• Systemic estrogen replacement and progesterone therapy: Estrogen is released into the bloodstream through injections, pills, skin patches, gels, creams, rings and sprays. Progesterone is most commonly given with an oral capsule.

• Local estrogen therapy: Estrogen is distributed as a vaginal ring, tablet, or cream. Small doses of estrogen are released into the vaginal tissue.

Depending on your health needs, a healthcare provider may recommend taking HRT daily. As you take HRT, a healthcare provider will periodically monitor your menopause symptoms to assess the effectiveness of the treatment. Don’t be afraid to speak openly with them about any concerns you have while going through treatment.

What Does the Research Say About HRT?

Early results from the WHI study were often applied to all hormone therapy, but the trial mostly looked at a specific combination – CEE (estrogen from horse urine) plus synthetic progesterone – in women who were older and farther from menopause than most new users. Later research showed that risks vary by age, timing, and type of hormone. For example, estrogen alone (CEE) didn’t raise breast cancer risk in women without a uterus.

Today, guidance supports personalized hormone therapy, with the best risk-benefit balance for healthy women under 60 or within about 10 years of menopause. Reflecting this, in 2025 the FDA started removing broad black box warnings from many menopausal hormone therapy products, while keeping targeted cautions, like the risk of endometrial cancer for women with a uterus using estrogen alone. Clinicians now focus on matching the right formulation, dose, route, and timing to each woman’s individual needs and goals.

What are the Risks of Hormone Replacement Therapy?

A healthcare provider may hesitate to prescribe HRT if you have a history of blood clots or breast cancer. At standard doses, estrogen absorbed through the skin (like patches or gels) hasn’t been shown to raise the risk of blood clots or stroke. Taking estrogen by mouth can slightly increase these risks, but they stay low for healthy women under 60 or within about 10 years of menopause.

However, modern forms of HRT using transdermal estrogen and bioidentical progesterone may reduce the risk of breast cancer. Transdermal HRT (distributing HRT through the skin) may work better for those with a history of blood clots as well. Bioidentical hormones are plant-based and operate similarly to hormones produced naturally in the body.

As with any treatment, there is a risk of experiencing certain side effects. Some women may experience the following side effects with HRT:

• Breast soreness

• Vaginal spotting

• Headaches

• Dizziness

• Moodiness

• Bloating

Potential Reasons a Healthcare Provider May Not Prescribe Hormone Replacement Therapy

A healthcare provider may not prescribe HRT if you have preexisting conditions that may worsen with hormonal treatment. If you have a family history of hormone related cancers, gallbladder disease, liver disease, or deep vein thrombosis, or if you are an active smoker, a healthcare provider may recommend alternate forms of treatment. 

Health Benefits of Hormone Replacement Therapy

The sooner you start HRT, the more likely you are to experience the benefits of hormonal balance. Women who start HRT earlier, before menopause officially starts, are more likely to see improvement in long term effects of a low hormone state such as bone loss, cardiovascular disease and cognitive decline associated with menopause.

Other health benefits of HRT include the following:

• Protects your heart health

• Reduces the risk of osteoporosis

• Improves mood swings

• Improve cognitive function

• Improves risk of sacopenia

Tips for Discussing HRT with a Healthcare Provider

It’s important to get into the habit of advocating for yourself in the healthcare space to receive the best treatment possible. Not every healthcare provider is the same, so confidence and patience are key. In some cases, you may have to have a couple of conversations with your healthcare provider before they’re comfortable prescribing HRT. However, it’s important to be polite but stern about why you believe you need HRT.

When speaking with a healthcare provider, it’s important to be honest about the severity of your symptoms. This can help give them a better idea of why you’re requesting HRT and the difference it can make in your day-to-day life. They may then ask additional questions.

When discussing HRT with your healthcare provider, some health professionals may still only be aware of outdated research about the treatment. If this happens, consider consulting with a different healthcare provider for a second opinion.

How Can LifeMD Help Restore Hormonal Balance?

It’s normal for estrogen levels to change at various points in your life. However, LifeMD can help you get ahead of menopause before it progresses. With LifeMD, a licensed healthcare professional can help you understand more about your hormonal health and how to treat menopausal symptoms early.

The LifeMD Women’s Health Program offers compassionate, personalized care tailored to your unique needs. Whether you’re entering menopause or managing other common women’s health concerns, a healthcare provider will work with you to create a treatment plan that’s right for you.

Make an appointment to see if you qualify.

Lauren Cramer, PA- C

Lauren is a passionate and dedicated board-certified physician assistant. She received her Bachelor’s degree in Kinesiology and Exercise Science from SUNY Cortland — graduating magna cum laude while competing as a three-sport collegiate athlete in indoor and outdoor track and cross country. She went on to complete her Master’s degree in Biological Sciences and earn her Physician Assistant degree from Daemen College in Buffalo, New York. Lauren has years of focused experience in perimenopause, menopause, and postmenopause care, specializing in hormone replacement therapy (HRT), bone health optimization, and a functional medicine approach to women’s wellness. She integrates evidence-based hormone therapy with lifestyle, nutrition, and metabolic strategies to support long-term vitality, cognitive health, and bone density. In addition to her women’s health expertise, Lauren has a well-rounded background in allergy, asthma, otology, laryngology, and rhinology. Functional medicine has always been a passion of hers, and she continues to pursue advanced certification to deepen her ability to deliver personalized, root-cause care to her patients.

Talk To A Doctor

How does LifeMD work?