Estrogen replacement therapy helps treat perimenopause and menopause symptoms by stabilizing your body’s estrogen levels. Here’s what you need to know about estrogen hormone therapy, plus how to tell if it’s right for you.
Perimenopause and menopause are normal biological progressions that millions of people around the world experience. Generally occurring between your late 30s and early 50s, these transitional stages bring you out of your reproductive years and into the next biological period of time.
For many people, perimenopause and menopause are also frustrating, uncomfortable, and even painful processes, accompanied by a number of physical and emotional symptoms.
The good news is, there are lots of treatment options available to help ease perimenopause and menopause symptoms, including hormone treatments like estrogen replacement therapy.
Here’s what estrogen replacement therapy is, how estrogen therapy can combat these symptoms, and how to know if estrogen replacement therapy is right for you.
What is estrogen replacement therapy? Estrogen replacement therapy is a type of hormone replacement therapy .
Hormone replacement therapy, or HRT, seeks to supplement your body’s hormone levels through hormonal medication.
When you begin the perimenopausal transition to menopause, your body’s production of estrogen and progesterone fluctuates and declines significantly—and this can lead to lots of different perimenopause symptoms and menopause symptoms .
Declining estrogen, in particular, is associated with symptoms like:
Many people find that stabilizing hormone levels with estrogen replacement therapy or other types of HRT can help ease some of these symptoms.
During estrogen replacement therapy, also called estrogen-only HRT, you take estrogen to supplement your body’s levels of this hormone.
Estrogen-only HRT can be used on its own if you’ve had your uterus removed (a hysterectomy). If you still have a uterus, you’ll need to supplement your progesterone levels, too (more on that later).
What are the different types of estrogen replacement therapy? Estrogen replacement therapy comes in a few different forms.
Some are systemic, meaning the estrogen enters your bloodstream and circulates throughout your body.
Systemic forms of estrogen replacement therapy include the estrogen-only:
Pill , taken orallyPatch , placed on skin on your lower bodyGel , applied to skin on your lower body or armsSpray , applied to skin on your inner arm or thighInjection , injected every three to four weeksOther forms of estrogen replacement therapy are localized (or nonsystemic), meaning the estrogen stays in a specific part of your body.
Localized estrogen replacement therapies are vaginal medications that administer estrogen in the vagina only, using a vaginal:
Vaginal estrogen replacement therapies are inserted directly into the vagina and reapplied at different frequencies depending on the type, ranging from a couple of times a week to every few months.
If you’re only taking vaginal estrogen, you don’t have to take combined HRT —regardless of whether or not you’ve had a hysterectomy.
What are the signs you need to start estrogen replacement therapy? For people who are experiencing difficult perimenopause and menopause symptoms, estrogen replacement therapy can be a helpful option.
Estrogen replacement therapy is FDA-approved to treat specific perimenopause and menopause symptoms:
Hot flashes and night sweats (vasomotor symptoms) Bone loss Vaginal symptoms Estrogen replacement therapy may also help treat other perimenopause and menopause problems, some of which are associated with the above symptoms, including:
Sleep disturbances and insomnia Joint pain Pain and discomfort during sex Urinary tract infections (UTIs) Overactive bladder and urinary incontinence Mood swings, depressive symptoms, and depression If you’re struggling with any of these perimenopause and menopause signs and symptoms, estrogen replacement therapy may be the right treatment method to help you get relief.
As with any medication, it’s important to talk to your healthcare provider first to understand your unique situation and determine whether estrogen is a safe treatment.
Here’s a closer look at the FDA-approved uses to see how estrogen replacement therapy can help during perimenopause and menopause.
Vasomotor symptoms “Vasomotor symptoms” is the scientific, collective term for hot flashes and night sweats (nighttime hot flashes). While we don’t yet know what exactly causes vasomotor symptoms, research has shown that they’re connected to low estrogen levels.
Hot flashes are one of the most common and well-known symptoms of perimenopause and menopause. Up to four out of five U.S. women experience hot flashes , with one in four experiencing them every day.
Vasomotor symptoms are a sudden and intense feeling of heat in your head, face, neck, chest, and/or upper back, often accompanied by:
Sweating Flushing and blotches Accelerated heart beat Cold chills following the hot flash Estrogen replacement therapy is the first-line treatment for moderate to severe vasomotor symptoms—in other words, it’s the first form of treatment prescribed if your hot flashes interfere with your day-to-day.
By treating vasomotor symptoms, estrogen replacement therapy may also help relieve sleep disturbances and improve sleep quality, since you sleep better when you aren’t suffering through night sweats. Some research has also shown that estrogen replacement therapy may help improve insomnia.
Bone loss Estrogen plays an important part in keeping your bones strong and healthy.
When estrogen levels fluctuate and decline, bone loss can accelerate over time, which increases the risk of osteoporosis. Up to 20% of bone loss can occur during the menopausal transition, resulting in higher rates of osteoporosis postmenopause.
Estrogen replacement therapy has been shown to prevent bone loss and reduce fractures in postmenopausal people.
Estrogen replacement therapy may also help ease perimenopause and menopause joint pain, which can occur due to declining estrogen levels. However, research is ongoing.
Keep in mind, however, that estrogen replacement therapy is not prescribed as a treatment for existing osteoporosis that predates perimenopause and menopause. Instead, estrogen replacement therapy can help with bone loss and discomfort that occurs because of lower estrogen levels during perimenopause and menopause.
Vaginal symptoms Declining estrogen levels can cause uncomfortable and painful vaginal symptoms during perimenopause and menopause.
Vaginal atrophy and related vaginal, sexual, and urinary symptoms may affect up to three-quarters of menopausal people. Symptoms include:
Dryness Itching Irritation Burning General discomfort Decreased lubrication Pain and discomfort during sex Recurrent UTIs Overactive bladder and urinary incontinence Vaginal estrogen replacement therapy is one of the most effective treatments for these symptoms, particularly when other non-hormone therapies (like lubricants and moisturizers) haven’t helped.
Vaginal estrogen increases lubrication, blood flow, and sensation in vaginal tissue, which can ease dryness and irritation. This can also make sex more comfortable and enjoyable, which may help you navigate low sex drive during perimenopause .
It may also help relieve recurrent UTIs, overactive bladder, and urinary incontinence (sudden urges to pee, accompanied by a decrease or loss of bladder control).
Vaginal estrogen replacement therapy (vaginal tablet, cream, gel, or ring) is the recommended treatment method for vaginal symptoms. If you’re only addressing these symptoms, you likely won’t take systemic forms of estrogen.
Is estrogen replacement therapy right for me? If you’re experiencing perimenopause and menopause symptoms like hot flashes and night sweats, bone loss, or vaginal dryness, estrogen replacement therapy may be able to help.
Estrogen replacement therapy is a safe option for you if you meet these three conditions:
You’re under 60 You reached menopause 10 or fewer years ago You aren’t at high risk of breast cancer, blood clots, or stroke Estrogen replacement therapy has low risk levels for:
Stroke Blood clots Breast cancer Research is ongoing, but some evidence suggests that the risk of stroke and blood clots may be even lower with estrogen-only:
Low-dose pills Patch Gel Spray For those who meet all three of the above estrogen replacement therapy conditions, these risks are even lower. In this case, the North American Menopause Society says that the benefit-risk ratio is favorable for treating vasomotor symptoms and preventing bone loss. In other words, the potential benefits likely outweigh the potential risks.
As for vaginal estrogen, it does not increase your risk for stroke, blood clots, or breast cancer when taken on its own.
Do I need estrogen-only HRT or combined HRT? You can take estrogen replacement therapy on its own if you’ve had a hysterectomy.
If you’re interested in estrogen replacement therapy but you have a uterus, not to worry: you still have HRT options!
In this case, you can take what’s known as combined hormone replacement therapy (combined HRT). Combined HRT supplements estrogen replacement therapy with progestogen, a synthetic progesterone that acts as progesterone in your body.
Taking combined HRT protects against the risk of uterine cancer. If you don’t have a uterus, you don’t need to worry about this risk.
Is estrogen replacement therapy right for me?: the bottom line Perimenopause and menopause can come with difficult symptoms that impact your daily life.
If this sounds familiar, estrogen replacement therapy may be able to help you manage symptoms, find relief, and improve your well-being.
The decision to start estrogen replacement therapy depends on lots of different factors, including your needs, your treatment priorities, and your medical history.
Other treatment strategies for managing perimenopause and menopause symptoms include lifestyle and diet changes, certain vitamins and supplements, and certain prescription medications.
Together, you and your doctor can weigh the pros and the cons to decide if estrogen replacement therapy is right for you.
