Hormone therapy and menopause

During menopause, oestrogen and progesterone levels in your body fluctuate and decrease. The greater these fluctuations, the more symptoms you may experience, such as hot flushes or mood swings. For severe hormonal symptoms, hormone therapy (HT/HRT) can help stabilise hormone levels, reducing or eliminating symptoms.

Blister packs with pink and beige tablets, loose white pills and a skin patch arranged on a wooden board with dried flowers on fabric surface

HRT: what are the options?

What is hormone therapy?

Hormone therapy supplements the sex hormones (oestrogen and progesterone) in your body during the period when your hormone levels are fluctuating and decreasing. This stabilises hormone levels and reduces fluctuations, significantly alleviating or even completely eliminating hormonal symptoms.

Hormone medication supplements both female sex hormones: oestrogen (oestradiol) and progesterone. Oestrogen supplementation reduces the hormonal symptoms experienced during menopause. Progesterone, on the other hand, protects against the excessive build-up of uterine lining (caused by oestrogen supplementation). This is important because an excess can lead to heavy bleeding and increase the risk of uterine cancer. If you are postmenopausal or do not have a uterus, progesterone is not necessary.

Together with your doctor, you will determine the right hormone dosage to alleviate or reduce your symptoms. The dosage is gradually increased. It may take a few months to find the appropriate form and dose.

Man with short brown hair wearing a light medical coat, smiling indoors with wooden shelves and a plant in the background
Dr. EAH KnauffGynaecologist
Hormone therapy can quickly and safely relieve menopausal symptoms for many women.

When can hormone therapy help?

Since the 1960s, hormone therapy has been widely used to relieve menopausal symptoms. Various international organisations, such as the North American Menopause Society, recommend it as the first and most effective choice for (vasomotor) symptoms, such as hot flushes, during menopause. HRT can help with:

  • Vasomotor symptoms (hot flushes and night sweats)
  • Vaginal symptoms, such as dryness, itching, or pain
  • Bone loss (and its prevention)
  • Sleep problems
  • In some women, other symptoms may also improve, such as heavy menstrual bleeding, migraines, and mental health issues (such as mood swings, stress, and low mood)

When is hormone therapy not the first step?

HRT is not the first choice for every woman. For mild symptoms or when someone is not ready to opt for it, other forms of support can be considered, such as lifestyle changes, dietary adjustments, or the use of supplements.

Additionally, there are medical situations where hormone therapy is not recommended, such as a history of hormone-sensitive cancer, thrombosis, or certain liver conditions. Personal preference also plays an important role. Therefore, hormone therapy is always carefully and individually assessed.

What forms of hormone therapy are available?

Hormone medication comes in various forms (such as tablets, creams, and pessaries) and can contain either bioidentical or synthetic versions of oestrogen and progesterone.

The choice of administration method and the type of oestrogen and/or progesterone depends on various factors, such as the nature of your symptoms. Most prescribed treatments contain bioidentical oestrogen (oestradiol). Bioidentical oestradiol works exactly like the oestradiol naturally produced by a woman’s body.

In addition, it often contains bioidentical progesterone or synthetic progestogens (such as levonorgestrel or dydrogesterone). The best option varies from woman to woman. Some respond better to bioidentical hormones, while others benefit more from synthetic ones or a combination of both. This is usually determined over time and adjusted based on how your body responds.

If you still have a uterus, hormone therapy is usually given as a combination of oestrogen and progesterone. Oestrogen helps reduce menopausal symptoms, while progesterone is needed to protect the uterine lining from excessive build-up caused by oestrogen. If you do not have a uterus or are postmenopausal, progesterone is not always necessary.

Blister pack of hormone tablets with medication box labelled 1 mg placed beside a glass of water on a light surface

What can you expect from hormone therapy?

Hormone therapy aims to stabilise your hormone levels. Within a few days, the first menopausal symptoms may begin to subside. Over time, many women notice improved sleep, fewer hot flushes, and reduced vaginal symptoms. Muscles and joints may also become less sensitive, and some women feel more energetic.

The dosage is usually gradually increased. It may take several weeks to months to find the right form and dosage. The effect varies from person to person.

Hormone therapy is generally not used indefinitely. Doctors often recommend evaluating after a few years to see if the treatment can be tapered off, depending on your symptoms and situation.

Risks and side effects

Hormone medication is considered by specialists to be the most effective treatment for menopausal symptoms, but it does carry some risks. These risks primarily apply to women who start treatment later in menopause. These include:

  • Increased risk of breast and uterine cancer with long-term use (five years or more).
  • Slightly increased risk of cardiovascular disease (such as thrombosis).
  • Slightly increased risk of stroke. If you smoke, have high blood pressure, or high cholesterol, the risk is significantly higher.

The risk appears to be lowest with bioidentical hormones administered through the skin.

At the same time, recent studies show that women who start hormone therapy early and use it for several years during menopause tend to live longer and healthier lives. Hormone therapy appears to reduce the risk of cardiovascular disease, dementia, osteoporosis, and overall mortality. These positive effects are especially observed in women who start around the onset of menopause and are treated under medical supervision.

Hormone therapy is also not recommended for women with a history of breast cancer, hormonal cancer, stroke, thrombosis, liver disease, or abnormal vaginal bleeding.

Side effects of hormone therapy

As hormone levels increase and/or the correct hormone dosage is determined, some side effects may occur during the first months of treatment:

  • Headaches
  • Nausea
  • Breakthrough bleeding
  • Tender or sensitive breasts

Key differences between treatment options

Below is an overview of the main differences between hormone therapy, hormone-free medication, supplements, and lifestyle and dietary changes. Not every woman wants or is able to use hormone therapy. This comparison can help you determine which option best suits your symptoms, health, and personal preferences.

Treatments for menopause symptoms

Many women experience symptoms during menopause. Fortunately, there are things you can do. Various treatments are available, depending on your personal preferences and medical history. If you have several symptoms, a combination of treatments is often the best approach. Below are the options and how they compare: 

Hormone therapy

A single treatment for multiple menopause symptoms

Effectiveness

  • Extensive scientific evidence
  • Risk of side effects 
  • Safe to use
  • Very fast-acting 
  • Prescription-only 

Hormone-free

Treatment for individual symptoms, alternative to hormone therapy

Effectiveness

  • Extensive scientific evidence 
  • Risk of side effects 
  • Very safe to use 
  • Fast-acting 
  • Prescription-only 

Supplements

Natural and hormone-free

Effectiveness

  • Growing scientific evidence 
  • Very low risk of side effects 
  • Very safe to use 
  • Takes weeks to months to take effect 
  • Available over the counter 

Diet & Lifestyle

The foundation for a healthy body

Effectiveness

  • Scientific evidence  
  • No side effects 
  • Very safe 
  • Supports overall health and the effectiveness of medication 
  • Takes weeks to months to see results
Discover how it works

Personalised product advice for your symptoms

80% of women experience symptoms during menopause. Luckily, there’s something you can do about it. Start the assessment and receive personalised product advice from a doctor.

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  1. 1

    Complete a medical questionnaire

    Take your time to fill in our comprehensive medical questionnaire to outline your situation and treatment preference. Afterwards, you can make the payment of 43 pond for the product recommendation. 

    2

    Receive a product recommendation via chat

    Within 48 hours, a doctor will prepare a product recommendation for the first 3 months, tailored to your symptoms, medical situation and treatment preference. You then decide which products you wish to order, complete the ID-Check and make the payment.  

    Any questions? Just ask the doctor in the chat. We will save your recommendation for 30 days, giving you plenty of time to think it over. 

    3

    Start your treatment

    Your products will be delivered to your home from the pharmacy within 3 days, so you can start your treatment without delay. During the treatment, the doctor will check in with you. You can also ask any questions you may have via the chat.

Or

Intake: your personalised treatment advice from a doctor

Not sure which treatment is right for you? The intake process includes a medical questionnaire about your symptoms, medical history, and treatment preferences. Your answers provide the doctor with a complete picture of your situation and preferences. Within 48 hours, you will receive personalised product advice.

Why an intake helps:

  • The intake costs 43 pond
  • You receive personalised advice from one of our doctors tailored to your symptoms and health situation
  • You can indicate your treatment preference or leave the choice to the doctor
  • You start a treatment that matches your symptoms, avoiding unnecessary medication or supplements
  • You can ask your treating doctor questions about the advice via chat, both before starting and during treatment

FAQ

Is hormone therapy safe?
How quickly will I notice the effects of hormone therapy?
Will I have to use hormone therapy permanently?
What if hormone therapy is not suitable for me?
Do I always need personalised advice?