Hormone replacement therapy is not a single treatment, it is a category with many distinct options that differ in hormone type, formulation, delivery method, and dosing approach. Understanding what is available helps you have a more informed conversation with your provider and advocate for care that genuinely fits your needs.
Hers
Hers is one of the most recognizable consumer telehealth brands in women's health, and their HRT program extends that brand's user-friendly approach to menopause care. Women who want a polished digital experience, easy onboarding, a clean interface, and a trusted brand name behind their prescription, will find Hers the most frictionless path to getting started with HRT online. Their menopause-focused care team handles everything from consultation to prescription delivery.
Estrogen Therapy
Estrogen is the primary hormone used in HRT and the most effective treatment for most menopause symptoms, particularly vasomotor symptoms (hot flashes and night sweats) and genitourinary symptoms.
Systemic Estrogen (Full-Body Effect)
Hers
Hers is one of the most recognizable consumer telehealth brands in women's health, and their HRT program extends that brand's user-friendly approach to menopause care. Women who want a polished digital experience, easy onboarding, a clean interface, and a trusted brand name behind their prescription, will find Hers the most frictionless path to getting started with HRT online. Their menopause-focused care team handles everything from consultation to prescription delivery.
Systemic estrogen reaches the bloodstream and affects the entire body, including the brain (for mood and cognition), bones (for density), and cardiovascular system. Delivery options include:
- Patches: Transdermal patches changed every 1–3 days. Associated with lower clotting risk than oral forms.
- Gels and sprays: Applied daily to skin. Provides steady absorption with minimal peak-trough variation.
- Oral tablets: Convenient but associated with slightly higher clotting and stroke risk due to first-pass liver metabolism, important consideration for those with cardiovascular risk factors.
- Implants/pellets: Subcutaneous implants releasing estrogen over months. Less precise dosing; not FDA-approved, though used by some compounding practices.
Local/Vaginal Estrogen
Low-dose vaginal estrogen treats genitourinary syndrome of menopause (vaginal dryness, discomfort, recurrent UTIs) with minimal systemic absorption. Safe for most women, including many breast cancer survivors with appropriate oncologist guidance. Forms include:
- Vaginal creams (Premarin, Estrace)
- Vaginal rings (Estring, local only; Femring, systemic)
- Vaginal tablets or suppositories (Vagifem, Yuvafem)
Progesterone / Progestogen
Women with an intact uterus require progesterone alongside estrogen to protect the uterine lining from estrogen-driven overgrowth. Options include:
- Oral micronized progesterone (Prometrium): Bioidentical, FDA-approved, favorable safety profile, mild sedating effect (take at night)
- Synthetic progestins (e.g., medroxyprogesterone acetate): Widely used but associated with slightly higher breast cancer risk in combination therapy compared to micronized progesterone in some analyses
- Progesterone IUD (Mirena): Delivers progestogen locally to the uterus, minimizing systemic exposure, an option for women who want estrogen systemically but want to limit progestogen effects
Testosterone for Women
Though not approved for women, testosterone is increasingly recognized as important for libido, energy, and cognitive function. It is used off-label in low doses, typically via cream or gel compounded specifically for women. Evidence for sexual function benefits is the most robust; long-term safety data continues to accumulate.
Combination HRT
Most women with a uterus use combined estrogen-progesterone therapy. There are two approaches:
- Cyclic/sequential HRT: Estrogen taken daily; progesterone added for 10–14 days per month. Often results in a monthly bleed similar to a period. Common in perimenopause.
- Continuous combined HRT: Both hormones taken daily with no break. Aims to eliminate monthly bleeding. Most appropriate 12+ months after last period.
Choosing the Right Type
| Priority | Preferred Option |
|---|---|
| Lower clotting risk | Transdermal estrogen (patch, gel, spray) |
| Convenience | Oral tablets or weekly patch |
| Vaginal symptoms only | Local vaginal estrogen |
| Progestogen with least systemic effect | Mirena IUD + systemic estrogen |
| Avoiding monthly bleeding | Continuous combined HRT |
Frequently Asked Questions
Is there a best type of HRT?
No single formulation is universally best. The right choice depends on your symptoms, health history, uterus status, personal preferences, and risk factors. Transdermal estrogen with oral micronized progesterone is often preferred by menopause specialists because of its favorable risk profile, but many other options are appropriate in different clinical contexts.
Are bioidentical hormones safer than synthetic?
Regulated bioidentical hormones (estradiol, micronized progesterone) have a favorable evidence base. The term "bioidentical" as used by compounding pharmacies is not a regulated safety claim. See our guide on bioidentical vs traditional HRT for a full comparison.
Can I switch types if one does not suit me?
Yes, formulation changes are common and expected as treatment is refined. Working with a menopause-informed clinician who takes an iterative approach is important for long-term success.
Find a Provider Who Offers Your Preferred HRT Type
Our comparison covers HRT providers who offer the full range of estrogen delivery methods and formulations, including transdermal options and testosterone support, with licensed menopause-informed clinicians.
Compare HRT Providers →Editor's Choice, HRT for Women
Hers
Hers is one of the most recognizable consumer telehealth brands in women's health, and their HRT program extends that brand's user-friendly approach to menopause care. Women who want a polished digital experience, easy onboarding, a clean interface, and a trusted brand name behind their prescription, will find Hers the most frictionless path to getting started with HRT online. Their menopause-focused care team handles everything from consultation to prescription delivery.