Hormone Therapy for Women in Menopause

Hormone therapy for perimenopause and menopause

If hot flashes, night sweats, broken sleep or vaginal discomfort are wearing you down, hormone therapy may help. Here is how HealifyMD clinicians evaluate it, which options are in the plan and how risks are weighed.

Price: $349 first month, then $99/month
Included: Estradiol options, progesterone, vaginal estriol
With a uterus: Progesterone is needed with systemic estrogen
Labs: Priced separately

Who hormone therapy can help

Hormone therapy is the most effective treatment for hot flashes and night sweats. It also treats vaginal dryness and painful sex, and it helps prevent bone loss and fractures. Some women notice better sleep and mood, partly because night sweats stop waking them.

Menopause is confirmed after 12 months without a period, usually between 45 and 55, but symptoms often begin years earlier in perimenopause. You do not need to wait until your periods stop to discuss treatment.

What your clinician looks at first

Diagnosis in midlife women is mostly based on symptoms and your menstrual history, because hormone levels swing widely during perimenopause and a single blood test can mislead. Your clinician will review your symptoms, cycle pattern, personal and family history of blood clots, stroke, heart disease and breast cancer, your blood pressure and any medications.

Labs are ordered when they add information, for example to check thyroid function, iron, lipids or blood sugar when symptoms overlap with other conditions, or to establish a baseline before treatment.

Estrogen options in the plan

Estrogen relieves hot flashes and other systemic symptoms. Delivery through the skin avoids first-pass processing in the liver and is associated with a lower risk of blood clots than oral estrogen, which is one reason it is often preferred for women with certain risk factors.

Topical estradiol (compounded), applied to the skin.
Estradiol cream (compounded).
Estradiol patch, changed on a set schedule.
Estriol vaginal cream (compounded), a low-dose local option for vaginal dryness, irritation and pain with sex.

Progesterone: why it matters if you have a uterus

If you still have your uterus, taking estrogen alone raises the risk of endometrial hyperplasia and cancer. A progestogen is added to protect the uterine lining. Oral micronized progesterone has the strongest evidence for this protection, and it can also help some women sleep.

Progesterone cream is included in the plan, but creams have not been shown to reliably protect the uterine lining, so they are not a substitute for oral progesterone when systemic estrogen is used. Your clinician will explain which form you need. Women who have had a hysterectomy usually do not need progesterone for this purpose.

Understanding the risks

Risks depend on your age, time since menopause, health history, the dose and the route. Oral estrogen raises the risk of blood clots and stroke. Combined estrogen and progestogen raises breast cancer risk after several years of use. For most healthy women, the benefits are most favorable when therapy starts before 60 or within 10 years of menopause.

In November 2025 the FDA announced it would remove boxed warnings about heart disease, breast cancer and dementia from menopausal hormone therapy labels. The endometrial cancer warning remains for estrogen-alone products. The change does not remove the need for an individual risk discussion.

A note on compounded hormones

Most products in this plan are compounded. Compounded hormones are not FDA-approved, are not reviewed by the FDA for safety, effectiveness or quality, and are not interchangeable with branded products. FDA-approved estradiol and micronized progesterone products are available, and you can ask your clinician whether one would suit you better.

Who should not use systemic hormone therapy

Women with a history of breast or endometrial cancer, unless directed by their oncologist.
Women with a history of blood clots, stroke or heart attack.
Women with unexplained vaginal bleeding, until it is evaluated.
Women with active liver disease.
Anyone who is pregnant.

What follow-up looks like

Your clinician checks in after you start to review symptoms, side effects such as breast tenderness or spotting, and blood pressure. Doses are adjusted gradually. Any new or unexpected bleeding should be reported, because it may need evaluation. Your plan is reviewed at least yearly, including whether to continue.

Common questions

Is hormone therapy safe?

For many healthy women under 60 or within 10 years of menopause, the benefits outweigh the risks, but your own history determines what is safe for you.

Do I need both estrogen and progesterone?

If you have a uterus and use systemic estrogen, yes. Women without a uterus usually take estrogen alone.

Patch, cream or gel: which is right for me?

It depends on your preferences, skin, risk factors and how consistent you can be; skin-based estrogen is often chosen when clot risk is a concern.

How soon will I feel a difference?

Many women notice fewer hot flashes within a few weeks, though finding the right dose can take a few months.

Can I start hormone therapy in perimenopause?

Yes. Treatment can begin while you still have periods, and your clinician will tailor it to an irregular cycle.

What does the price include?

The $349 first month, which includes your evaluation and baseline labs, and $99/month after that cover the hormone therapy program, including the estradiol, estriol and progesterone products listed; other labs are separate.

Is vaginal estriol the same as systemic hormone therapy?

No. Low-dose vaginal estrogen treats local tissue with minimal absorption and is used for vaginal and urinary symptoms.