13 Hormone Replacement Therapy (HRT) Benefits for Menopause

Posted on September 12, 2025

During perimenopause—the years leading up to your final period—your body becomes a bustling hub of hormonal change. Picture Grand Central Station, only instead of passengers racing to make their trains, baristas serving coffee and bagels, and tourists pausing to gawk at interesting architectural details, you’ve got estrogen levels zigzagging all over the place, progesterone taking the elevator down to the basement, and testosterone swinging from the chandelier. The result: An arrivals board filled with symptoms like irregular periods, hot flashes, and an even hotter temper, while your memory and libido are scheduled to depart at totally unpredictable times.

Hormone replacement therapy (HRT) is a type of medication used during perimenopause and menopause to replenish some of the hormones that naturally decline with age. For many women, it’s a light at the end of the tunnel. The words “hormone replacement therapy” are a tad misleading, as you’re not exactly replacing the hormones, so much as you’re supplementing them, adding back in just a fraction of what you made during your 20s and 30s. For this reason, HRT is sometimes called menopausal hormone therapy (MHT) or just hormone therapy (HT). But as with acronyms like “LOL,” “IRS,” and “BOGO,” the letters “HRT” have been burned into the collective consciousness, so that’s what we’ll use throughout this story.

Widely considered the most effective treatment for relieving some of the most stressful symptoms of perimenopause and menopause, HRT works by helping blunt some of the physiologic effects of rapidly shifting hormone levels. Depending on your most irksome symptom, the effects are usually felt within weeks.

You might even consider hormone therapy a form of health insurance, as starting HRT within 10 years of your last period can reduce your future risk of several chronic conditions, including osteoporosis and heart disease, the number one killer of women. HRT may also help reduce diabetes risk and boost weight loss in women using GLP-1 inhibitors.

Not every woman is a candidate for HRT (more on that in a bit), but for those who are under age 60 or within a decade of their final period and “are trying to age well, hormone therapy is one of the best things you can do for symptom relief and longevity,” says Christy Beyer, MD, MSCP, Medical Director of Midi Health.

What Is HRT for Women?

As your peak reproductive years wind down, estrogen and progesterone levels begin to decline. For estrogen in particular, the descent is less of a straight drop and more like Newton’s cradle, those stainless-steel balls that click back and forth, rising high and low for a while before gradually slowing to a stop.

Those wild up-and-down estrogen shifts can affect any organ or bodily system that relies on estrogen to thrive, resulting in uncomfortable symptoms. Many people assume that just means irregular periods and vaginal dryness. But women have estrogen receptors nearly everywhere—your brain, heart, bones, skin, pancreas, and immune system, to name a few—so you may experience the fallout in the form of memory blips, increased cholesterol levels, achy bones…. You get the picture.

HRT comes in several forms and combinations. First, let’s talk about forms.

Non-systemic HRT

This type of HRT works locally to address specific symptoms, including vaginal dryness and irritation. Non-systemic HRT has minimal systemic absorption, and comes in these forms:

vaginal creams
vaginal rings
vaginal suppositories

Systemic HRT

This type of HRT enters your bloodstream and circulates to different organs and tissues in your body, comes in the form of:

pills
patches
topical gels and sprays
pellets (which Midi doesn’t recommend)

As for combinations, systemic HRT can include estrogen, progesterone (or progestin, which is synthetic progesterone), or a combo of the two:

Combined estrogen and progesterone therapy

This is the most common form of HRT, typically prescribed to women who still have their uterus. (As in: It hasn’t been removed via a hysterectomy.) That’s because estrogen can thicken the uterine lining—and that’s a known risk factor for uterine cancer. Taking progesterone while taking estrogen is key because it reduces this thickening and brings the uterine cancer risk back to baseline. Some women who’ve had their uterus removed (and thus don’t require uterine cancer protection) still opt for progesterone, as it’s been shown to improve midlife insomnia.

Estrogen-only therapy

Systemic estrogen-only therapy is typically reserved for women who have had a hysterectomy. Nonsystemic estrogen-only therapy may be used by women with a uterus if the HRT in question is vaginal estrogen, which remains local and therefore doesn’t increase uterine cancer risk.

Progesterone-only therapy

Solo progesterone is usually prescribed for sleep issues, including insomnia and night sweats that disrupt your sleep. It doesn’t matter whether you still have your uterus for this one.

Benefits of HRT

The three most widely agreed-upon clinical indications for HRT for women are:

Persistent hot flashes and night sweats: HRT dampens these symptoms (technical term: vasomotor symptoms) by up to 90%.
Osteopenia (lower-than-normal bone density): Starting HRT within 10 years of your last period can help keep your bones stronger for longer periods of time (including reduced fracture risk).
Irritating vaginal and urinary symptoms (like vaginal dryness and recurrent urinary tract infections) that interfere with sex drive, sexual satisfaction, and overall quality of life: “Once you’re over 50 and losing estrogen, the biggest hit is to the genitourinary system,” says menopause expert Holly L. Thacker, MD, director of the Cleveland Clinic Center for Specialized Women’s Health and past chair of The Menopause Society’s Physician Education Committee. Prescription vaginal estrogen can help quench vaginal dryness and irritation. Nonsystemic formulations like estrogen creams, suppositories, or rings have been shown to eliminate these symptoms in 80% to 90% of women who use them.

Many women also report that, in addition to overall improved quality of life, HRT helps with the following equally annoying and potentially life-altering midlife symptoms:

achy joints
issues with memory and cognitive functioning
mood swings, anxiety, irritability, and anger
weight gain and redistribution (the shifting of fat to the midsection)

It may also lead to:

elevated energy levels and reduced fatigue
improved skin elasticity and reduced dryness
healthier hair growth

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