Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it’s now called) was also thought to have the long-term benefits of preventing heart disease and osteoporosis.

Attitudes about hormone therapy changed abruptly in 2002, when a large clinical trial found that the treatment actually posed more health risks than benefits for postmenopausal women. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And most women on hormone therapy discontinued its use, often without talking to their doctors.

Hormone replacement therapy (HRT) is a system of medical treatment for surgically menopausal, perimenopausal and to a lesser extent postmenopausal women. It is based on the idea that the treatment may prevent discomfort caused by diminished circulating estrogen and progesterone hormones. It involves the use of one or more of a group of medications designed to artificially boost hormone levels. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. It often referred to as “treatment” rather than therapy.

HRT is available in various forms. It generally provides low dosages of one or more estrogens, and often also provides either progesterone or a chemical analogue, called a progestin. Testosterone may also be included. In women who have had a hysterectomy, an estrogen compound is usually given without any progesterone, a therapy referred to as “unopposed estrogen therapy”. HRT may be delivered to the body via patches, tablets, creams, troches, IUDs, vaginal rings, gels or, more rarely, by injection. Dosage is often varied cyclically, with estrogens taken daily and progesterone or progestins taken for about two weeks every month or two; a method called “sequentially combined HRT” or scHRT. An alternate method, a constant dosage with both types of hormones taken daily, is called “continuous combined HRT” or ccHRT, and is a more recent innovation. Sometimes an androgen, generally testosterone, is added to treat diminished libido. It may also treat reduced energy and help reduce osteoporosis after menopause.

Bioidentical hormone replacement therapy refers to the use of hormones that are chemically identical to those produced in a woman’s body, though they are also associated with the practices of pharmaceutical compounding and saliva testing to determine, and adjust a woman’s hormone levels (the latter two practices are extremely controversial – compounding has not demonstrated any benefits and presents risks of uncertain dosing, potency and possible contamination; saliva testing is considered to have no merit due to the natural fluctuations in hormone levels and the lack of support for a specific dosage of hormones being ideal). Proponents also claim that BHRT can offer advantages beyond those typical of traditional HRT, though there is no evidence to support these claims.

Back ↵