The recent FDA Panel on Menopause and Hormone Replacement Therapy (HRT) made headlines when experts unanimously called for removing misleading black box warnings from certain HRT medications. For women navigating perimenopause and menopause, this development highlights an important truth: Hormone therapy isn’t the risky treatment many believe it to be. In fact, when administered correctly, it’s often the most effective solution for managing life-disrupting symptoms.
Jennifer Chapman, MMS, PA-C, has spent years working as a certified Physician Assistant (PA-C), first in orthopedic care, then in specialized women’s health at Tryon Women’s Center. Amy Kemmerlin, certified Family Nurse Practitioner (FNP-C), brings both personal and professional experience to weight management and hormone therapy. Together, they provide some answers to frequently asked questions about HRT, including: What is hormone replacement therapy, and what are the signs that you need HRT?
What is hormone replacement therapy and how does it work?
HRT is a medical treatment that involves replacing hormones that are declining in the body. It is typically used to treat symptoms associated with menopause, such as hot flashes, night sweats, vaginal dryness, mood swings, and osteoporosis. HRT involves administering what’s typically referred to as bioidentical hormones, such as estrogen and progesterone, to restore hormone levels and alleviate these symptoms. Rather than letting symptoms worsen, HRT helps women maintain bone health, mental health and clarity, energy, and overall wellness as they age.
Hormone replacement therapy works by addressing the root cause of peri or post-menopausal symptoms rather than treating each symptom individually. When a patient reports specific concerns, Chapman and Kemmerlin listen carefully to match symptoms with potential hormone deficiencies.
“HRT is not a one-size-fits-all approach – the type, route, and dose of hormones you supplement really differ depending on the person,” Chapman emphasizes. “We have a ‘toolbox’ per se, that we can work from, and we individualize our treatment based on what symptoms you are currently struggling with. We aren’t just focusing on the prescription options either; we take a whole-body approach with nutritional and emotional support into consideration as well.”
What are the signs that you need hormone replacement therapy?
Recognizing when your body might benefit from hormone support can significantly improve your quality of life.
“The biggest thing I note as a menopause provider is: everyone has a different and personalized experience of symptoms,” notes Chapman. “When you are in perimenopause, you experience the symptoms before we would be able to notice any decrease on a hormone panel because hormones naturally fluctuate daily, weekly, and monthly, with your cycle.”
Common signs indicating you might benefit from HRT include:
- Hot flashes
- Night sweats
- Disrupted or poor quality sleep
- Brain fog
- Fatigue
- Low libido
- Mood swings
- Skipped or irregular periods
Chapman explains that symptoms often point toward specific hormone needs: “If someone presents with sleeping difficulty, we’ll make sure your sleep hygiene is optimized, but also consider if progesterone supplementation may be beneficial because we know that a drop in progesterone can affect the way our brain prepares for sleep and the quality of sleep we attain. Or, for instance, in women who are experiencing night sweats, irregular periods, fatigue, vaginal dryness, estrogen supplementation may be a consideration. Figuring out what the best approach is for each patient is based on the patient’s own medical history and priorities.”
The key is recognizing that these symptoms aren’t just inevitable parts of aging, but treatable symptoms of hormone disruption. Women don’t have to suffer through this natural aging process.
What does HRT do for your body?
Hormone replacement therapy addresses multiple symptoms simultaneously by targeting their underlying cause: unpredictable fluctuations in hormones.
The treatment doesn’t replace your natural hormone production entirely. “With perimenopause, you’re still producing your own hormones, but they’re just a bit more erratic or inconsistent than they used to be,” Chapman explains.
HRT provides consistent support to help your body maintain optimal function during this natural hormonal transition. Rather than managing multiple medications for separate symptoms, hormone therapy often addresses several concerns with fewer interventions, helping women feel more like themselves again. HRT is not a catch-all for every health issue that you experience during this phase of life, and it is important to see a provider who can take a look at your overall health picture when considering HRT.
What are the different types of HRT?
Route, formulation, and timing all significantly impact HRT effectiveness and safety – key points emphasized by the recent FDA panel.
“With systemic estrogen, the safest way to administer it is through the skin, most often through a patch or a gel. Vaginal estrogen is a cream or tablet. ” Chapman explains. “Progesterone is typically administered as a pill at night, as it can induce drowsiness. Testosterone is administered as a daily gel or in some patients, and a pellet is a convenient route.”
Treatment options for supplemental hormones include:
- Daily pills
- Vaginal creams or tablets
- Patches
- Pellets placed in the glute muscle
“Dosing is really important, and patient-specific – it’s like Goldilocks, trying to find the dose and route that is just right for you is key,” Chapman emphasizes. “We start at a conservative level to see how the body responds, and depending on how you feel on that starting dose, we have room to increase as needed.”
Depending on the type of HRT and if treating during peri/post-menopause, patients typically return initially in 8-12 weeks to see how the initiation doses feel. Then once their levels are optimized, we follow up in 6-12 months to continue monitoring overall benefits and health.
Chapman emphasizes that we still need research to demonstrate the benefits versus the risks of having patients on HRT for long-term use (such as for 20-30 years): “We continue to live longer than previous generations, so research, especially in women’s health, is lacking. Continuing to stay up-to-date with the research to offer our patients the best long-term health care is a priority for all of our providers at Tryon Women’s Health.”
Does HRT cause weight gain or help with weight loss?
Weight concerns shouldn’t prevent you from considering hormone therapy if you’re experiencing menopausal symptoms.
“Everything research shows is that HRT is weight-neutral. It won’t cause weight gain or weight loss,” clarifies Kemmerlin. “However, optimizing your hormone levels is often the first step in tackling hormonal weight gain. Sometimes people start to feel better, eat better, have more energy, which helps weight loss because you can get back to healthier habits.”
Some patients may notice initial water retention or bloating with the start of HRT, but Kemmerlin says this typically normalizes within the first month. The indirect benefits of HRT include improved sleep, increased energy, and a better mood, often helping women return to healthier lifestyle patterns that support weight management naturally.
Is HRT covered by insurance? What does it cost?
Tryon Women’s Center physicians want to ensure that cost isn’t a barrier to exploring hormone therapy options. The Tryon team helps patients find affordable options through pharmacy programs in which prescriptions can be mailed at significantly lower prices than traditional pharmacies. Current options make treatment accessible for most patients willing to explore different pharmacy resources.
“We try to be upfront as much as we can,” Chapman explains. “A lot of the medications have generic forms, which are helpful. Estrogen and progesterone, in some form, are typically covered by insurance. Testosterone use in women is not currently FDA-approved, so it is not covered by insurance, but we help patients shop around to find the best pharmacy cost. Testosterone has been approved for use in women in other countries, such as Australia, Great Britain, Ireland, and New Zealand, so there are women-specific testosterone formulations. We are hopeful that the US will catch up with this standard of care for women in the near future.”
Why does the FDA panel want black box warnings removed?
The recent FDA panel of specialists, including gynecologists, urologists, orthopedists, neurologists, and cardiologists, unanimously recommended removing black box warnings reflecting current scientific understanding of HRT safety.
“The black box warning was put on estrogen packaging based on the WHI study in the early 2000s that created some panic about the increased risks of breast cancer, heart attack, blood clots, and stroke with HRT,” Chapman explains. “This elevated risk noted in this study was using hormone formulations that we don’t currently use or are not first-line therapies. The black box warning creates a lot of fear in women who are really suffering from their menopausal symptoms, and decide against taking it because of this warning. This is a conversation I take time to have with every woman when I prescribe this medication.
Chapman emphasizes that oral administration of estrogen can increase one’s risks for blood clots and strokes, but these concerns are unfounded for vaginal estrogen, as it stays local in the vaginal tissue. In fact, Chapman notes that the American Urological Association recently updated their guidelines for the Genitourinary Syndrome of Menopause to say that treating postmenopausal patients with vaginal estrogen or DHEA, an estrogen precursor, actually reduces the risk and susceptibility of UTIs in women as we age, along with providing other benefits to urological health.
“The FDA has not yet responded with their decision,” Chapman shares, “But women deserve this standard of care for their healthspan.”
What are the real risks and benefits of HRT?
Every medical treatment involves weighing potential risks against benefits, and hormone therapy is no exception.
Potential side effects include breast tenderness, irregular bleeding or spotting, bloating, headaches, adult acne, abnormal hair growth or a deepening voice, and are hormone-specific. Many of these side effects can be resolved with a dose adjustment. Special populations where HRT is controversial are patients with a history of breast cancer, who have clotting deficiencies, or have been post-menopausal for 10+ years. Patients with certain types of breast cancer history may face increased risks, though research is ongoing and requires conversation with your oncologist to weigh the risks vs. benefits, Chapman notes.
Chapman provides an important perspective: “When we take oral birth control, we are taking much higher levels of hormones to override our own hormone levels and manage menstrual symptoms or prevent pregnancy. The level of hormones we use in peri and post-menopause is much lower, as we are just trying to keep enough hormones circulating to maintain physiological homeostasis. Just because we outlive the function of our ovaries doesn’t mean the rest of our health should suffer.” Kemmerlin adds, “You’re already producing these hormones. We’re just topping you off or picking up where they dropped off.”
The alternative – managing multiple medications to treat individual menopausal symptoms – often exposes patients to more side effects while providing less comprehensive relief than properly administered hormone replacement therapy.
Making an informed decision about HRT
Understanding hormone replacement therapy empowers you to make informed decisions about managing menopausal symptoms. The recent FDA panel’s recommendations reflect growing scientific consensus that properly administered HRT offers significant benefits with manageable risks for most women.
“We’re always taking factors into consideration, such as what their cardiovascular health is, and their individual risk factors,” Chapman explains. Rather than avoiding treatment due to outdated warnings or misconceptions, women should focus on finding qualified physicians who can personalize hormone therapy to their specific needs and health profiles.
If you’re experiencing symptoms that might benefit from hormone replacement therapy, don’t let fear or misinformation prevent you from exploring your options. The goal isn’t just managing symptoms; it’s helping you feel as energetic, healthy, and strong as possible going through this life transition.
Ready to learn more about hormone replacement therapy? Visit the Tryon Women’s Center page to schedule a consultation and discover how personalized HRT might improve your quality of life.
