Does Hormone Replacement Therapy work?

Everyone wants to know: Does hormone replacement therapy actually work? Makes sense – you’re lying awake, sweating at 2 a.m., your mood is all over the place, and you’d really like to know if HRT is going to help. Quick answer: for many people, yes, it works. But how well it works depends on your symptoms, when you start, which kind you use, and your own health background. I’ll walk through what the research shows, how to weigh the pros and cons, and what it’s really like to try HRT with a solid plan. So, does hormone replacement therapy work?

What is HRT and how does it work?

Hormone replacement therapy means replacing the hormones that drop off during perimenopause or menopause – usually estrogen and progesterone, sometimes testosterone for certain cases. Here’s the thing: estrogen receptors are everywhere: your brain, bones, skin, blood vessels, even the urogenital tract. That’s why the symptoms can feel like they’re coming from all directions.

By restoring steadier hormone levels, HRT can cool down hot flashes, help you sleep better, less night sweats, and support tissues that need estrogen. You’ve got two main ways to get estrogen: by mouth (oral) or through the skin (transdermal) – like patches, gels, or sprays. Oral estrogen (for instance, estradiol tablets such as Winona’s Estrogen Tablet) goes through your liver first, which can bump up clotting factors and triglycerides a bit.

Transdermal estrogen reaches your bloodstream directly and is generally easier on your metabolism and clotting risk. For example, some women use a transdermal estradiol patch (like Winona’s Estrogen Patch) to get steady estrogen with a lower clotting risk compared to pills. If you still have a uterus, you need progesterone too, to keep the uterine lining safe. Micronized progesterone (the kind that matches what your body makes) is usually easier to tolerate and can help some people sleep. This often looks like micronized progesterone at night (similar to Winona’s Progesterone Capsules), which many women find gentler and sometimes a bit calming. Dosing isn’t one-size-fits-all. The goal is the lowest dose that works, with regular check-ins to reassess.

If you’re still figuring out whether you’re in perimenopause or full menopause, check out Perimenopause and Weight Gain: What Really Helps for a clear breakdown of what’s happening in your body.

Does HRT actually reduce hot flashes and night sweats?

Absolutely – this is where HRT really shines. Study after study shows that estrogen therapy cuts down hot flashes and night sweats by about 70 to 90 percent within a month or two. Some people notice relief sooner. If hot flashes are making life miserable and you’re a good candidate, HRT is your strongest option. There are non-hormonal meds too – SSRIs, SNRIs, gabapentin, clonidine, and a newer drug targeting neurokinin 3 receptors – but generally, none works as well as estrogen.

My HRT story – what it felt like, day by day

When I first thought about HRT, I hesitated. All those scary news headlines stuck with me. But after months of waking up drenched, feeling foggy, and basically planning my life around my symptoms, I finally made an appointment. I started with a low-dose estradiol patch and took micronized progesterone at night.

The first week? Not much happened. Around week three, though, night sweats backed off. By week six, I was finally sleeping through the night and the brain fog cleared. Stressful days still happened, but my baseline felt more like myself. That’s just my story, not a guarantee, but it shows how the effects can build up gradually.

Is HRT safe? What are the real risks?

Risks depend on the kind of hormones, how you take them, your age, your health, and how long it’s been since menopause. The “timing hypothesis” is important: starting HRT before age 60 or within ten years of your last period is linked with better heart safety. Transdermal estrogen at usual doses has a lower risk for blood clots than the pill form.

What’s changed with HRT safety in 2025?

In November 2025, the FDA removed the black box warnings from hormone therapy after reviewing decades of data. The original 2002 study was misinterpreted—HRT doesn’t significantly increase breast cancer risk for most women. This is a major shift in how doctors and patients view menopause treatment.

What Doctors Are Saying Now (2025)?

“The FDA’s decision to remove black box warnings is a vindication of what we’ve known for years—HRT is safe and effective for most women in early menopause.” — Dr. Marty Makary, FDA Commissioner

Will HRT help with mood, brain fog, and sleep?

Sleep usually gets better as those night sweats and hot flashes calm down. Taking micronized progesterone at night can also have a mild calming effect. The data on mood and cognition is trickier. In perimenopause, when your hormones are swinging up and down, some people get new anxiety or brain fog. If you’re struggling with sleep specifically, Hormonal Insomnia Treatment: Sleep Better! offers practical strategies that work alongside or without HRT.

Can HRT help your bones, heart, and metabolism?

Estrogen slows down bone loss after menopause and lowers your risk of fractures while you’re on it. When it comes to your heart and metabolism, it’s a bit more nuanced. If you start transdermal estradiol soon after menopause, it can help with cholesterol and blood vessel health, or at least not hurt. But if you wait until you’re over 60, or it’s been more than ten years since your last period, the risks start to outweigh the benefits. In those cases, it’s not recommended for prevention. If you’re mainly worried about breaking bones or heart risk, try non-hormonal meds and lifestyle tweaks first. Use HRT mainly for symptoms that bother you.

How long should you stay on HRT?

There’s no one-size-fits-all answer. Most doctors check in every year and talk about tapering off after two to five years if your symptoms have calmed down. Some people stay on longer, at the lowest dose that works, if symptoms stick around. Really, the main question is what are you hoping to sustain or protect, and how do your needs change over time?

How does your risk change over time?

Yearly check-ins and shared decisions work best here. What about local vaginal estrogen – is it different? Absolutely. Vaginal estrogen gives a tiny dose right where it’s needed for dryness, irritation, painful sex, or frequent urinary troubles. If your main issue is dryness or painful sex, local vaginal estrogen (like Winona’s Vaginal Estrogen Cream) can be an option to discuss with your clinician. Hardly any gets into your system at standard doses. Most guidelines say it’s safe for most people, even many who can’t take regular HRT. You can use it alongside non-hormonal moisturizers and lubricants.

Who shouldn’t take HRT, and what else can you try?

Skip systemic HRT (unless a specialist says otherwise) if you have a history of hormone-sensitive cancer, blood clots, stroke, active liver problems, or unexplained bleeding. Other options with good evidence: SSRIs or SNRIs for hot flashes, gabapentin for sleep and night sweats, CBT-I for insomnia, plus simple things like cooling bedding, fans, and paced breathing. Building muscle, eating more protein and fiber, and getting sunlight help too – these add up, no matter what meds you’re on.

What happens when you start HRT ?

First couple weeks: you might notice you sleep a little better, or having fewer hot flashes.

By weeks three to six, sleep often steadies out.

By 6 – 12weeks, energy and focus can pick up.

Side effects of HRT?

Sometimes breast tenderness, spotting, or a skin reaction where the patch sits. Usually, these fade with a dose tweak or a different formula. If you start to feel wired or moody, adjusting the progesterone might help. Keep a simple note of your sleep, hot flashes, and mood to fine-tune as you go.

How do you get a plan that fits?

Show up with your top three symptoms, a quick rundown of medical and family history, and a clear goal. Ask about patch versus pill, micronized progesterone, and what the follow-up will look like. Define “success” in real terms – like sleeping through the night most of the week, or no more than one short hot flash a day. Agree on when you’ll check in next. If HRT’s not the right fit, ask for a step-by-step plan with non-hormonal options so you don’t lose momentum. For your next step, check out A Beginner’s Guide to Hormone Testing below – it’ll help you make sense of labs before you order anything.

Comparative Overview of HRT Providers

Availability

• INNER Balance: All 50 states
• effecty: All 50 states
• MyMenopauseRx: All 50 states
• WINONA: 48 states (user must verify state on their site)
• Alloy: All 50 states + DC

Specialties

• INNER Balance: General HRT, Perimenopause, Menopause, Endometriosis, PCOS, Postpartum
• effecty: Hormone Therapy, Weight Loss, Longevity. Press the button below to get 50$ off for your 1st order!

• MyMenopauseRx: Broad symptom coverage—mood/anxiety/depression, weight/body changes, hot flashes/night sweats, sleep, period problems, painful sex/vaginal dryness/libido, brain fog/memory, hair/skin, joint pain/bone health, cancer effects
• WINONA: Menopause HRT, vaginal dryness, regenerative care, testosterone for women, weight maintenance, preventive care, hot flashes, mood/anxiety/depression, skin care
• Alloy: Hot flashes, night sweats, fatigue, vaginal issues, anxiety, facial acne, brain fog, weight gain, low libido, hair loss, bone fragility

If you prefer an online route, telehealth services like Winona let you complete an intake form, see suggested treatments in a portal, and have them shipped to your door.

How It Works (Onboarding Flow)

INNER Balance:

1. 5-minute health quiz
2. Prescription treatment (no visit required)
3. Start treatment + ongoing support

effecty:

1. Medical questionnaire
2. Licensed provider reviews and prescribes
3. Meds shipped with expedited delivery

MyMenopauseRx:

1. Intake + insurance validation
2. Schedule 1:1 with physician to create plan
3. Scripts sent to your preferred pharmacy (use your insurance)

WINONA:

1. Intake form
2. Portal signup + payment info
3. Doctor recommends treatments in portal with prices
4. You approve or decline
5. Shipping in ~5–9 days

Alloy:

1. Create account + pay $49 startup; complete intake
2. Physician creates plan
3. Prescriptions delivered to your door

Formulations Offered

• INNER Balance: Bioidentical HRT – vaginal cream (estradiol + progesterone; “Oestra”)
• effecty: Bioidentical HRT – estradiol patch, gel, or tablet. Press the button below to get 50$ off for your 1st order!

• MyMenopauseRx: Bioidentical HRT – creams, patches, spray, pills
• WINONA: Bioidentical HRT – combo creams (for example, Winona’s Estrogen Body Cream with Progesterone), patches, tablets, caplets, plus vaginal estrogen cream, DHEA, and estriol+tretinoin skincare.
• Alloy: Bioidentical HRT – creams, patches, spray, pills; also non-hormonal options (e.g., paroxetine)

“Voted Best For”

• INNER Balance: Sleep improvement
• effecty: Choice and flexibility (1:1 consult optional; pick patch/gel/tablet; providers who listen). Press the button below to get 50$ off for your 1st order!

• MyMenopauseRx: Most insurance-friendly
• WINONA: No pre-testing/labs; no initial consultation fees
• Alloy: Extremely simple process; no pre-testing; very affordable overall

Pricing Snapshot

INNER Balance:

• Oestra Cream: $199/month for first 6 months; then $99/month from month 7 onward
• Free consult at 3-month check-up to adjust dose; no initial consult required

effecty:

• Estradiol Patch: $125/month
• Estradiol Gel: $125/month
• Estradiol Tablet: $60/month
• Progesterone Tablet: $19.95/month

Press the button below to get 50$ off for your 1st order of any of the above products!

MyMenopauseRx:

• Insurance-based pricing—varies by plan, deductible, copays; scripts go to your pharmacy

WINONA:

• DHEA Pills: $27/3 months
• Estrogen Body Cream: $89/month
• Estrogen Body Cream with Progesterone: $89/month
• Estrogen Patch: $149/month
• Estrogen Tablets: $54/month
• Progesterone Body Cream: $89/month
• Progesterone Capsules: $39/month
• Vaginal Estrogen Cream: $89/month
• Sildenafil Arousal Cream: $79/order
• Estriol Face Cream w/ Tretinoin: $150/3-month supply
• Note: most will need an estrogen + progesterone pairing if uterus intact, or a combo cream

Alloy:

• Startup/Initial Consult Fee: $49
• Estradiol Pill: $119.97/3 months
• Evamist: $209.97/3 months
• Estradiol Gel: $209.97/3 months
• Estradiol Patch: $224.97/3 months
• Low-Dose Birth Control Pill: $119.97/3 months
• Paroxetine: $104.97/3 months
• Progesterone: $0 with estradiol (3-month supply)

Pre-Testing and Labs

• INNER Balance: No pre-testing or startup fee; intake form required
• effecty: No pre-testing or startup fee; intake form required
• MyMenopauseRx: No pre-testing required; labs may be needed/offered after consult
• WINONA: No pre-testing or startup fee; intake required
• Alloy: No pre-testing; intake required

Insurance and HSA/FSA

Quick Recommendations by Scenario

• Want the lowest ongoing price after six months and a vaginal combo cream format: INNER Balance (Oestra drops to $99/month from month 7)
• Want maximum flexibility (choose consult vs. no consult; choose patch/gel/tablet) and coupon: effecty
• Want to use your own insurance and local pharmacy pickup: MyMenopauseRx
• Want no labs, broad menu (creams, patches, tablets, DHEA, vaginal estrogen) and transparent monthly pricing: WINONA
• Want a simple, guided process with low initial fee and bundled progesterone at $0 with estradiol: Alloy

So, does Hormone Replacement Therapy work?

For many people, yes. Hot flashes, night sweats, and sleep usually get better. Mood, memory, and daytime energy often improve too, but that part’s more personal. Safety depends on your timing and health – starting early, using transdermal estradiol, and micronized progesterone tends to be safer, but you and your doctor need to weigh it together.

If you’re having symptoms and you’re eligible, a careful, time-limited trial with follow-up makes sense. If HRT isn’t your path, you’ve still got solid alternatives – you don’t have to tough this out alone. For more guidance on navigating your options, visit Hormone Replacement Therapy Guidelines You Can Trust.

References

• The North American Menopause Society – The 2023 Nonhormone Therapy Position Statement: https://pubmed.ncbi.nlm.nih.gov/37252752/
• Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during and after the Women’s Health Initiative randomized trials. JAMA. 2013 – https://pubmed.ncbi.nlm.nih.gov/24084921/
• Scarabin PY. Progestogens and venous thromboembolism in menopausal women. Climacteric. 2018 – https://pubmed.ncbi.nlm.nih.gov/22024394/
• Baber RJ, Panay N, Fenton A. IMS recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016 – https://www.tandfonline.com/doi/full/10.3109/13697137.2015.1129166
• US FDA decision to remove black box warnings from estrogen containing menopause hormone therapy – summarized in New York Times, NPR, Reuters. Overview in Greek of the FDA decision and new therapies for menopause symptoms – DailyPharmaNews.

Disclaimer

This article is for educational purposes only – not medical advice. It does not replace individualized care. Always consult your clinician to discuss your specific symptoms, history, and risks before starting, changing, or stopping any therapy.

Affiliate Disclosure:
Some links in this article are affiliate links. If you choose to purchase through them, I may earn a commission at no extra cost to you.