Hot flashes ruining your sleep? Mood swings affecting your relationships? Brain fog affecting your work? And is dryness making intimacy painful? You’re not alone. Millions of women suffer through menopause daily, but you don’t have to. Let’s break down menopause, from stages and signs, to treatment options like hormone replacement therapy and non-hormonal approaches. This is part 2 of our series. Plus, in our ‘People Also Asked’ section below, see what other women, just like yourself, are asking or even submit your own question. Let’s get started.

• This is Part 2 of our 2 Part Menopause Series.
• Hormone therapy comes in pills, patches, gels, vaginal rings, and pellets
• Bioidentical hormones are chemically identical to your body’s hormones, unlike synthetic options
• Starting HRT within 10 years of menopause provides maximum benefits
• Transdermal estrogen (patches, gels) carries lower blood clot risk than oral pills
• Non-hormone options reduce hot flashes by 40-50% for many women
• Looking for menopause relief? Download our E-Book or view our treatment Offers

What You Need to Know Before Making Treatment Decisions

Before discussing treatment options, safety, and how to choose the right menopause provider, it’s important to understand what’s actually happening in your body. In Part 1 of our menopause series, we walked through what menopause and perimenopause really are, why symptoms happen, how menopause is diagnosed, and which health risks increase after this transition. If you haven’t read Part 1 yet, we highly recommend you do before jumping right into treatment options. It’s the foundation of context needed to understand treatment choices.

Different Forms of Hormone Therapy

Pills are the most common form. You take them daily, they’re convenient, and most insurance covers them. However, oral estrogen is processed through your liver, which slightly increases blood clot risk compared to other delivery methods.

Patches deliver estrogen through your skin. You change them once or twice weekly depending on the brand. They provide steady hormone levels and bypass your liver, resulting in lower blood clot risk than pills. Some women dislike the adhesive or find the patches visible under clothing.

Gels and creams are applied to your skin daily, usually on your arms or thighs. Dosing is flexible, which some providers prefer. The downside? Transfer risk. If someone touches your skin where you applied the gel before it dries, they absorb some of the hormone too.

Vaginal rings are inserted into your vagina and changed every three months. They’re excellent for treating vaginal and urinary symptoms specifically. Low-dose vaginal rings treat local symptoms with minimal systemic absorption. Higher-dose rings can treat both local and whole-body symptoms.

Vaginal tablets and creams are applied directly to vaginal tissue a few times weekly. They treat vaginal dryness, painful intercourse, and urinary symptoms effectively with very little hormone entering your bloodstream. These are safe for almost everyone, even women who can’t use systemic HRT.

Pellets are loved by many women. These tiny rice-sized pellets are implanted under your skin, usually in your hip or buttock area, during a quick in-office procedure. They last 3-6 months and provide steady, consistent hormone levels around the clock.

Here’s why pellets work so well. No daily pills to remember, No patches that fall off or leave residue, No creams that transfer to others. Once they’re in, you’re done for months. The hormones release slowly and steadily, mimicking how your ovaries used to function.

No peaks and valleys like you get with pills or even some patches.

Women on pellets often report better symptom control than they experienced with other delivery methods. Energy stays consistent. Sleep improves. Hot flashes diminish or disappear entirely. Many women say they finally feel like themselves again.

The insertion procedure is simple. Local numbing, small incision, pellet inserted, you’re done in minutes. Most women barely feel it. You might have minor soreness for a day or two, but that’s it. No downtime required.

The main consideration? Once pellets are in, you can’t adjust the dose until they wear off. So it’s important to work with an experienced provider who knows how to dose pellets correctly from the start. When done right, pellets offer convenience and symptom relief that’s hard to beat. We see excellent results with pellets in our practice, which is why they’re one of our preferred treatment methods.

Progesterone comes in pills taken orally, as an IUD like Mirena, or as vaginal gel. If you have a uterus, you need progesterone to protect your uterine lining from overgrowth caused by estrogen alone. Without it, you’re at increased risk for uterine cancer.

What’s the Difference Between BHRT and HRT?

Bioidentical hormones are chemically identical to the hormones your body produces naturally. Synthetic hormones have a similar but not identical chemical structure. This distinction matters more than you might think.

Here’s what many women don’t know about synthetic hormones. Many are derived from pregnant mare’s urine. Yes, horse urine. They’re modified to be patent-able and mass-produced, but they’re not identical to human hormones. Your body recognizes the difference.

Bioidentical hormones match your body’s hormones exactly, molecule for molecule. This can make a difference in how your body responds and how you feel on treatment. Many women report fewer side effects and better symptom relief with bioidentical options.

Now, there are two types of bioidentical hormones. FDA-approved bioidentical products like estradiol patches, pills, and gels are standardized and regulated. These work well for many women and most insurance covers them. Compounded bioidentical hormone therapy, or BHRT, is custom-mixed by a specialized compounding pharmacy based on your specific needs and your provider’s prescription.

The advantage of compounded BHRT? It’s personalized. Your provider can adjust the exact dose and combination of hormones for your body, not use a one-size-fits-all approach. If you need adjustments, your formula can be modified. If standard doses don’t work for you, compounded BHRT offers flexibility that mass-produced options can’t match.

Yes, compounded BHRT typically costs more than insurance-covered synthetic hormones. But for many women, the personalized approach and better symptom control are worth the investment. We’re not against synthetic hormones. Some women do great on them. But we believe you should know all your options and choose what’s right for your body and your budget.

The bottom line? Both work. Both have their place. The best choice depends on your symptoms, your body’s response, your insurance coverage, and your personal preferences.

Is Hormone Therapy Safe?

So what exactly are the risk involved? The 2002 Women’s Health Initiative study sent shockwaves through medicine and terrified millions of women. Headlines screamed about increased cancer and heart disease risks from HRT. Many women stopped their hormones immediately. Providers became afraid to prescribe them.

But here’s what actually happened, the study’s interpretation was flawed in critical ways. Newer research and re-analysis show a much more nuanced picture. Timing matters enormously. The type of hormones matters.

Duration of use Matters. Your age and how long it’s been since menopause matters.

The timing hypothesis is now well-established. Starting HRT within 10 years of menopause appears safest and provides the most benefits. Starting HRT after age 60 or more than 10 years past menopause carries higher cardiovascular risks. This makes sense when you understand how estrogen affects blood vessels. Healthy vessels respond positively to estrogen. Vessels that already have plaque buildup may not.

Breast Cancer Risk

Yes, there’s a small increased breast cancer risk with combination estrogen plus progesterone therapy after about 5 years of use. Let’s put this in perspective. The increased risk is comparable to drinking two or more alcoholic drinks daily or being overweight. It’s real but modest.

Estrogen-only therapy, for women after hysterectomy, shows no increased breast cancer risk in most studies. Some studies even suggest a decreased risk. This is one reason why having a uterus or not affects your treatment decisions.

The risk returns to baseline within 2-3 years after stopping HRT. Regular mammograms remain essential whether you’re on HRT or not. Most breast cancers aren’t caused by hormone therapy. They’re caused by genetic factors, lifestyle factors, and simple bad luck.

Blood Clot Risk

Oral estrogen, pills, increases blood clot risk more than transdermal estrogen like patches or gels. Pills are processed through your liver, where they affect clotting factors. Patches bypass your liver, resulting in lower clot risk.

The risk is highest in the first year of use. It’s also higher if you’re over 60, obese, a smoker, or have a personal or family history of blood clots. This is why your provider asks detailed questions about your medical history before prescribing HRT.

For most healthy women starting HRT in their 40s or 50s, the absolute risk remains low. But for women with risk factors, choosing patches over pills or avoiding HRT altogether may be the safer choice.

Who Should NOT Take HRT

Some women absolutely should not take systemic hormone therapy. A personal history of breast cancer tops the list. Blood clot history or stroke means HRT is too risky. Active liver disease prevents your body from processing the hormones properly.

Unexplained vaginal bleeding needs investigation before starting hormones. Coronary heart disease is a concern if you’re starting HRT many years after menopause. Certain blood clotting disorders make HRT dangerous.

These are hard contraindications. For other women, it’s about weighing benefits versus risks based on your specific situation. A skilled provider helps you make this decision, not by following a one-size-fits-all protocol but by considering your symptoms, health history, and priorities.

Prescription Medications

Several prescription medications reduce hot flashes without using hormones. Low-dose antidepressants like paroxetine, which is FDA-approved specifically for hot flashes, venlafaxine, and escitalopram reduce hot flashes by 50-60% in most women. They also help if you’re dealing with mood symptoms alongside physical ones.

Gabapentin, an anticonvulsant medication, reduces hot flashes and is especially helpful for night sweats that disrupt sleep. Oxybutynin treats both hot flashes and excessive sweating. Fezolinetant, brand name Veozah, is a newer non-hormone medication specifically developed for menopausal hot flashes.

These medications work differently than hormonal options (such as HRT and certain forms of birth control) and have their own side effects. But for women who can’t or won’t use hormone therapy, they provide meaningful relief for many.

Lifestyle Changes

Reducing triggers helps some women. Limit caffeine, alcohol, spicy foods, and hot beverages if these worsen your hot flashes. Keep your bedroom cool, use fans, and invest in moisture-wicking sleepwear and bedding.

Regular exercise, at least 30 minutes most days of the week, reduces symptom severity and improves overall health. It won’t eliminate hot flashes but it helps. Stress management through yoga, meditation, or deep breathing techniques makes a difference for some women.

Maintaining a healthy weight matters too. Excess weight, particularly around your midsection, worsens hot flashes. By the way, if weight loss is challenging, our medical weight loss programs can help. and increases health risks. Weight loss isn’t easy during menopause but it’s worth pursuing.

Vaginal Health Products

Vaginal moisturizers used regularly, 2-3 times weekly, help replenish moisture to vaginal tissues. They’re not just for use during sex. They’re maintenance products that improve tissue health over time.

Water-based lubricants reduce friction and discomfort during intercourse. They don’t improve underlying tissue health but they make sex less painful. These products are safe for all women, including those who can’t use hormone therapy.

The combination of regular moisturizers plus lubricants during sex helps many women, though they don’t work as well as vaginal estrogen for most.

Supplements

Black cohosh, soy isoflavones, and red clover are heavily marketed for menopause symptoms. Research shows minimal benefit for most women. Some small studies show modest improvements but the results aren’t consistent or dramatic.

Vitamin D and calcium aren’t symptom treatments. They’re essential for bone health. You need 800-1,000 IU of vitamin D daily and 1,200mg of calcium, especially if you’re not taking estrogen.

Supplements aren’t regulated by the FDA. Quality and actual dosing vary wildly between brands. Some contain little to no active ingredient. Others contain potentially dangerous amounts. Many supplements interact with prescription medications.

If you want to try supplements, discuss it with your provider first. Set a reasonable trial period, 2-3 months. If they don’t help, stop wasting your money.

How Do You Find the Right Menopause Provider?

Not all doctors have specialized training in menopause management. Some providers still rely on outdated information from studies conducted decades ago. As a result, symptoms are often dismissed as normal aging when they are actually very treatable. This can unfortunately lead to women suffering longer than necessary.

Choosing a provider with dedicated menopause training can make a world of difference in symptom relief and overall quality of care. If you’re looking for specialized menopause care in Pembroke Pines, Cooper City, or South Florida, obviously, we’d love to bring you in. That said, even if you decide to seek care elsewhere, we’ve created a comprehensive guide on what to look for in a menopause specialist provider so you can confidently make your decision.

Don’t worry, you’re not alone. Remember that we are here to help and support you. Your well-being is important to us, and we’re committed to assisting you through any challenges you may be facing. Besides, having questions is a good and healthy thing! Check out our additional resources below:

• Rather watch? Here’s a video of Nelly, one of our esteemed providers, discussing the topic.
• Prefer reading? Here’s an article the National Institutes of Health (NIH).
• More reading? See the American College of Obstetricians & Gynecologists (ACOG)’s Article.
• Specific medical questions? It’s best to schedule an appointment.
• General questions? Use the Live Chat on the bottom right or reach us via:
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