Estrogen Therapy for Menopause: What to Expect from Treatment

Estrogen Therapy for Menopause: What to Expect from Treatment

Menopause is a time of big changes, and it comes with its own set of problems. But contemporary science has come out with safer and more personalized hormone therapies. Here’s what you need to know about new, evidence-based estrogen and progesterone therapy, especially bioidentical formulations, and why seeing a functional medicine professional can help you do well.

Why Bioidentical Oral Progesterone Is a Game Changer

Bioidentical oral progesterone is different because it calms you down and reduces anxiety by its metabolite allopregnanolone that interacts with the GABA receptor in the brain. Scientific studies have shown that oral bioidentical progesterone induces significant anti-depressant, anti-stress, sedative, effects and decreases anxiety. This helps many women feel less anxious and sleep better at night. In contrast, synthetic progestins can depress mood and comes with other negative side effects that give HRT a bad rap. Bioidentical micronized progesterone is also safer than synthetic progestins.

A lot of specialists now say that taking bioidentical progesterone at night will help you relax and get better sleep as well as improve mood. It is especially helpful for women who are having trouble sleeping and are anxious during perimenopause, post partum depression and menopause. It is also very important for bone health as well. 1–5

Rethinking Estrogen Therapy: The Way It Works Matters

Not all medications that contain estrogen are the same. Oral estrogen has a greater risk of blood clots and venous thromboembolism (VTE) in women, as demonstrated by numerous clinical investigations. Transdermal (given through the skin) estrogen therapy (patches, gels, creams, or vaginal inserts), however, has a negligible risk of clotting and keeps the good effects of estrogen. The route of administration matters. 

Transdermal Estrogen combined with bioidentical progesterone: 

• Does not elevate clots or embolism risk.6
• Keeps the benefits for heart health, bone health, menopausal symptoms, and does not increase blood pressure or diabetes.7
• Doesn’t cause coronary artery spasm and is linked to a lower risk of gallstones, diabetes, and a rare risk of breast cancer.8,9

A quote from NPR: “Women should know that hormone therapy is safe and beneficial,” says Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.”

Experts and organizations all around the world support this.

More than 20 top groups, including the North American Menopause Society (NAMS), now say that for most healthy menopausal women under 60, the benefits of hormone therapy (particularly personalized, bioidentical regimens) outweigh the risks. Their 2022 position statement promotes personalized care, innovative, safer ways to provide hormone, ongoing monitoring, and regular reevaluation to improve health and lower risks. 10 However even if over age 65, HRT is still safe and an option. 11

Why You Should See a Functional Medicine and BHRT Specialist

Professionals that are very good at balancing hormones should handle bioidentical hormone replacement therapy (BHRT). They should also make sure that the hormones are eliminated, metabolized, and integrated into your overall health plan. An expert will:

• Make the treatment fit your symptoms, genetics, family history, and personal preferences.
• Keep an eye on metabolism, detoxification, gut health and address your care holistically.
• Use the safest hormones and ways to get them, based on the most recent research.

The main point is:

If you’re going through perimenopause, menopause, post partum depression or other hormone imbalances, don’t employ old treatments or programs that don’t work for everyone. Look for doctors who have a lot of expertise with personalizing bioidentical hormone therapy. Apply for a no obligation clarity call to see if we are a good fit. 

Transdermal estrogen and oral bioidentical progesterone can help you feel more like yourself, address your symptoms, and preserve your health—all in a safe and confident way.

Your care should be as unique as your adventure.

References:

1. Haufe A, Baker FC, Leeners B. The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review. Sleep Medicine Reviews. 2022;66:101710. doi:10.1016/j.smrv.2022.101710
2. Stefaniak M, Dmoch-Gajzlerska E, Jankowska K, Rogowski A, Kajdy A, Maksym RB. Progesterone and Its Metabolites Play a Beneficial Role in Affect Regulation in the Female Brain. Pharmaceuticals (Basel). 2023;16(4):520. doi:10.3390/ph16040520
3. Belelli D, Lambert JJ. Neurosteroids: endogenous regulators of the GABA(A) receptor. Nat Rev Neurosci. 2005;6(7):565-575. doi:10.1038/nrn1703
4. Cable JK, Grider MH. Physiology, Progesterone. In: StatPearls. StatPearls Publishing; 2025. Accessed August 23, 2025. http://www.ncbi.nlm.nih.gov/books/NBK558960/
5. Prior JC. Progesterone for the prevention and treatment of osteoporosis in women. Climacteric. 2018;21(4):366-374. doi:10.1080/13697137.2018.1467400
6. Olié V, Canonico M, Scarabin PY. Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women. Curr Opin Hematol. 2010;17(5):457-463. doi:10.1097/MOH.0b013e32833c07bc
7. Mueck AO. Postmenopausal hormone replacement therapy and cardiovascular disease: the value of transdermal estradiol and micronized progesterone. Climacteric. 2012;15 Suppl 1:11-17. doi:10.3109/13697137.2012.669624
8. L’Hermite M. HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT. Climacteric. 2013;16 Suppl 1:44-53. doi:10.3109/13697137.2013.808563
9. Simon JA. What’s new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone. Climacteric. 2012;15 Suppl 1:3-10. doi:10.3109/13697137.2012.669332
10. “The 2022 Hormone Therapy Position  Statement of The North American Menopause Society” Advisory  Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028
11. Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses. Menopause. Published online April 9, 2024. doi:10.1097/GME.0000000000002335