Young woman researching the signs that you may need hormone replacement therapy

What Are Signs That You May Need Hormone Replacement Therapy?

Medically reviewed on December 29, 2023 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Menopause is inevitable, but it doesn’t have to be uncomfortable.

With hormone therapy (HT), healthcare providers can help relieve common menopausal symptoms—like vaginal discomfort and hot flashes—in their patients by prescribing medical hormone treatments. These medications help to amplify hormone levels to pre-menopausal levels.[1,2]

If you’re curious about whether hormone therapy is right for you, keep reading to learn more about how it works and signs that may indicate a need for treatment.

How Do Hormone Replacement Therapies Work?

As women and people assigned female at birth (AFAB) age, their period—the process by which the body dispels an unfertilized egg—will come to a stop. Leading up to this transition, people may experience inconsistent monthly menstrual cycles and hot flashes (in which the neck, face, and chest become flushed with warmth).[3,4]

Most often, menopause arises between the ages of 45 and 55, and it lasts around seven to 14 years. Lifestyle choices, such as smoking, as well as genetics, have the greatest impact on the duration of menopause.[3,4]

That said, hormones are the mechanisms behind these changes—specifically, estrogen and progesterone.

Understanding Estrogen And Progesterone

Understanding the role of estrogen vs. progesterone is important. Both are steroids—or sex—hormones, and they play a significant role in female reproductive health.

There are three types of estrogen produced by the body: estradiol, or E2, presents during the reproductive or childbearing years. It assists in maturing an egg and preparing it for possible fertilization and helps to thicken the uterine lining to support conception. When estradiol levels become depleted—as is the case during menopause—bone growth and development become impaired and mood swings may increase. Low estradiol levels also halt menstruation, prompting [5,6]:

  • Vaginal dryness
  • Hot flashes
  • Night sweats
  • Sleeping difficulties
  • Hormonal belly

After menopause, a new type of estrogen takes over—estrone (E1). The ovaries produce this type of estrogen hormone. It supports female sexual function, although it’s weaker than its predecessor.[6]

Conversely, the female body produces progesterone following ovulation, a time in which a mature egg travels from the ovary and into a fallopian tube to prepare for fertilization. If fertilization occurs, progesterone works to thicken the uterine lining and prevent muscle contractions in the uterus to create a hospitable environment for the egg.[6]

If pregnancy doesn’t occur, progesterone levels decrease, triggering menstruation.[6]

Progesterone levels also decrease as the body prepares for menopause. Symptoms of low progesterone in menopausal women and people AFAB include [7]:

  • Headaches
  • Mood changes
  • Trouble sleeping
  • Hot flashes
  • Bloating
  • Weight gain

Understanding Hormone Replacement Therapy

To treat menopause-related symptoms, healthcare providers can implement two types of hormone replacement therapies.

The first is called estrogen therapy (ET). Patients experiencing menopausal symptoms after a hysterectomy take medicated estrogen vaginally, in the form of a cream, tablet, or ring, or systemically, in the form of a pill, skin patch, gel, cream, or spray. Systemic ET contains a higher dose of estrogen, while vaginal applications are low-dose and used to primarily treat only the vaginal and urinary menopause symptoms.[1, 8]

In other cases, a healthcare provider may prescribe a form of estrogen progesterone/progestin hormone therapy (EPT) that combines estrogen and progesterone. People who still have a uterus most commonly adopt this type of hormone replacement therapy. It’s available in pill form for oral consumption and within low-dose intrauterine devices (IUD).[1]

Who Might Benefit From HRT?

HRT does not come without its risks. While it’s generally considered safe, HRT can put people at a higher risk of [6, 8]:

  • Heart disease
  • Stroke
  • Blood clots
  • Breast cancer

So, what are the signs that you may need hormone replacement therapy? The benefits may outweigh the risks if you experience [6, 8]:

  • Moderate to severe hot flashes
  • Vaginal dryness, itching, or burning
  • Pain during intercourse
  • Signs that indicate an increased likelihood of developing osteoporosis

Two additional life experiences may make you a good candidate for hormone replacement therapy: early menopause or estrogen deficiency. Together, early menopause and estrogen hormone deficiency can occur anytime from ages 40 to 45, as a result of ovarian failure, and may put people at a higher risk of osteoporosis, heart disease, depression, and neurological diseases.[9]

In other cases, an estrogen hormone deficiency may arise as a result of [10]:

  • Eating disorders, like anorexia and bulimia
  • Genetic conditions, like Turner syndrome and Fragile X
  • Autoimmune diseases
  • Cancer treatments, like radiation or chemotherapy
  • Conditions impacting the pituitary gland
  • Hypothalamic amenorrhea

Monitor Your Hormone Levels With Everlywell

Sex hormones, like estrogen and progesterone, significantly impact the biological processes of women and people AFAB. When these hormones decrease—whether naturally by way of menopause, or unpredictably, as a result of certain medical conditions or treatments—the body reacts.

Fortunately, people who are experiencing uncomfortable hormonal imbalance symptoms can ask their healthcare provider about hormone replacement therapy to relieve discomfort and return to equilibrium.

If you’re curious to learn more about your hormone levels, try the Everlywell At Home Women’s Hormone Test, which assesses the levels of 11 critical hormones, including progesterone and estrogen. Once you receive your physician-reviewed results, you can speak with an Everlywell healthcare provider through a women’s online health appointment to learn more about next steps and your treatment options.

Order your test today to get started.

Hormonal Belly: What it is And How To Treat It

The Connection Between Hormones and Weight Loss

Understanding Cortisol vs. Cortisone


  1. Professional CCM. Hormone therapy for menopause symptoms. Cleveland Clinic. Last reviewed June 28, 2021. URL. Accessed December 27, 2023.
  2. Hormone therapy: Is it right for you? Mayo Clinic. Published December 6, 2022. URL. Accessed December 27, 2023.
  3. What is menopause? National Institute on Aging. Last reviewed September 30, 2021. URL. Accessed December 27, 2023.
  4. Office of the Commissioner. Menopause. U.S. Food And Drug Administration. Published December 14, 2023. URL. Accessed December 27, 2023.
  5. Professional CCM. Estrogen. Cleveland Clinic. Last reviewed February 8, 2022. URL. Accessed December 27, 2023.
  6. Society E. Reproductive hormones. Endocrine Society. Published January 24, 2022. URL. Accessed December 27, 2023.
  7. Professional CCM. Low progesterone. Cleveland Clinic. Last reviewed January 16, 2023. URL. Accessed December 27, 2023.
  8. Hormone therapy: Is it right for you? Mayo Clinic. Published December 6, 2022. URL. Accessed December 27, 2023.
  9. Professional CCM. Premature and early menopause. Cleveland Clinic. Last reviewed September 6, 2022. URL. Accessed December 27, 2023.
  10. Professional CCM. Low estrogen. Cleveland Clinic. Last reviewed February 8, 2022. URL. Accessed December 27, 2023.

Jordan Stachel, M.S., RDN, CPT is most fulfilled when guiding others towards making stepwise, sustainable changes that add up to big results over time. Jordan works with a wide variety of individuals, ranging in age from children to the elderly, with an assortment of concerns and clinical conditions, and has written for publications such as Innerbody. She helps individuals optimize overall health and/or manage disease states using personalized medical nutrition therapy techniques.
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