Hormone Replacement Therapy
HRT prescribed by a clinician who actually knows your history.
Hormone replacement therapy is one of the most evidence supported tools available for perimenopause and menopause. At Areté, prescribing decisions are individualized, based on your symptoms, health history, goals, and current medical evidence, not a protocol off a shelf.
What HRT can address
The benefits are broader than most women realize.
Hormone therapy is best known for managing hot flashes and night sweats, but for appropriate candidates, its effects extend across multiple body systems. Current evidence supports HRT for a range of symptoms and long term health outcomes.
Vasomotor symptoms
Hot flashes and night sweats. The most immediate and often dramatic response to hormone therapy.
Sleep quality
Improved sleep architecture and reduced nighttime disruption in many women on HRT.
Cognitive function
Emerging evidence for brain fog, memory, and concentration. Estrogen has neuroprotective properties.
Mood & mental health
Hormonal stabilization can meaningfully improve mood, irritability, and anxiety in many women.
Bone density
Estrogen plays a critical role in maintaining bone mass. HRT is one of the most effective options for bone protection.
Cardiovascular health
When initiated close to menopause, evidence supports a cardioprotective effect in appropriate candidates.
Genitourinary health
Local estrogen therapy for vaginal dryness, painful sex, and recurrent UTIs. Effective at low doses with minimal systemic absorption.
Body composition
Hormonal support for lean mass preservation and metabolic shifts that are difficult to address through lifestyle alone.
Libido & sexual health
Estrogen and testosterone both play roles in sexual function. Evaluation and treatment are individualized.
The evidence has evolved significantly.
The 2002 Women's Health Initiative (WHI) study created widespread fear about HRT that shaped clinical practice for two decades. That data has since been substantially reanalyzed and contextualized, including an 18-year follow-up analysis in JAMA (Manson et al., 2017) and The Menopause Society's 2022 Hormone Therapy Position Statement. For most healthy women under 60 or within 10 years of menopause onset, current evidence supports HRT as safe and effective, with benefits that often significantly outweigh risks. Prescribing decisions at Areté are based on the current body of evidence, not 2002.
Sources
Selected references
The clinical claims on this page are drawn from the following peer-reviewed studies and society position statements.
- Rossouw JE, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002. pubmed.ncbi.nlm.nih.gov/12117397
- Manson JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 2017. pubmed.ncbi.nlm.nih.gov/28898378
- The North American Menopause Society. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022. pubmed.ncbi.nlm.nih.gov/35797481
- American College of Obstetricians and Gynecologists (ACOG). Hormone Therapy for Menopause (Patient FAQ). acog.org/womens-health/faqs/hormone-therapy-and-menopause
- Cauley JA, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA. 2003. pubmed.ncbi.nlm.nih.gov/14519708
- Hodis HN, et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol (ELITE). New England Journal of Medicine. 2016. pubmed.ncbi.nlm.nih.gov/27043774
- Gleason CE, et al. Effects of Hormone Therapy on Cognition and Mood in Recently Postmenopausal Women: Findings from the Randomized, Controlled KEEPS-Cognitive and Affective Study. PLoS Medicine. 2015. pubmed.ncbi.nlm.nih.gov/26039424
Formulations & delivery methods
The right formulation for your body and your life.
Hormone therapy isn't one size fits all. At Areté, I work with FDA approved and compounded preparations across multiple delivery methods, choosing based on your clinical picture, preferences, and what the evidence supports for your situation.
Transdermal patches & gels
Estrogen delivery
Bypass first pass liver metabolism. Often preferred for lower clotting risk and more stable hormone levels compared to oral forms.
Oral estrogen
Estrogen delivery
Convenient and effective for many women. Dosing and form considered in context of your cardiovascular and clotting risk profile.
Progesterone / progestins
Uterine protection
Required for women with an intact uterus. Bioidentical oral micronized progesterone (Prometrium) or other options based on your history and tolerance.
Testosterone
Libido & energy
Prescribed when indicated for low libido, energy, and mood, typically compounded to achieve appropriate physiologic female dosing.
Local vaginal estrogen
Genitourinary symptoms
Topical cream, ring, or suppository for vaginal dryness, painful sex, and recurrent UTIs. Effective at doses with minimal systemic absorption.
Compounded preparations
Individualized dosing
Custom formulations from licensed compounding pharmacies. For patients requiring doses or combinations unavailable in commercial preparations.
A note on "bioidentical" hormones
"Bioidentical" refers to hormones that are chemically identical to those your body produces naturally, and many FDA approved medications qualify. Not all compounded hormones are bioidentical, and not all bioidentical hormones are compounded. At Areté, I use the most appropriate formulation for your clinical situation, whether that's an FDA approved medication or a compounded preparation, and I'm transparent about the evidence base for each.
Frequently asked questions
Answers to common questions.
Is HRT safe?
For most healthy women under 60 or within 10 years of menopause, the current evidence supports HRT as safe and effective, and the benefits often substantially outweigh the risks. The clinical picture is more nuanced for women with a personal history of certain cancers, blood clotting disorders, or other specific conditions. At Areté, safety is assessed individually based on your complete health history, not a blanket policy.
Does HRT increase cancer or blood clot risk?
The risk associated with estrogen and progesterone therapy is small for most women and the risk profile differs depending on the type of hormone therapy, formulation, duration and individual risk factors. These are real conversations I have with you during your clinical evaluation, not questions to dismiss or to fear without context.
How long can I stay on HRT?
The old guidance of "use the lowest dose for the shortest time" has been substantially revised. For many women, the benefits of continued HRT for bone density, cardiovascular health, cognitive function, and quality of life outweigh the risks of long term use. Duration is reassessed periodically based on your ongoing symptoms, health status, and goals. There is no universal cutoff age or time limit that applies to every woman.
Can HRT be managed through telehealth?
Yes. At Areté, HRT is prescribed, managed, and adjusted through telehealth visits across Colorado. Prescriptions are sent directly to your preferred pharmacy, including compounding pharmacies when appropriate. In person evaluation is not required for HRT management, though lab work, ordered through a local Quest draw site (or drawn at home if you're an established patient in Ridgway, Ouray, Telluride, or Montrose), is typically part of your initial assessment and ongoing monitoring.
Is HRT covered by insurance?
Areté does not bill insurance. However, many FDA approved HRT medications are available at low cost through cash pay pharmacies, often less than insurance copays. Compounded preparations are not covered by insurance and are billed directly through the compounding pharmacy. I work to find the most affordable sourcing for every patient and if you have insurance you can certainly apply it to FDA approved HRT. Membership fees are FSA/HSA eligible, and a superbill is available if you'd like to submit for potential out of network reimbursement.
Written by Michelle Mullins, AGACNP-BC, FNP-BC
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