If you’ve ever been suddenly hit with a wave of heat from out of nowhere, congratulations! You have now entered the world of hot flashes. If you’ve suddenly found yourself in Insomnia Land, welcome as well. If you’re a woman of at least 45 years (or maybe younger) with these symptoms, you’re probably in the throes of menopause. Like millions of other women out there, you’re probably seeking answers to this bewildering time. Or you want ways to alleviate your symptoms, which may include many others besides hot flashes or insomnia. You may have even talked with your healthcare provider and heard of hormone replacement therapy (HRT). While that is a good option for many, many women, there are lots of things to consider to find the right HRT configuration for you. You’ve also got all kinds of additional options for hormone replacement therapy, such as those that support your body’s own production of hormones and those that support your body when your hormones have said goodbye altogether.

So what HRT options do you have? They fall into four categories:

  • Prescription hormones
  • Hormone support supplements
  • Bone, brain, and heart support supplements
  • Phytonutrients and other dietary changes

The HRT option that’s best for you depends on a lot of things, including whether or not you’ve had a hysterectomy, your unique combination of symptoms, and your thyroid function. We’re here to help you make an informed decision, so let’s take a deeper dive into each of those categories.

Hormone Replacement Therapy Options

Prescription Hormone Replacement Therapy

Menopause isn’t something that happens overnight. In fact, its onset—perimenopause—can take years to fully play out. It’s not necessarily a slow and consistent decline or a gradual increase in symptoms either. The erratic loss of your two sex hormones—estrogen and progesterone—can show up in erratic symptoms as well. You got tons of hot flashes last month, but none this month? That’s par for the perimenopausal course. The key is to discover which of those hormones you’re missing the most of and fill in the gap. This is usually done with a DIY saliva test or a blood test done at your doctor’s request. Your doctor will also want to know about your symptoms, family history, and other influencing factors. 

Your options for prescribed HRT include:

  • Estrogen only
  • Progesterone only
  • Estrogen and progesterone together
  • Testosterone only

Estrogen Only

The thing about estrogen is that a lot of things that go on in our bodies are dependent on it. Among other things, estrogen helps:

  • Regulate the menstrual cycle
  • Keep bones strong
  • Keep blood pressure in check
  • Maintain vaginal moisture

If you’re experiencing low estrogen, meaning your ovaries aren’t producing as much of it as they used to, you’re likely experiencing one or more of these symptoms:

  • Painful sex due to lack of vaginal lubrication
  • Urinary tract infections (UTI’s) or an increased number of them, because your urethra is thinning
  • Irregular or absent periods
  • Mood shifts
  • Hot flashes
  • Breast tenderness
  • Headaches or accentuation of pre-existing migraines
  • Depression
  • Brain fog
  • Fatigue

Your doctor may prescribe estrogen to alleviate these symptoms and reduce your risk of developing osteoporosis, cardiovascular disease, or other hormonal imbalances. Since studies have shown that long-term or high-dose estrogen therapy can increase your risk for complications like cancer, your doctor should prescribe the lowest effective dose for the shortest amount of time necessary. You should also discuss with your doctor the best administration method (e.g., oral, cream, ring, pellet, etc.). Some methods, particularly oral, have been studied far more than others, so more is known about their safety and risks.

Prescription drugs on a doctors worksheet for options for hormone replacement therapy

Progesterone Only

Estrogen and progesterone counterbalance each other. In fact, picture a pair of life-long girlfriends. Estrogen’s the outgoing one. She’s the life of every party. Progesterone’s the calm one who is content to comfort estrogen when her escapades get the better of her. During menopause, some women experience estrogen dominance, sometimes called “unopposed estrogen.” That’s when progesterone just gets too tired of calming estrogen down and goes and takes a nap. 

What does “tired” progesterone feel like? It means that your body might not be making enough progesterone on its own, leading to headaches or migraines, mood changes, anxiety, depression, or irregular menstrual cycles. It could also mean that your body has too much estrogen in it, for a variety of reasons, including:

  • Medications
  • A high percentage of body fat
  • High levels of stress
  • Drinking too much alcohol
  • Liver problems 

So progesterone-only HRT might be what you need. Like estrogen, progesterone HRT comes in a variety of administrations, so ask your doctor about those as well.

Estrogen and Progesterone

Ultimately, both estrogen and progesterone each do better when they have the other one to balance them out. Your doctor might prescribe estrogen and progesterone (or progestin, the hormone’s synthetic version) for a number of reasons. Generally, the combination brings down the risk of heart attack, stroke, blood clots, cancer, and bone breakage that estrogen-alone therapy might entail.


Testosterone, normally thought of as the hormone belonging solely to men, is also found in women. In fact, both your ovaries and adrenal glands make it. It, along with other sex hormones like DHEA, helps to support a healthy sex life and assertive energy. Some women might experience testosterone deficiency as a result of surgery, adrenal or pituitary disease, premature ovarian failure, or the use of high-dose corticosteroids or some estrogen preparations. And some might experience it simply because they’re growing older or experiencing menopause. 

Testosterone supplementation might do the trick for you, if you’re one of those women. You should definitely get your testosterone levels checked before talking with your doctor about testosterone supplementation. If they’re normal but you’re still experiencing a low libido, an estrogen deficiency could be at fault. 

Hormone Support

Certain plants contain phytonutrients that support your body’s own production of hormones. You can find these phytonutrients in the foods you consume and the supplements we offer. Though they’re much weaker than the hormones provided either by your own body or by HRT, they have antioxidant properties and the ability to prevent free-radical damage to cells, meaning they help slow down premature aging. You can take them in addition to HRT or, for some people as an alternative to it, particularly in perimenopause.

Like estrogens, phytoestrogens bind to estrogen receptors, and when they do, they exert an “adaptogenic” effect. As Dr. Christiane Northrup says in her book The Wisdom of Menopause: “This means that if your estrogen levels are low, the herbs will have an estrogenic (estrogen-like) effect, but if your estrogen levels are too high, they will block the stronger estrogens.”

So, for instance, if you ever wanted an excuse to eat more garlic, now’s the time.

Garlic - Learn how to support your bones, brain, and heart.

Bone, Brain, and Heart Support

You never realize how much your body depends on estrogen until it leaves. Indeed, estrogen does many things besides keeping us feminine and healthy. It strengthens bones, keeps brains functioning optimally, and helps keep problems like high blood pressure in check. When you enter menopause, your risk for developing osteoporosis, dementia, and heart problems increases. HRT strives to fill in the gaps estrogen leaves behind, but it can’t do everything. You still need to make sure your bones don’t get more brittle, your brain doesn’t get foggier, and your heart and arteries don’t get plugged. That’s where extra support comes in.

First of all, the best things you can do to optimize your chances of weathering menopause wtih grace are:

  • Reduce or eliminate your alcohol intake
  • Quit smoking
  • Improve your diet, not only by eliminating trans-fatty acids and excess sugar, but also by prioritizing proteins and vegetables and drinking lots of water
  • Exercise. It might not be fun for some, and it may not help you lose weight, but your body will thank you for it.

Secondly, no matter how much milk you might drink, you’ll need more vitamin D during perimenopause and beyond to keep those bones strong. That’s where supplementation with products like Ortho Molecular’s Vitamin D comes in. Instead of taking a “buckshot” approach with a menopause multivitamin, take a more strategic and customized approach. Let us help you put together a supplement regimen that meets your unique needs!

The Short of It

Whether you’ve been newly and unwittingly inducted as a citizen of Menopause Territory, or you’re a long-time resident looking for better options, we’re here to help you navigate its streets. Your options for hormone replacement therapy might seem overwhelming, but working with us and your healthcare provider, you can get clarity about what your body’s doing and which option is best for you. Whether it’s HRT, hormone support, or supplementation for bone, brain, and heart support, or, more likely, a combination of all three, there is a solution that will get you feeling better in no time.

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  1. 21 MENOPAUSE SUPPLEMENTS - Smith Rexall on June 2, 2022 at 1:09 pm

    […] and so is the way they experience menopause and the way they handle it. For those who choose to supplement or even replace HRT with botanicals, they have plenty to choose from, like black cohosh and ginseng. But the combination you choose […]

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