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Signs That You May Need Hormone Replacement Therapy

cartoon woman with clock and calendar indication menopause

A woman’s body experiences fluctuations in hormone levels throughout her lifetime. Hormone fluctuations in estrogen and progesterone (female sex hormones) occur with ovulation, menstruation, pregnancy, and menopause. These hormonal shifts are normal, but other hormonal imbalances can lead to a wide range of symptoms.

Hormone replacement therapy (HRT) is a medical treatment prescribed to women to balance hormone levels around menopause. HRT helps to relieve symptoms of menopause by replacing declining estrogen and progesterone levels.

Please continue reading to learn more about hormone replacement therapy (HRT), including some of the signs and symptoms of hormone deficiency. We’ll also talk about the risks and benefits of hormone replacement therapy.

What causes low estrogen?

Estrogen is an important hormone that triggers sexual development during puberty and helps to maintain the female reproductive system. It also plays an essential role in other organs such as the heart, blood vessels, brain, urinary tract, breasts, bones, muscles, skin, and hair. 

Estrogen levels rise and fall throughout a woman’s life. This often occurs in sync with a natural process like the menstrual cycle. These hormonal changes and fluctuations in estrogen levels are normal. Low estrogen hormone levels usually occur during a natural change like menopause, when the ovaries stop producing eggs and enough estrogen.

The hormone imbalances associated with menopause include low estrogen and low levels of other hormones. For example, around the time of menopause, the body’s ability to make hormones in the ovaries declines, leading to a drop in the body’s testosterone levels. This can lead to you losing muscle mass in addition to the usual symptoms of estrogen deficiency.

Sometimes, hormonal imbalance is the result of conditions like primary ovarian insufficiency or premature ovarian failure. Hormone imbalance can also occur in women with thyroid disorders or those who have undergone chemotherapy. Consistently low estrogen levels at different ages can cause problems such as slowing sexual development or making it harder to get pregnant

What are the symptoms of low estrogen?

The signs and symptoms of low estrogen that are common around menopause include: 

  • Dry skin
  • Breast tenderness
  • Reduced bone density and bone loss
  • Loss of muscle mass
  • Trouble concentrating
  • Irritability or mood swings
  • Vaginal dryness
  • Hot flashes 
  • Night sweats
  • Amenorrhea (no periods) or irregular periods
  • Weight gain, especially in the belly area
  • Headaches before or during your period
  • Dyspareunia (painful intercourse)
  • Decreased libido (sex drive)
  • Insomnia
  • Fatigue

How do you know if you need hormone replacement therapy?

Many women start hormone replacement therapy when they start experiencing menopause symptoms such as hot flashes, mood changes, bone loss, headaches, vaginal dryness, etc.

If you experience symptoms that interfere with everyday life and your ability to enjoy life, these are signs you require hormone replacement therapy. There is usually no need to undergo blood tests before starting these treatments. Your doctor will explain the various types of hormone replacement therapy (HRT) available and recommend the best one that will provide relief from your symptoms. 

At what point should you start HRT (hormone therapy)?

Some women may need to start hormone replacement therapy at an early age to treat symptoms related to conditions like early menopause (before age 45), abnormal bleeding, infertility, etc. 

The most common point in time when women start hormone replacement therapy is around menopause. Menopause is a normal part of the aging process, and most of the symptoms go away on their own. However, if you find you are feeling frustrated or the symptoms are uncomfortable or unbearable, you should see a doctor about starting hormone replacement therapy. 

What are the benefits of taking hormone replacement?

In menopausal women, the main benefit of hormone replacement therapy is that it relieves menopausal symptoms like hot flashes, mood swings, vaginal dryness, and low sex drive. HRT also protects against osteoporosis (weak and brittle bones, bone loss, and an increased risk of fractures). 

What are the risks of hormone replacement therapy?

Like with all medications, there can be some unwanted and unpleasant side effects from HRT. You should know that for most women, the benefits of hormone replacement therapy outweigh the risks. The overall risk of treatment is small, and it depends on the type of HRT and the duration of treatment, as well as your underlying medical conditions. Some of the known risks of hormone replacement therapy include:

Breast cancer

Combined HRT can lead to a small increase in the risk of breast cancer. Estrogen-only HRT does not increase the risk of breast cancer. The increase in risk depends on how long you take HRT and falls after you stop taking hormone therapy. Because of this risk, it is important to stay up-to-date with your breast cancer screening if you’re taking hormone treatment. If you have had cancer or have a family history of cancer, it is advisable to consult with your physician to evaluate the use of HRT. 

Blood clots

 HRT tablets can lead to a small increase in the risk of blood clots. This risk is not present with HRT gels or patches. 

Heart disease and stroke

Estrogen is linked to both positive and negative effects on the cardiovascular system. Having enough estrogen in the body can help to lower high cholesterol (bad cholesterol) and raise good cholesterol. Hormone replacement therapy can reduce the risk of heart disease and stroke when started before age 60. However, taking HRT tablets can sometimes lead to a small increase in the risk of stroke in women under 60 years of age. 

What is bioidentical hormone replacement therapy?

Women who need hormone replacement can take the treatment in a variety of ways, such as:

  • Estrogen creams, tablets, or rings inserted into the vagina
  • Dehydroepiandrosterone (DHEA) creams applied to the vagina
  • Estrogen creams, gels, or lotions applied to the skin
  • Progesterone creams applied to the skin
  • Estrogen or estrogen-progesterone skin patches
  • Estrogen or progesterone tablets taken by mouth

The best type of HRT for you will depend on your symptoms and health history. Some women prefer to use bioidentical hormone therapy, which is a natural hormone preparation derived from plants. While bioidentical hormone replacement therapy may have some benefits, such as causing fewer unpleasant side effects, the risks have not been well studied. 

Wrapping Up

Hormone replacement therapy (HRT) is a safe and effective way to raise hormone levels and treat the symptoms of menopause. Your doctor may start you on a low dose and adjust the dose based on your response. You are an ideal candidate for hormone replacement therapy if you have severe menopause symptoms. While short-term use of HRT is generally considered a safe way to treat hormone deficiency, long-term use of hormone replacement therapy is discouraged because the risks increase the longer you take it. 


  1. https://my.clevelandclinic.org/health/diseases/22354-low-estrogen
  2. https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/