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Hormone Replacement Therapy in Charlottesville, VA
Reviewed by Margaret Willis, FNP
What is Hormone Replacement Therapy?
Hormone replacement therapy (HRT) is a prescription treatment used to replace declining estrogen and, in some cases, progesterone and testosterone during perimenopause and menopause. HRT helps relieve symptoms such as hot flashes, night sweats, sleep disturbances, brain fog, mood changes, and vaginal dryness. It can also support bone health and reduce the risk of osteoporosis in appropriate candidates.
Types of Hormone Replacement Therapy
There are two primary forms of HRT used during perimenopause and menopause:
Systemic HRT: Systemic hormone replacement therapy delivers estrogen, with or without progesterone, throughout the body. It comes in pills, patches, sprays, gels, and certain vaginal rings. Because the hormones enter the bloodstream, systemic HRT treats whole-body symptoms such as hot flashes and night sweats.
Low Dose Vaginal HRT: Low-dose vaginal estrogen therapy treats genitourinary syndrome of menopause, including vaginal dryness, irritation, and discomfort with intimacy. This form is applied directly to the vaginal tissue and results in minimal absorption into the bloodstream.
Who Benefits from Hormone Replacement Therapy?
You might benefit from hormone replacement therapy if you are:
- Experiencing menopause or perimenopause with disruptive symptoms
- Struggling with hot flashes, night sweats, or sleep disturbances
- Noticing mood swings, irritability, or brain fog
- Dealing with vaginal dryness or discomfort during intercourse
- Experiencing a decrease in energy or libido
- Concerned about bone health and osteoporosis risk
- Managing hormone-related changes after a hysterectomy
What are the Risks?
Hormone replacement therapy is safe for many healthy individuals, especially when started before age 60 or within 10 years of menopause. However, like any medical treatment, it carries potential risks. These risks can vary depending on the type of hormones used, the dose, how the hormones are taken, how long they are used, and your overall health.
Some forms of hormone replacement therapy have been linked to a small increase in the risk of blood clots, stroke, and breast cancer when used long-term. Estrogen taken without progesterone can increase the risk of uterine cancer in individuals who still have a uterus. Your provider will review your health history and personal risk factors to determine whether hormone replacement therapy is right for you and which option best fits your needs.
What To Expect
If hormone replacement therapy is right for you, your provider will discuss your symptoms, medical history, and goals for treatment. They will explain how HRT works and answer any questions you might have before recommending a personalized approach.
After starting treatment, you might begin to notice improvements in your symptoms within a few weeks, though full effects can take time. Some people might experience side effects such as bloating, headaches, breast tenderness, or emotional lability. Follow-up appointments will help monitor your progress, adjust dosages if needed, and make sure the treatment is working as intended.
Why Choose The Center For Advanced Gynecology
The Center for Advanced Gynecology, established in 2018, is dedicated to improving your health by offering expertise in various areas, with a specific focus on gynecological care and advanced surgical techniques when surgery is needed.
Our team provides specialized expertise in non-surgical treatment of chronic pelvic pain, painful intercourse, pudendal neuralgia, and vaginal, vulvar, and bladder pain.
Since opening our doors, we have recognized the need in our community for more than just specialty care and have a growing practice in routine gynecologic care, cancer screening, Pap smears, menopausal management, hormone therapy, breast care, contraceptive care, urinary incontinence, and pelvic organ prolapse.
Frequently Asked Questions
Hormone replacement therapy helps relieve menopause symptoms by restoring declining levels of estrogen. For individuals who still have a uterus, progesterone is added to protect the uterine lining. Sometimes there is a need to add testosterone as well. By bringing hormone levels back into a more balanced range, HRT can reduce hot flashes, night sweats, mood changes, sleep disturbances, and vaginal dryness.
Yes. Hormone therapy is the most effective treatment for hot flashes. By restoring declining estrogen levels, it helps regulate the body’s temperature control system, which often becomes more sensitive during menopause. Many patients notice fewer episodes and less intensity once treatment begins.
Estrogen therapy alone has been shown to DECREASE the risk of cumulative risk of breast cancer. Previously highlighted studies from the Women’s Health Initiative had claimed an increased risk with combined use of particular oral estrogens and progestins together, but re-analysis calls into question those initial findings (Chlebowski et al. JAMA 2020;324:369–80; Mikkola et al. Menopause 2016;23:1199–203; Hodis HN, Sarrel PM. Climacteric 2018;21:521–8). We would argue that combination estrogen and progesterone replacement does NOT increase risk of or death from breast cancer over baseline risk. Your provider will review your personal and family history, along with any other health risks, to help determine the safest option for you.
Hormone treatments do not directly cause weight gain. Weight changes during midlife are often related to aging, lifestyle factors, and shifts in metabolism. In some cases, balancing hormones can support muscle mass and make it easier to maintain a healthy weight. While HRT is not a weight loss treatment, some patients find it helps as their body adjusts during this transition.
Safety depends on your individual health history. Estrogen taken without progesterone can increase the risk of endometrial cancer in individuals who still have a uterus, which is why progesterone is typically added for protection. Your provider will carefully evaluate your medical background and help you decide whether treatment is appropriate.
The term bioidentical hormones refers to hormones that are chemically identical to those produced naturally by the body. Many FDA-approved hormone replacement therapies use bioidentical hormones that are manufactured under strict federal regulations.
Bioidentical hormones can also be prepared by compounding pharmacies, which are regulated by state pharmacy boards rather than the FDA. In addition to bioidentical options, there are synthetic hormone preparations available. Each type has its own considerations, and your provider can help you decide which approach best aligns with your health history and treatment goals.