HRT Treatments and Modalities

The transdermal estradiol patch delivers bioidentical estrogen through the skin, avoiding first-pass liver metabolism. Often the safest route for women with VTE risk factors.

Subcutaneous hormone pellets deliver estrogen or testosterone over 3-6 months. The major medical societies raise specific concerns — here's what to know before choosing this route.

Oral estrogen and progesterone pills are the longest-studied form of HRT. Here's when they're the right choice and when a patch is safer.

Low-dose vaginal estrogen treats genitourinary symptoms — dryness, painful sex, recurrent UTIs — with minimal systemic absorption. Safe for many women who cannot take systemic HRT.

Progesterone pairs with estrogen to protect the uterus from endometrial cancer. Oral micronized progesterone is the current first-line bioidentical option.

Testosterone is a normal female hormone that declines with age. The Global Consensus Position Statement supports its use for hypoactive sexual desire disorder in postmenopausal women — with careful dosing to physiologic range.

Bioidentical means molecularly identical to human hormones. Many FDA-approved HRT products are bioidentical. Compounded BHRT is different — here's the distinction that matters.

DHEA is an adrenal hormone that declines with age. Vaginal DHEA (prasterone / Intrarosa) is FDA-approved for GSM. Oral DHEA supplements are unregulated and evidence is weak.