Menopause can bring hot flashes, night sweats, poor sleep, mood changes and vaginal dryness. Much of that comes down to hormones your body used to make on its own. Here's a simple look at the three hormone treatments you'll see at OnlyHuman, and how a licensed provider helps you choose.
Estradiol
Estradiol is the main form of estrogen the body makes. During a woman's reproductive years it's produced mostly by the ovaries, and it's the strongest of the body's three natural estrogens. It plays a role in:
- Regulating the menstrual cycle
- Keeping body temperature steady, which is why low levels cause hot flashes
- Protecting bone density
- Supporting vaginal and urinary tissue
- Skin, hair, mood, sleep and memory
During menopause, the ovaries make much less estradiol. That drop causes most menopause symptoms.
As a medication, estradiol is chemically identical to the estradiol your body makes, so it's considered "bioidentical." FDA-approved estradiol comes as patches, gels, sprays, tablets, vaginal creams, vaginal inserts and vaginal rings. It replaces what the body no longer makes, to ease symptoms like hot flashes, night sweats and vaginal dryness.
- Patch: A small adhesive patch worn on the lower belly or hip and changed once or twice a week. It releases a steady dose through the skin, with nothing to remember daily.
- Gel: A measured amount rubbed onto the arm or thigh once a day. It dries quickly and absorbs through the skin.
- Tablet: A daily pill swallowed by mouth. It's simple and familiar, and usually the most affordable option.
- Body cream: Usually compounded. It's applied to the skin daily, and the dose can be customized by the provider. Compounded products are not FDA-approved.
For vaginal and urinary symptoms (dryness, discomfort with sex, urinary urgency):
- Vaginal cream: Applied inside the vagina with an applicator, usually daily at first and then a few times a week.
Progesterone
Progesterone is a hormone the ovaries make after ovulation, in the second half of the menstrual cycle. It balances estrogen's effect on the uterine lining, helps regulate periods, and has a calming effect that can help with sleep. During perimenopause, progesterone is often the first hormone to drop, which can cause irregular periods, poor sleep and anxiety.
As a menopause treatment, progesterone has two main uses:
- Protecting the uterus. For women who still have one, estrogen alone can thicken the uterine lining and raise the risk of endometrial cancer. Progesterone prevents that, so it's usually prescribed alongside estrogen.
- Sleep and calm. Taken at bedtime, it can help some women fall asleep and stay asleep more easily.
Forms:
- Capsules (micronized progesterone): FDA-approved and bioidentical, usually taken at bedtime because they can cause drowsiness. This is the standard choice for protecting the uterus.
- Cream: Usually compounded and applied to the skin. It absorbs less predictably, and major menopause medical societies don't consider it reliable for protecting the uterus with estrogen therapy. Compounded medications are not FDA-approved.
Biest 50:50
Biest 50:50 is a compounded estrogen made from equal parts of two estrogens:
- Estradiol: the main and strongest estrogen the body makes during the reproductive years.
- Estriol: a much weaker estrogen, made mostly during pregnancy.
Biest 50:50 is a compounded blend of estradiol and estriol, customized by your provider. Compounded medications are not FDA-approved.
How your provider decides
Hormone therapy isn't one-size-fits-all. A licensed provider reviews your symptoms, health history and goals, talks through the benefits and risks with you, and decides whether treatment is right for you, and in what form. Results vary.
This article is for general education and is not medical advice. Talk with a licensed provider about your own health.
