Everything You Need To Know About HRT

Your Primer for Hormone Health

by Christiane Northrup, M.D.

The topic of hormone replacement therapy (HRT) during menopause, especially with bioidentical hormones, seems to raise more questions than answers. Given the amount of misinformation and confusion that exists, I have prepared the following primer. It covers the ABCs of HRT and addresses some of the most commonly asked questions.

How Do You Know If You Are In Menopause?

The term “menopause” refers to the final menstrual period. When doctors use the term “menopausal,” we really mean that someone is going through perimenopause, the process leading up to menopause, and which ends a year or so after the final menstrual period. Now, the final menstrual period is a retrospective diagnosis. You don’t know you’re done until one year has passed. And, even though your hormones are in flux during that year, you could still get pregnant, so use birth control! Plus, you may require hormonal support both during and after perimenopause.

Who Needs Hormone Support?

Hormones are a Godsend for some women and just aren’t appropriate for others. Healthy women going through perimenopause may not require any additional hormone support. Menopause is, after all, a natural process, not a medical event requiring medication. In fact, some women make all the hormones they need from their own adrenals and ovaries, and they sail through the process.

However, many women enter perimenopause exhausted from chronic sleep deprivation, nutritional deficiencies, difficult marriages, or a lifestyle of over-giving to parents or children. These women are running on empty and often their bodies lack the raw materials to produce adequate hormones.

In addition, women who’ve had hysterectomies (with or without ovary removal) frequently require additional hormone support because surgery interferes with the blood flow to the ovaries. The end result is low hormone levels. And, in the case of ovary removal, instant menopause.

What Hormones Do You Need?

Most people believe that midlife women need estrogen. However, there are actually three sex hormones that can drop to low levels or become out of balance relative to one another:

  • Estrogen
  • Progesterone
  • Androgens (such as Testosterone)

Because all three hormones are produced by the ovaries, when a woman approaches menopause and stops ovulating, these hormone levels typically change.

Some women might be perfectly comfortable with no supplemental hormones, some might need progesterone only, and some might need all three. Another thing to keep in mind is, as you transition from perimenopause to post menopause, you might need to adjust which hormones you are taking. This can mean adding or subtracting a specific hormone, increasing or decreasing an amount, and even eliminating them altogether.

What Symptoms Can Supplemental Hormones Help With?

Supplementation with any combination of estrogen, progesterone and testosterone, or all three, can help ease many of the symptoms women experience during perimenopause and menopause.   These symptoms include:

  • Irritability, sleeplessness, anxiety, premenstrual migraines. Natural progesterone can calm these symptoms very effectively. Sometimes the only thing that is necessary is 1/4 tsp. –1/2 tsp. of 2% progesterone cream (about 30-60 mg), which is available over the counter. Research has shown that small amounts of transdermal progesterone are, indeed, absorbed into the blood stream. Burry ¹
  • Hot flashes and night sweats. Hot flashes and night sweats are caused by fluctuating levels of estrogen, which is why estrogen therapy is the gold standard for relieving hot flashes. I always recommend using the lowest dose you need to feel better. Interestingly, natural progesterone cream can also relieve hot flashes in many women.
  • Chest Pain. Some women also experience midlife chest pain from coronary artery spasm. Natural progesterone has been shown to be very helpful in this regard—and at very low doses of only 30 mg (1/4 tsp. of 2% progesterone cream) applied as a cream to the skin. Hermsmeyer²
  • Low sex drive. Many women experience a waning sex drive during perimenopause. Low sex drive is associated with low testosterone levels, so a little bit of testosterone (or its precursor, DHEA) supplementation may help. Also, most of the time low sex drive at midlife is the result of unfinished business in a relationship, the need for more sleep, low vitamin D levels, or simply the need to reinvent oneself. That’s why the number one predictor of good midlife libido is a new partner! I always tell people that they need to become that new partner, not necessarily ditch their husbands. 
  • Vaginal dryness. Vaginal dryness can play a part in loss of sex drive, too. For most women, a little estrogen applied vaginally is all that’s needed to restore sex drive and make intercourse more pleasurable. Some don’t even need that. A little KY Jelly or one of the other numerous lubricants on the market is fine.

Are Hormones Safe?

Bioidentical hormones are, theoretically, safer than estrogens made from horse urine or synthetic progestin. As a matter of fact, some studies show that natural progesterone is far safer than synthetic progestin. The bottom line is that, because of the confusion about which hormone preparations are bioidentical and which are not, most experts lump everything together and warn women of the well-defined risks that have been associated mostly with the synthetic compounds. That said, even bioidentical estrogen is a growth hormone in the body and may have adverse effects on uterine and breast tissue, especially if not balanced with progesterone.

In my opinion, there’s no harm in trying a small amount of bioidentical hormone replacement to see if it’s right for you. You will know the answer very quickly because your body will either say “yes” or “no.”

What Are Bioidentical Hormones?

Bioidentical hormones are hormones that match the hormones found in your body. Their chemical structure and shape were designed by Mother Nature. Pharmaceutical companies make some bioidentical hormones (synthesized from yams and soy) that are FDA-approved and sold in standard doses. These include a wide variety of patches and vaginal gels. They are available by prescription, and can be purchased in a typical pharmacy, including those that accept insurance.

You can also get bioidentical hormones made specifically for you through a compounding pharmacy. You need a prescription for custom-made hormone preparations.

One thing you need to remember is that “natural” or “plant-based” does not necessarily mean bioidentical. When it comes to a hormone, bioidentical means that it matches exactly what’s normally occurring in your body!

Learn more about bioidentical hormones here. You can also listen to my podcast on bioidentical versus synthetic hormones here.

Are Progestins and Progesterone the Same?

Progestins are a class of hormones that include bioidentical progesterone. The confusion stems from the fact that there are many synthetic progestins available that have some progesterone-like actions in the body. Medroxyprogesterone acetate (MPA), also known as Provera (and used in drug Prempro), is a good example. Other synthetic progestins that have progesterone-like activity include norethindrone acetate and norgestryl are frequently used in synthetic HRT formulations. These three progestins are commonly found in birth control pills, too.

Because synthetic progestins are not found anywhere in nature, they have many more side effects than bioidentical progesterone, causing PMS, headaches, bloating, and even constriction of coronary arteries. Numerous studies show that bioidentical progesterone typically relieves these cycle-related concerns and provides relief for women with angina. But because synthetic progestins are lumped in the category “progesterone” in the medical literature, many doctors think synthetic progestins and bioidentical progesterone are the same. The only “real” progesterone occurs naturally in the female body (or is made in the lab to match it exactly.)

Are Pills or Creams Better

The most physiologic way to take hormones is through the skin—either with a cream or a vaginal gel. That way the hormone goes right into the blood stream without having to be metabolized by the liver. All the patches work this way (transdermally). There are a number of estrogen gels available and a progesterone gel that is used vaginally. Because taking hormones in pill form forces the liver to first process the hormone, you have to use bigger doses to get the same effect. This is undesirable because it can cause the liver to produce increased clotting factors.

How Do Stress Hormones Affect Perimenopause?

The stress hormones cortisol and epinephrine, which are produced by the adrenal glands, can wreak havoc on normal hormone metabolism. For example, if you are skipping ovulations, have progesterone levels that are very low, but estrogen levels that are high (called estrogen dominance,) your body will convert your estrogen into substances that act like additional stress hormones. That’s why so many women notice that their symptoms go away when they learn to meditate, get more sleep, or go on vacation. Their bodies, when relaxed, can metabolize excess stress hormones beautifully.

Hormone metabolism also gets messed up by following a diet high in processed foods and foods that elevate blood sugar, such as white bread, white potatoes, and white sugar products.

Many experts believe that the key to quelling menopausal symptoms lies in getting stress hormone levels under control. Given that stress hormones are associated with everything from midlife weight gain to poor sleep, I certainly agree!

What About Thyroid Hormones?

When women start skipping ovulations, they may develop a condition known as estrogen dominance. In the face of stress, estrogen can be metabolized into substances that act like stress hormones. To compensate, your body may lower levels of thyroid hormone so as not to overstimulate your heart. The result is subclinical hypothyroidism.

It’s always a good idea to get your thyroid checked. Your TSH level should be no higher than 3, even though in many labs the range for normal is up to 4.5! You should also get your Free T4, Free T3 and Reverse T3 checked to be sure you have enough circulating thyroid hormone and that you are not converting T4 to Reverse T3.

Finally, up to 15 percent of women are iodine deficient, which can also cause subclinical hypothyroidism as well as sore breasts! (Believe it or not, breasts require 3 mg of iodine per day to be healthy!) The safest way to increase your iodine level is through eating kelp tablets, seafood, and a couple eggs per week. Iodine supplements are available, of course, but it’s important to work with a healthcare practitioner who has experience with this.

What Is a Compounding Pharmacy?

Compounding pharmacies, also called formulary pharmacies, specialize in creating hormone (and other) prescriptions tailored to individual needs. The bioidentical hormones used by compounding pharmacies are all FDA approved—and are the same hormones that drug companies also use in their pills, patches and vaginal gels.

How Do You Individualize Your Hormone Treatment?

Your doctor can prescribe customized hormones based on test results or any symptoms you have so that you take only what you need to maintain the optimal levels of hormones in your body. For example, you may have a prescription created using a combination of one or more of the bioidentical estrogens (estradiol, estrone, estriol) combined with bioidentical progesterone and an androgen in the form of DHEA or testosterone, if needed. These hormones are mixed into a lotion, cream, or other base and applied to the skin. (Because the estrogen known as estradiol can be converted by the body into the other types of estrogen, I generally recommend just that one.)

You may need to purchase your hormones from a compounding pharmacy, but it’s also possible to create a bioidentical hormone replacement regimen using hormone preparations available from conventional pharmacies.

Is Hormone Testing Helpful?

Hormone testing is controversial because a hormone level measures only a point in time (like looking at the speedometer in your car only once during a road trip) and hormones fluctuate widely throughout the day. This is true whether you use blood, saliva or urine tests. Results also depend upon what you eat, your activity level, the time of day, and your nutritional status. Still, a baseline blood test is a good starting point for monitoring therapy. Today, most experts prefer blood, or serum, hormone values over saliva. These should be done by a lab that has a lot of experience in this area. I, personally, like the Dutch test, which stands for Dried Urine Test for Comprehensive Hormones. You collect samples throughout a 24-hour period and it’s far more accurate than a serum test, which measures just one point in time. The test is done by Precision Analytical, Inc., and it is proving to be a real game-changer in providing patients with their full hormonal health picture.

How Can You Find a Healthcare Practitioner?

Fortunately, more and more healthcare providers, including OB/GYNs and nurse practitioners who specialize in women’s health, are knowledgeable about HRT and bioidentical hormones so all you need to do is ask around or search online for one near you. You can also contact a local compounding pharmacy. They are usually happy to provide the names of local practitioners who work with them. 

Where Can You Go For More Information?

My book The Wisdom of Menopause is a complete resource for health concerns at midlife. Chapter 5 provides in-depth information on hormone therapy. It even lists the names of some of the bioidentical formulations available with a prescription at conventional pharmacies, such as Estragel (bioidentical 17 beta estradiol as a skin cream).

I’ve also been interviewed on television and radio programs a number of times to talk about hormone replacement and bioidentical hormones. I encourage you to explore the Press & Media section of this site and catch up on any that you’ve missed.

Remember that a one-size-fits-all approach to hormone replacement therapy (HRT) is not good medicine. Every woman is different. If you’re approaching or in perimenopause, I encourage you to learn all you can about the different options so you can partner with your doctor effectively. Midlife and beyond can be the best years of your life! They don’t have to be laden with medical challenges.

Do you use HRT? Please share your experiences with me.

Learn More — Additional Resources

The Wisdom of Menopause, by Christiane Northrup, MD



Burry, K., Patton, P., Hermsmeyer, K., 1999. Percutaneous absorption of progesterone in postmenopausal women treated with transdermal estrogen. American Journal of Obstetrics and Gynecology, June 180(6 Pt1):1504-11.

Hermsmeyer, K., et. al, 2008. Cardiovascular effects of medroxyprogesterone acetate and progesterone: a case of mistaken identity? Nature Clinical Practice: Cardiovascular Medicine, Jul 5(7):387-95.



Last Updated: September 11, 2017

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Medi-gyn
    2 months ago

    Dear Dr. Northrup,

    I just wanted to take a moment to express my sincere gratitude for your enlightening article on the ABCs of Hormone Replacement Therapy (HRT). Your dedication to empowering individuals with knowledge about their health is truly commendable, and your insights have been invaluable to me.

    Navigating the complexities of hormonal health can be daunting, but your clear and concise breakdown of HRT has shed light on a topic that is often shrouded in misconceptions. Your emphasis on personalized care and informed decision-making resonated deeply with me, reminding me of the importance of advocating for my own well-being.

    As someone who has been considering HRT as a potential treatment option, your article provided me with a comprehensive overview of the benefits, risks, and considerations involved. Your commitment to holistic health and integrative medicine is evident in your approach, and I feel empowered to explore HRT with a greater sense of clarity and confidence.

    Thank you for your unwavering dedication to improving the lives of others through your expertise and wisdom. Your contributions to the field of women’s health are truly remarkable, and I am grateful for the positive impact you continue to make in the lives of countless individuals worldwide.

    With heartfelt appreciation,

  2. Alice Carroll
    4 months ago

    Thanks for also talking about how compounding medicine can also be an option when planning to undergo hormone replacement therapy. I’d like to find a good expert to consult about that because I’m consider to undergo such a therapy one of these days. I think that will help me be a lot more comfortable and active in the future.

  3. Mel
    1 year ago

    I was using a bioidentical yam based hrt cream for years after surgical menopause. I loved it. Had to change doctors 16 months ago and he told me” I was too old and I would die” even though he said he’d never heard of it when I showed him the bottle. Since then (now I realize) I am a nut job without it. My thyroid went wacky; lowered my dosage after stopping hrt almost to nothing 25mcg since the hormones speak to each other. Horrible mood swings, crying, rage, not sleeping have been my plight since the stop. My compound was the estradiol and I miss it. I’m 69 and normally very active. I am also my husband’s 24/7 caregiver so I need my self care if for no other reason. I don’t have a uterus and no ovaries. What’s the cancer scare all about. I’ve tried cortisol manager at bedtime which gives me hot flashes waking me up. I’ve tried estroven and one night of it takes over 48 hours to lose the dizzy groggy effects. I don’t even drink my one cup of green tea anymore in case it increases my symptoms. I eat a clean diet and get lots of movement caring for us this home as well as walking and stationary biking. Chamomile and lavender tea is good for daytime but can’t do that at bedtime so I don’t wake up 2 p. Next trial for sleep are lavender pills that should be here Wednesday. I pray I’m setting boundaries and still cross over to a place I don’t want to be with the constant internal aggitation. I crave quiet from the world but that’s impossible because I am in this world. Now you have my life story with hormones and the debilitating effect on my life and relationships. Tomorrow I will call a woman integrative medicine clinic for their opinion on this matter as well. I want and need my quality of life back. I feel for everyone on here with their own stories. We have to go thru it to be sympathetic, really. Thank you for this forum.

  4. susan
    2 years ago

    I would like to know why there are no replies to the questions? Its not really helpful to read everyones questions and have no answers. There were some that would have answered my question …….

    1. Kristine
      2 years ago

      I think they have been erased. I use to see the replies.

  5. Char
    2 years ago

    Dr Northrup
    I am 70 and wondering if Bioidentical HRT is safe for me considering my family history? My mother died of breast cancer, a survivor of 35 years but then it returned. Also, my older sister has had three bouts with Breast Cancer , the last surgery was
    a double mastectomy.

    I was just wondering if it I need it but just feeling lackluster…zero libido (not dating), lack of focus/concentration, energy, .. not always sleeping soundly.

  6. Angie Cordova
    3 years ago

    Is mini troche safe for replacing testosterone? They prescribed them for 30 days. Can they give you cancer?

  7. Stephanie
    4 years ago

    What is a highly absorbable brand of progesterone cream?

  8. Kim
    4 years ago

    I am in menopause and using the estrogen patch (just increased from .0375 to .05) and take a progesterone pill in the evening (200 mg). I recently started taking a testosterone troche in the morning and have had extra trouble sleeping (which is not unusual for me). Any suggestions?

  9. Maheen Fatima
    4 years ago

    A number of problems occur in the body due to the imbalance of hormones. Fixing such issues is not always easy but balancing hormones may just solve the mystery. I want to know more details about the effects and side effects of Bioidentical hormone therapy. thanks for sharing this post.

  10. Maheen Fatima
    4 years ago

    Thanks for sharing such a useful article with us; A number of problems occur in the body due to the imbalance of hormones. Fixing such issues is not always easy but balancing hormones may just solve the mystery.

  11. Donna Dorans
    4 years ago

    I am 66 and I’ve been taking biodentical hormones for about 8 years. I take the estradiol patch .035 , 100 mg progesterone and Dhea 25. My estrogen is 105 and I’m wondering if that’s ok. I used to see Dr guay ( he was great)who handled my hormones but he has since passed away. He had great respect for you so thought I would ask for advice. Also wondering if generic prometrium is as good as the non generic.

    1. Eva Robertson
      4 years ago

      I am 66 years young and started perimenopauze at age 42 which sym p toms I controlled with progesteron cream and homeopathic remedies. However It did not work anymore for me and I had tocresortvto chemical HRT Angelique now for 15 years and an feeling good on them. Over the years I have tried several times to come off it with bio identical hormones in the firm of creams patches etc but with unsuccessful results feeling miserable and all the menopausal symptoms returned even tried Chinese remedies. I live in South Africa what do you suggest and where can I get the Pueraria Mirifica here to try?

  12. Jel
    5 years ago

    I can’t seem to find any info. for perimenopausal women who eat a whole food vegan diet who are healthy and have no or little symptoms. Is there any benefit to hrt? The only info is that hrt keeps your organs young. But I would like to know from a trusted authority on this. And also does it help wrinkles. I am getting wrinkles by the day and want to know how other women are addressing this. All the older women I know are on HRT and are almost wrinkle free but they are not healthy and do not eat healthy. Anyone have any sources for me? Thank you!

    1. Jennifer Van Laanen
      3 years ago

      Did you discover anything on this?

  13. Steele Honda
    5 years ago

    Thanks for pointing out that women who’ve had hysterectomies frequently require additional hormone support because surgery interferes with the blood flow to the ovaries. I think that it would be smart to start looking into hormone replacement therapy if you knew you were going to get surgery like a hysterectomy where you might need it. I think that would help make it a lot less stressful when you had to decide on it afterward.

  14. Jane Mathers
    5 years ago

    Thank you Christian. I have ordered your plant based product, and will take a rest from the bioidentical hormones for two months, and continue if this works well for me.
    My pharmacy informs that there is a risk for cancer using the bioidentical hormones.

  15. Maria
    5 years ago

    My doctor prescribed estrodial 2mg and progesterone 200mg. Are they safe levels, I’ve been experiencing chest pain on the right side at night and not sleeping well. I did go to see a cardiologist and he found nothing. Should I look for another doctor? Are my Rx’s too high of a dosage? Any information would be greatly appreciated.

  16. Kristen Swan
    5 years ago

    Menopause is a natural process which every women has to go through during her lifetime. But, the case varies in everyone. While some face no issues, others have to go through a lot of challenges as mentioned in the article. There are many options available to relieve the symptoms of menopause. But, it is always advisable to consult the experts as to what treatment options will be favorable for you.

  17. Kim
    5 years ago

    I am 55 and have had my last period 13 months ago. I ‘ve never taken any hormones. Had hot flashes, terrible sleeping and irritability my entire life!!!!!!
    Am I going to be okay because I haven’t taken anything?

  18. paula
    5 years ago

    I am 63; on bioidentical compounded HRT of 400 mg progesterone, 2.5 mg esridiol, and 7.5 mg of testosterone. These are compounded into one pill and taken at night.
    My latest blood test lab results were: Estradiol 39.5 pg/mL, Progesterone 7.2 ng/mL and testosterone 55ng/dL,
    TSH 1.160uiU/mL,
    free T4 1.06 uiU/mL,
    free T3 2.8 pg/mL and
    reverse T3 20ng/dL
    My energy level and ability to sleep have greatly improved. However my hair loss which was occurring prior to above regimine increased when I began therapy and within past 6 months has increased dramatically. I am now experiencing thinning overall and noticeable baldness on the top of my head.
    This is so frustrating and discouraging to me since one of the main reasons I began HRT was hair loss.
    Please help!

    1. Amy
      5 years ago

      fyi if you ever see my post…you may be inducing androgenic alopecia…high androgens = DHT which causes hair loss. Back off the testosterone. You need to give it 2-3 months after a change in meds to see if you induce more loss or start to recover. I would halve you test or stop it entirely. Give it 6 months and monitor. Take Saw Palmetto to block DHT conversion for a couple of months after stop/reducing test. Speaking from experience unfortunately but good luck. fyi if you test for DHT you may not be high but it is still the culprit of the hair loss.

  19. Susan Lynch
    5 years ago

    Age 64, ovaries removed 3 years ago uterus intact. So suffer vaginal atrophy and related persistant urinary tract infections, unable to have sex. I am seeing a functional GP who did Dutch Testing and has prescribed the following: Progesterone 10mg Estriol 1mg testosterone 1mg in hydrated coconut (medium shell mould) pessary. Directions: insert ONE pessary into vagina DAILY as directed by your doctor. Issue is I cannot find any information regarding this combination of hormones delivered vaginally via hydrated coconut pessary (kept in fridge). Is it relatively safe? Is it effective? Is there anyone out there that can shed light on this?

  20. Connie Burleson
    6 years ago

    I am 75 years young and had a complete hysterectomy when I was 41. I have been taking Premarin since then. My regular doctor wants me to get off of it. I had high blood pressure, but am on daily meds for it and it is now under control. I have never taken progesterone. Would you agree that I should get off of it?

  21. Sutton Turner
    6 years ago

    I like how you said that trying a small amount of bioidentical hormone replacement to see if it’s right for you. My friend with prostate cancer is thinking of doing hormone therapy. Thanks for the tips on hormone therapy.

  22. Brigitt Angst
    6 years ago

    I am a 60 year old woman with Turner Syndrome living in the UK. Due to lack of ovaries I have never produced my own estrogen. Currently I am on Hormone patches and my blood estrogen level are in the mid-range of the normal range of women of my age. Whilst my doctors at the Turner Clinic are pressuring me into coming off estrogen I want to continue with hormone replacment as I am worried I will bottom out with no significant estrogen levels affecting mental acuity, mood and much more… I would love to hear Dr Northrup’s advice

  23. Ken Hwan
    6 years ago

    I found it very helpful to learn that women who are very giving of their time and hard-working sometimes lack the materials in their body to produce any hormones for menopause. My wife has a full-time job as well as four children, and sometimes my wife tells me that she feels too overwhelmed. I will be sure to ask her if she thinks that she might benefit from hormone replacement therapy.

    1. Cindy
      3 years ago

      Road I’m on… estrogen tested fine and I’m not in menopause yet. I lack progesterone. I’m looking for natural answer. I’ve read that soy isn’t good for us and it’s in one of the gels I think.
      Anyone have suggestions? Thanks

  24. IndieRythm
    6 years ago

    Thanks for this article. I’m 50. This ends in a question or anyone with guidance or experience. I’ve taken birth control pills for 35 years with a week break every 4-6 weeks. In the past few years, during my “week off” I’d have hot flashes/night sweats…and haven’t been sleeping well. I’m very fit and healthy, but my doctor would like to see me go off the pill. I don’t think I’m having periods anymore. We decided to try a weaning experiment. For a few months I cut my low dose pills (Lutera) in half and started just taking one daily – no weeks off. Relief – I did not have any ugly symptoms. I’m told that was close to the equivalent of the lowest dose birth control pills. For a couple of months now I’ve been cutting the pills into quarters and I’m still doing okay. I don’t really have a good idea of how much a quarter pill of Lutera is compared to a typical HRT dose? Is it still higher? Should I be weaning further? I’m not sure if I can cut them further or if I might want to try to get a lower dose of the same combination of progestogen and estrogen that seems to be working for me?

  25. Kristen Park
    6 years ago

    I’ve read so much negative information about HRT that I tried to go off it after a year. But I couldn’t sleep, so I’m going back on it (waiting for it to kick in). Before HRT I tried black cohash, soy, vitamin e, antidepressant with no luck. I’d like to try other natural remedies, but the lack of sleep is not tolerable. I can’t wait a month to see if something may work on the hot flashes.

    Great article! I’m on bioidentical HRT.

  26. Emanuel Harris
    6 years ago

    Great information! In my opinion I think that HRT is not for everybody but it is for somebody. There are some side effects but for some people this is minor to experiencing the results.

  27. Heidi
    6 years ago

    I am about to start my prescriptions ( mixed cream) . My one concern is if I can’t handle side effects (say migraines) and decide this isn’t for me and stop using do my hormones go back to where I was when starting cream or does it crash even lower(I couldn’t handle that!) ?

  28. Watson Williams
    6 years ago

    It’s good to know that HRT can be really helpful for treating sleeplessness. My wife has been having a hard time sleeping lately, so this is good to know. I’ll make sure she looks into HRT to see if it could benefit her and help her start sleeping normally again.

    1. ann
      5 years ago

      Reading through the comments and see a comment by Watson Williams, a hubby looking after his wifey. LOVE!!!! love that you are looking for ways to support her health.

  29. Christine Mini
    6 years ago

    What is your opinion of Bioidentical HRT in timed released pellet form? I’m getting both Estadiol and testosterone in pellet form and taking a daily Progesterone supplement at bedtime.

  30. Earnest Watkins
    6 years ago

    It’s good to know that supplemental hormones can help with things like sleeplessness. My wife has been telling me about how restless she gets at night, and it has really affected her sleep quality. I’m sure she wouldn’t mind meeting with a good doctor to see if she could benefit from HRT. http://bayviewobgyn.com/gynecological-care/

  31. Marcie
    6 years ago

    I am on HRT. Estrogen patch Minivel, Progesterone pill, and a bit of testosterone just started a few days ago. I just got a message from my Dr saying my recent labs came in and I am VERY estrogen dominant and to: Half my dose of estrogen day 14-menses and increase progesterone by 2x day 14-menses. If I am so dominant then shouldn’t I stop the Minevel patch? Thanks for any insight!

    1. Marcie
      6 years ago

      The hormones are Bioidentical…

    2. You need to dump the testosterone. It is being turned into additional oestrogen. Dump it for a while and your oestrogen will come down. I have just been reading about it.

  32. Jo
    6 years ago

    Are the questions in the Comments section ever answered? Please let me know because I have a question but it’s similar to the questions already posted. Thank you for your assistance.

    1. Coulson Duerksen
      6 years ago

      This is a community where members often discuss topics in the comment threads. Questions may be answered by other members or Dr. Northrup, but we can not guarantee that every question will be answered by Dr. Northrup.

  33. Ms Divvi De Vendre
    7 years ago

    I am reading your comments on HRT, however in view of “Solving a breast cancer mystery” research in 2015 with Cancer Research UK and until now, it’s been unclear why having high levels of both molecules is good news for the patient, or what benefit testing for progesterone brings.

    But thanks to Cambridge-based Cancer Research UK researcher Dr Jason Carroll and his team, and their colleagues at the University of Adelaide in Australia, there are finally answers to this mystery.

    Without going to deeply into the finer details (which are available “Cancer Research UK”) and was an investigation into double positive cancer, it would seem that one of the main findings indicate that without the binding of the “pure” estrogen to pure bio-identical progesterone, the binding location on the DNA is incorrect as number of encrinoligists and HRT specialists have suspected for many years. Synthetic hormones or progestins that are not bio-identical fasten to the DNA in the incorrect position and have caused pain, suffering and death in hundreds of thousands of women worldwide.


    Divvi De Vendre

  34. claudette hanisch
    7 years ago

    Dr. Northrup,
    I am a 67 yr old woman with vaginal dryness and recently dx with osteoporosis, although I am interested in obtaining a second scan after reading Dr. Lani’s Bone Health Guide.
    The only illness I have is a Hypothyroid which was dx a year ago, and currently I’m taking Levothyroxin 75mcgs daily.
    The endocrinologist whom I’m seeing, has visited with me about using an estrodial patch in conjunction with oral progesterone primarily for bone health, as I won’t consider the traditional bone enhancing medications, ie Fosomax, etc. I have my uterus and ovaries and went through menopause at 44, at which time I read Wisdom of Menopause.
    She is traditional, but open to my concerns, although she hesitates to prescribe vaginal progesterone or topical creams due to compounding inconsistencies with doses.
    I would appreciate your opinion, more than you might imagine as this is causing me anxiety. Thank you.

  35. Inga Jarkikh
    7 years ago

    Dear Dr Northrup
    I am a 50 y.o, in early stges of menopause ( no period for 3 months first time).
    A recent ultrasonic scan showed an ovarian cyst. I was told I would still have periods but have to watch that cyst and scan it again in 3 months time.
    My main concern at the moment however is my overall health. Despite healthy lifestyle and diet I have many symptoms that ruin my quality of life such as long standing sleep mainrenance insomnia; hair loss, overall tiredness, regular heart palpitations.
    Can a cyst contribute to hair loss?
    A few general blood tests came back “normal”. , but something is clearly not ‘normal” for me. GPs usual suggestions of bog standard HRT or sleeping pills for insomnia drive me to dispair. I am struggling to find a private specialist who is able to connect various symptoms and see the WHOLE picture.
    I am considering bio identical HRT, but as you suggested in your blog, it has to be “good for me” and tailor made. I find that in the market of BHRT there are some who offer BHRT without even making any blood tests.
    I am based in London and would be extremely grateful if you can suggest a trustworthy doctor or a clinic who deals with these issues.

    1. Sydney
      6 years ago

      Have you had your thyroid levels checked?… many of your symptoms sound like hypothyroidism.

  36. Clare
    7 years ago

    Hi I’m 51 from m the Uk and have been taking prescribed HRT for 7 years. Recently I discovered a private doctor in Edinburgh who could prescribed Bioidentical hormones. I saw her on the 15 Aug and she prescribed the the same level of hormones & I just swapped. Stopping the prescribed & taking the bio identical. A week later I started hot flashes. Something I’d never had on the HRT and terrible sleep. It’s now 2 Oct and it’s still the same. Nothings settled down. What’s happening?

  37. Mary
    7 years ago

    I am 62, had breast cancer 6 years ago. I changed my diet immediately, stopped all
    dairy, started eating kale salads, whole soy, used tumeric. My needle biopsy showed
    stage 2 but by the time I had the lumpectomy the lab reported it as stage 1.
    Since then I have added kelp and maca to my diet and feel warmer and much calmer.
    Had I known more at the time about nutrition, I would have stayed on a healthier diet
    a bit longer and perhaps the cancer would have gone away completely.
    Prior to my cancer, I had been eating tons of dairy products for my bones!

    I would love to go to a functional medicine oncologist in the Denver area! Any references?

  38. Terri
    7 years ago

    I am very curious of your thoughts on Pellet Therapy also! I am 52. Have had all of the blood tests and Nurse Practioner is recommending pellet therapy and an oral Progesterone, which I am thankful I have read this and will be asking for a cream progesterone! My maternal grandmother died from breast cancer and my father has had prostate cancer. Would love your feedback. My state is a little behind and I have had to travel for decent healthcare. I am also worried the pellets are big business and not true patient care?

  39. Donna
    7 years ago

    Dr Diane Schwarzbein, endocrinologist, has a very successful approach to hormone therapy, see her book “The Schwarzbein Priciple”. There are also videos on YouTube.

  40. Karen
    7 years ago

    Does a tubal ligation affect hormones?

    1. Venessa
      6 years ago

      HELL YES !!! Without a doubt. There is a Face Book page dedicated to Post Tubal Ligation Syndrome. If you are on FB, please look it up and see all the horror stories. I had an ablation and ligation done in 2015, could have signed my own death certificate. Let me be clear, NO doctors will admit to this, but it’s REAL ! My troubles started there. Please do go and look up the page on FB you will be mortified to see even young girls go into premature menopause with all menopausal symptoms at the age of 30. Sad but true.

  41. Joanne
    7 years ago

    I recently moved and had to switch providers for my bioidentical hormones. The new provider informed me that neither she nor the compounding pharmacy she uses will add estrone to a prescription. It was suggested that it’s no longer used. My previous prescription contained all three estrogens ++ and I did beautifully for many years. Since the change of prescription, I have been experiencing night sweats and sleeplessness. Really would like to hear your thoughts.

  42. CJones
    7 years ago

    Are there any ObGyns who believe in bioidentical hormones in NYC that you can recommend? I moved from Illinois more than a year ago and I could not find one at NY Presbyterian. The doctor I went to told me to wean myself from bioidentical hormones.

  43. Paule Bernier
    7 years ago

    Hello everybody
    I am 55 years old ; I have been taking estradot( patches ) same thing as Estrogel : it is Estradiol ; and Prometrium ; blood test every 6 months ; I am doing very well . If your doctor wants to prescribe you Estrace ( a pill) and Provera : do not accept this ; find a specialist who has an expertise in that area .
    There are other options now .
    Read read read …
    Get informed….
    If you are French speaking you can look for a book called
    Les Hormones aux féminins written by Dr Sylvie Demers

  44. Diane Feen
    7 years ago

    I took these hormones for 8 years and it caused breast cancer in both of my breasts.
    if you have cystic breasts it is not a good idea.
    I am now living with the consequences of my actions.
    Breast cancer is no fun and taking these hormones is dangerous.

    1. Chelsea
      7 years ago

      what hormones were you taking?? a cream or a tablet or pill did you take bioidentical how did you find the breast cancer??

    2. Lisa Graham Brott
      3 years ago

      sorry you got cancer. As Dr. Northrup writes, one needs to look at all of their risk factors including family history, lifestyle and health as well as symptoms and stress levels and also carefully take as low of doses as possible and monitor our blood. Did you take bioidentical? What hormones and doses? Hope you will be well now.

  45. Theresa
    7 years ago

    Hi Christine,

    Is it possible to use natural progesterone cream as birth control? If yes, how?

    1. Laudie
      4 years ago

      Absolutely not.

  46. jenny
    8 years ago

    hi I’m jenny been going through the peri menopause its been extremely difficult. Mood swings sleep deprivation panic attacks aching bones hot flushes sense of hopelessness forgetful memory . One of the worst experiences of my life chronic fatigue have tried herbal and stuff tried menovical herbal stuff and other items from the herbal shop. Now been to see my gp as I’m am now trying hrt .

    given up caffeine just want to feel normal I appreciate all women have to go through this but the sleep deprivation has been shocking and memory loss hate it .

    hope my symptoms will ease


    1. Jenny you sound exactly like me. Tried bio identical hormones for 1.5-2 years and they did nothing to help me. My hormone numbers just would not rise, I think it was because my adrenals were so shot. They have to make up the progesterone short fall when your reproductive parts don’t. Failure to ovulate can cause all sorts of rouble. I am on adaptogenic herbs for my adrenal glands but am just about to add Bovine Adrenal Cortex to the mix too.

      I crashed out on peri menopause recently (had a complete breakdown, physical and mental) and my mothers female doc who I saw staged a HRT intervention. My own male doc just kept on giving me sleeping pills and anti depressants and endochronologists here in NZ don’t even believe in anything to do with adrenal output failure unless you have fully diseased adenals, i.e. Addisons Disease.

      This female doc I saw said bio identical hormones (estrogen pills and progesterone cream) were sound in theory but it’s the delivery into the body that was unstable. It gets clogged in the skin. Even my bio identical hormone supplier people admitted this. It’s all over the web about women having these bio ident hormones working for about 6 months and the crapping out. She also said perimenopause can be the danger phase for some women. Worse than actual menopause. It’s the sharp drops in hormones at this time that some womens bodies can’t cope with. They can be worse in the actual Meno for sure.

      So now I am on a peri menopausal HRT and have to watch out for breast cancer. But I will try anything as things were so terrible. I refuse radiation mammograms which will no doubt be banned in years to come. I do thermograms to look for any heat changes that come from cancer laying down its heavy vascular vein network which it needs to grow that tumour.

      1. Lisa Graham Brott
        3 years ago

        Sounds like you are trying many good things. May i ask what adaptogenic herbs for your adrenals? I need support for my adrenals and am working on my other hormones. Thank you.

  47. Susan hill
    9 years ago

    My sister was diagnosed with hormone positive breast cancer . I was taken off my Estrace. This has been about a year. I have no energy. My hot flashes are almost 24/7. My gynecologist is very much against HRT. I have been talking to a nurse practitioner who thinks I would benefit from natural progesterone. I am researching but I do not see a definitive answer that this will not put me at greater risk for breast cancer. Could I have your opinion. Thanks Susan

    1. Susan hill
      9 years ago

      I want to add that I’m 55. I had a total hysterectomy in 2008.

      1. cindy
        8 years ago

        I have the same question. I’m 55 and feeling very blah with hormones, adrenals, thyroid and that whole dynamic. A naturopath wants me to do bioidentical hormones. There is a lot of breast cancer in my family so I’m very wary of taking hormones. Is there a general recommendation for this kind of situation?

        1. Cynthia
          8 years ago

          According to Dr. Anna Garrett, she said OTC UPS progesterone cream will not cause cancer. It’s the abundance of estrogen that does this. I use progesterone cream, and it has really helped me during perimenopause.

  48. ki
    9 years ago


    Can I use natural progesterone cream while taking birth control pills to help ease cramping and flooding?

  49. sheila
    9 years ago

    Dr Northrup,

    I am 41 (FSH 9.5) and just beginning to sense hormonal fluctuation. For the last year, my cycles have varied from 26 to 29 days. I live in India, where the only “bio-identical” option available is oral micronized progesterone (100mg). I want to begin taking it in luteal phase to ease transition. Can I continue doing it as long as I wish or are there safety concerns associated with long term use? Please help! Sheila

  50. KO
    9 years ago

    I am also researching pellet therapy. I’m leery because once the pellet is implanted, there is no way to make adjustments or stop the dosing!

  51. P. Vinci
    9 years ago

    At age 72, i well into menopause, My M.D. is urging me to begin BioT HRT pellet therapy. And although she reassured me of its safety (that it’s been used for 30 years) I would like to research but can find very little information on pellet therapy.
    What do you think about this method (bioidentical pellets)? Where can I find credible studies in order to educate myself?
    Your assistance would be greatly appreciated.

    1. Dana
      6 years ago

      P. Vinci,

      I am no doctor, just an avid reader of medical texts and studies. As of right now (March 2018), research indicates that it is safest to use HRT during a certain window of time after menopause has begun (I believe it’s about 10 years). If begun after this window, it is potentially more dangerous, as I understand it. I urge you to do your own research on this, particularly if you’re 72, have been menopausal for more than 10 years (which I’m assuming you have been) and have not been using HRT. Best of luck to you!


      (Just realized this comment was posted 3 years ago, but I’m leaving my comment here anyway on the chance that it may be useful to someone else)

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