Cream, Patches, Pellets, Pills… What Are The Treatment Options For HRT
When it comes to hormone therapy, one size definitely does not fit all. The method that’s right for you depends not only on your symptoms, but also on your health history, lifestyle, and personal preferences.
Hormones can be delivered in different ways, and the choice often comes down to whether you need a treatment that works throughout your whole body or one that is targeted to a specific area.
Systemic hormone therapy
Systemic hormone therapy circulates through the entire body, making it the best option for women experiencing widespread symptoms such as hot flashes, night sweats, mood changes, brain fog, poor sleep, or concerns about bone and heart health.
Let’s start with estrogen, which can be given in pills, patches, injections, troches or lozenges, and pellets.
- Pills are familiar and convenient, but they carry a slightly higher risk of clotting and can affect the liver, which is why they are less commonly used today.
- Patches (called transdermal therapy) deliver estrogen directly into the bloodstream through the skin, providing steady levels and avoiding the liver, which makes them safer than pills for women with clotting risks.
- Injections can be useful for testosterone therapy or for steady dosing, though they are less commonly used for estrogen. Troches and lozenges dissolve in the mouth for systemic absorption, but their dosing can be unpredictable.
- Pellets, small implants placed under the skin, release hormones slowly over several months and appeal to women who prefer a “set it and forget it” approach. However, pellets are not FDA-approved, they cost more than other options, they are not covered by insurance, and once inserted, the dose cannot be easily changed.
Local hormone therapy
Local hormone therapy works differently. Instead of circulating through the body, it stays mostly where it is applied, with very little absorption into the rest of the system. Vaginal creams, tablets, or rings are especially effective for dryness, painful sex, or recurrent urinary tract infections.
Because the hormone levels remain localized, these treatments are not strong enough to improve hot flashes, sleep disturbances, or bone health, and they usually do not require progesterone since the systemic exposure of estrogen is so low.
The role of progesterone
For women who still have a uterus, progesterone must be added whenever systemic estrogen is prescribed. This is because estrogen alone can overstimulate the uterine lining and increase the risk of endometrial cancer. Progesterone balances this effect and provides protection for the uterus. But its role goes beyond uterine health.
Many women, even those who have had a hysterectomy use progesterone for its additional benefits, particularly its calming impact on mood and its ability to improve sleep quality1.
The safest and most widely used form is oral micronized progesterone, typically taken at night, which mimics the body’s natural hormone and is generally well tolerated. Other synthetic progestins are available, but they are less commonly chosen because they may not provide the same mood or sleep advantages.
The role of testosterone
Another hormone that is increasingly recognized as important in midlife and beyond is testosterone. While most people associate testosterone only with sexual health and libido, its benefits extend much further. In women, testosterone supports energy levels, motivation, muscle mass, bone strength, metabolism, and even aspects of cognitive function such as focus and memory.
Many women also report improvements in mood and overall vitality when testosterone is carefully restored to physiologic levels. Unlike estrogen and progesterone, testosterone is not available in FDA-approved formulations specifically designed for women in the United States, so it is often prescribed off-label in very low doses using compounded creams or, less commonly, injections. Careful monitoring is important, since dosing for women is far lower than for men.
Choosing the best therapy for you
The right choice depends on your individual needs. Here’s a quick cheat sheet to summarize the pros and cons of each:
- Estrogen: If you are only dealing with vaginal dryness or discomfort during sex, local estrogen therapy such as a cream or ring may be sufficient. If you are experiencing hot flashes, sleep problems, or cognitive changes, systemic therapy with both oral or transdermal estrogen and progesterone (if you have a uterus) is usually the better choice. For those who struggle with both local and systemic symptoms, combining the two approaches often provides the most relief.
- Progesterone may be recommended when mood changes or poor sleep are major concerns.
- Testosterone can be added when symptoms such as low energy, weak muscle strength, metabolic slowdown, or cognitive concerns are present—libido benefits often come as an added bonus.
The takeaway
My key takeaway is simple: local therapy is best for local symptoms, while systemic therapy is needed for whole-body concerns.
Sometimes, the most effective treatment involves a thoughtful combination of all three hormones: estrogen, progesterone, and testosterone.
Working with a knowledgeable menopause specialist can help ensure your plan is personalized, safe, and designed to support your long-term health and quality of life. One size, truly, does not fit all.
Check out your peri/menopause+ guide for more expert-backed advice on navigating lifestyle modifications and HRT.
Dr. Jila Senemar is a board-certified OB/GYN with over 20 years of experience specializing in menopause, hormone therapy, and metabolic health.
Based in Miami, she is dedicated to providing personalized, evidence-based care to help women thrive at every stage of life. Dr. Jila completed her residency at Long Island Jewish Medical Center and has served as an assistant professor at the University of Miami. She is fluent in English and Spanish, bringing a multicultural perspective to her practice.
As the founder of JilaMD and the Miami Menopause Collective, she integrates the latest research from the North American Menopause Society into tailored treatment plans focused on longevity and wellness. A recognized leader in women’s health, she is an active member of the American College of Obstetrics and Gynecology and the Florida Obstetrics and Gynecology Society.
Dr. Jila is also a published author in gynecologic surgery and adolescent medicine. Known for her compassionate approach, she empowers women with innovative, patient-centered care.
Dr. Jila Senemar is a board-certified OB/GYN with over 20 years of experience specializing in menopause, hormone therapy, and metabolic health.
Based in Miami, she is dedicated to providing personalized, evidence-based care to help women thrive at every stage of life. Dr. Jila completed her residency at Long Island Jewish Medical Center and has served as an assistant professor at the University of Miami. She is fluent in English and Spanish, bringing a multicultural perspective to her practice.
As the founder of JilaMD and the Miami Menopause Collective, she integrates the latest research from the North American Menopause Society into tailored treatment plans focused on longevity and wellness. A recognized leader in women’s health, she is an active member of the American College of Obstetrics and Gynecology and the Florida Obstetrics and Gynecology Society.
Dr. Jila is also a published author in gynecologic surgery and adolescent medicine. Known for her compassionate approach, she empowers women with innovative, patient-centered care.