9 Ways HRT Can Help Improve Menopause Symptoms & Your Long-Term Health

Hormone health is central to longevity. During perimenopause and menopause, fluctuations and steep declines in estrogen, progesterone, and testosterone trigger full-body changes, impacting cognition, sleep, metabolism, cardiovascular health, and bone density.

More and more, women are turning to hormone replacement therapy (HRT)—sometimes called hormone therapy or menopause hormone therapy (MHT)—as a way to feel like themselves again.  

At mindbodygreen, we’ve spent the last several years reporting on perimenopause, menopause, hormone health, and HRT. During that research, we’ve come to understand that HRT is an area that demands an incredibly nuanced approach: menopause is not a one-size-fits-all experience, and neither is HRT. 

But we also believe that more women should know the full scope of benefits that HRT might offer, so they feel empowered to discuss their options with their physicians. 

With age, hormone levels naturally decline, and many women begin to notice imbalances in their 40s (but it can start as early as mid-30s). Symptoms like fatigue, brain fog, weight gain, and low libido can creep in, but by tracking and optimizing hormones with HRT, these issues can be addressed head-on. 

HRT is a medical treatment that involves replacing hormones that have declined (or aren’t fully optimized) in the body. It is typically used to treat symptoms of perimenopause and menopause in women, and it can be an incredibly effective intervention for maintaining energy, cognitive function, and overall vitality.

By fine-tuning key hormones like estrogen, progesterone, and testosterone, HRT not only alleviates common symptoms of aging—fatigue, mood swings, and weight gain—but also helps you feel more energized, balanced, and in control for the long haul.

“HRT is probably the best thing that you can do to improve long-term health and longevity. I think it is better than almost anything else that we have out there outside of lifestyle optimization,” says former ER doctor and regenerative physician Amy Killen, M.D.

There are many changes that women may experience in midlife, which can wreak havoc on self esteem, confidence, and sense of self. 

“You might feel broken, but it’s possible to feel freaking amazing into your older ages,” says leading functional medicine physician Wendie Trubow, M.D. MBA. 

During perimenopause and menopause, many women report experiencing mood shifts—from increased anxiety and depression to bouts of irritability and stress. The reason why is complex and multifaceted, but it all comes down to hormones. During midlife, levels of estrogen and progesterone plummet. 

“These hormones play a crucial role in modulating our bodies’ neurotransmitters like serotonin, dopamine, and norepinephrine, which influence mood and emotional well-being,” explains board-certified OB/GYN Stephanie Hack, M.D. in our explainer on menopause and mood. “The decline in these hormones can lead to increased vulnerability to depressive and anxious emotions1 for many women.” 

On top of that, “Estrogen has neuroprotective properties; its reduction can affect brain function and mood regulation, leading to feelings of depression and anxiety,” Hack says. 

What HRT can do: 

Brain fog, forgetfulness, and difficulty concentrating are all connected to declines in estrogen and progesterone, which affect neurotransmitters and blood flow in the brain.

In fact, physician and women's health specialist Mariza Snyder, D.C. notes that estrogen acts as the "master CEO of the brain," supporting neurogenesis, neuroplasticity, and most importantly, energy metabolism in brain cells. 

Estrogen is so protective of the brain, that postmenopausal women are more likely to develop Alzheimer’s disease than men of the same age. 

What HRT can do: 

Research suggests that starting HRT earlier in menopause may protect aspects of cognitive function, and many women report clearer thinking and improved memory after beginning therapy.

87% of people going through menopause experience hot flashes daily—with some women experiencing upwards of 10 hot flashes daily. Characterized by a sudden onset of intense warmth, they also can cause facial flushing, heart palpitations, dizziness, anxiety, and even feelings of dread. 

“Estrogen is well-established as central to thermoregulation,” explains naturopathic doctor and menopause expert Trevor Cates, N.D. “It interacts directly with the hypothalamus. As estrogen declines, the hypothalamus becomes hypersensitive, narrowing what’s known as the body’s ‘thermoneutral zone.’ Even slight temperature fluctuations can trigger overheating.”

What HRT can do: 

Cates, a longtime advocate for bioidentical hormones alongside lifestyle interventions, notes that HRT can have a profound impact on the occurrence and intensity of hot flashes. 

“Estrogen replacement typically shows stronger direct efficacy for reducing hot flashes. In addition, recent research indicates supplemental progesterone can also decrease the frequency and severity of vasomotor symptoms—particularly when these symptoms coexist with anxiety or sleep disturbance,” says Cates.

For bone and muscle health, there’s no woman we trust more than world-renowned orthopedic surgeon Vonda Wright, M.D., who serves on mindbodygreen’s scientific advisory board. 

“One area that I'm particularly passionate about educating women and physicians on is the presence of musculoskeletal symptoms, which will impact 70% of menopausal women and leave 25% of them disabled2 due to the severity,” she writes about the alarming musculoskeletal symptoms of menopause. 

She explains that these changes can manifest in a variety of ways, including joint pain, bone density loss, reduced lean muscle mass, and increased risk of injury. 

The main culprit is estrogen loss. “This is because estradiol (the most biologically active form of estrogen) impacts nearly every type of musculoskeletal tissue in the body, including bone, tendon, muscle, cartilage, ligament, and fat,” she writes. 

What HRT can do: 

Along with lifestyle changes, Wright points to hormone treatments for support. 

For example, she notes that research has found when HRT is paired with resistance training, women experience greater increases in muscle and grip strength compared to those not taking hormones. Another study finds that postmenopausal women taking hormones were able to preserve bone density and reduce the risk of fractures.

Poor sleep quality, waking up still tired, multiple nighttime wakings, trouble falling asleep. These are all common: In fact, research shows sleep disruptions are actually one of the most common symptoms3. 

“During menopause, hormone levels disrupt your circadian rhythm,” clinical psychologist and sleep specialist Shelby Harris, Psy.D. explains about the sleep-menopause connection. 

This becomes a vicious cycle: running on low sleep can worsen other symptoms like mood, cognition, skin appearance, and so on, thereby exacerbating already present symptoms. 

What HRT can do: 

Declining estrogen impacts blood vessel flexibility, cholesterol balance, and blood pressure regulation, notes the American Heart Association, as estrogen holds many cardioprotective benefits. Postmenopausal women experience a sharp rise in cardiovascular risk.

In addition, other physical changes may further affect how the heart functions: Many side effects of menopause, including depression or hot flashes and night sweats, may all be related to cardiovascular disease5. And the physiological changes that occur during menopause, like a decrease in muscle mass and an increase in body fat, can also affect cholesterol levels and metabolic health6 in midlife.

What HRT can do: 

Estrogen helps regulate insulin sensitivity, fat storage, and energy expenditure.

"We absolutely see 5-10 pounds of weight gain on average during the menopausal transition," says physician Suzanne Gilberg-Lenz, M.D., national advocate for integrative women’s health and author of the book Menopause Bootcamp. 

Research shows that the majority of women gain an average of 1.5 pounds a year7 between the ages of 50 and 60, a majority of which is centered around the abdomen.  

What HRT can do: 

Studies suggest that HRT may support a healthier metabolic profile—improving insulin sensitivity, reducing abdominal fat accumulation, and helping preserve lean muscle mass when combined with exercise.

It makes sense that our sex hormones impact our reproductive health. During perimenopause and menopause many women experience genitourinary syndrome of menopause8, which is characterized by vaginal dryness, pain during intercourse, and urinary problems. 

This, understandably, can tank a woman’s sex drive. 

What HRT can do: 

Luckily, there’s a straightforward solution to this, says Gilberg-Lenz: “Vaginal estradiol is widely available, inexpensive, generic, and body-identical. It’s safe and effective for everyone. Preventing and treating vaginal dryness and genitourinary syndrome of menopause—which affects 85% or more of us and gets progressively worse over time—is game-changing,” she says. 

9. Collagen production 

In adulthood, collagen production is on a slow and steady decline of about 1-2% a year9. That’s until menopause. During the 5 year span around menopause, women may expect an up to 30% drop in collagen levels. 

This has a direct affect on what the skin looks and feels like there on out: Fine lines, sagging, and loss of firmness are common visual indicators—alongside increased sensitivity, dryness, and dullness. 

"As our hormones diminish in menopause, the functions they perform to maintain the health and vitality of the skin diminish as well," board-certified dermatologist Keira Barr, M.D., tells us. 

What HRT can do: 

With estrogen restored, the body can more effectively produce collagen, helping skin remain lifted and firm for years to come. In fact research shows that with the administration of estrogen, HRT can significantly delay skin aging. 

“Most women tend to be candidates for hormone therapy, but there are a few major contraindications,” says board-certified OB/GYN and menopause society specialist Jila Senemar, M.D. FACOG, who is an instructor in our peri/menopause+ course.  

And when is a good time to have these conversations? That’s simply when you start feeling off.

HRT is one of the most powerful tools we have for navigating perimenopause and menopause. When thoughtfully prescribed, it can ease symptoms, improve quality of life, and support long-term health. The key is personalization: finding the right type, dose, and timing with a trusted provider.