Hormone Replacement Therapy FAQ

Women experiencing symptoms of perimenopause or menopause — hot flashes, night sweats, sleep disruption, brain fog, mood changes, low libido, vaginal dryness, or unexplained weight gain — are generally good candidates. HRT requires a full hormone panel (estradiol, FSH, progesterone, testosterone, SHBG, thyroid) before our providers recommend any protocol.

Women with a personal history of hormone-sensitive cancers (breast, uterine), active blood clots, or uncontrolled high blood pressure require individualized evaluation. These are not automatic exclusions in all cases — our providers conduct a thorough risk assessment at every consultation.

No. Perimenopause — the 4 to 8 year transition before menopause — is often when symptoms are most disruptive. Estrogen and progesterone fluctuate erratically during perimenopause, and hormone support during this period can significantly reduce symptom burden. Our providers evaluate perimenopause patients the same way they evaluate menopausal patients — based on labs and symptoms, not age cutoffs.

Current guidance from NAMS (North American Menopause Society) supports HRT for most healthy women under 60 and within 10 years of menopause onset — this is often called the “window of opportunity.” Women who start within this window have the most favorable risk-benefit profile.

Women over 60 or more than 10 years post-menopause require more individualized risk assessment. Our providers do not apply arbitrary age cutoffs — they evaluate each patient’s clinical picture. Continuing HRT beyond 60 is appropriate for many women when the benefit-risk balance is favorable.

The most recognized symptoms are hot flashes and night sweats. But the full picture of hormone deficiency in women includes: disrupted sleep even without obvious night sweats, mood changes (anxiety, irritability, or depression that is new or worsening), brain fog and memory lapses, vaginal dryness and discomfort, low libido, fatigue, joint aches, and unexplained weight gain particularly around the abdomen. Many women experience these for years before recognizing them as hormonal. Our providers look at the full picture.

The breast cancer concern originates from the 2002 Women’s Health Initiative (WHI) study, which has since been substantially re-analyzed. The original study used conjugated equine estrogen combined with synthetic progestin (medroxyprogesterone acetate) — not bioidentical hormones — in women who were already significantly older and further from menopause than typical candidates today.

Current evidence from NAMS, the British Menopause Society, and the International Menopause Society supports that for healthy women under 60 within 10 years of menopause: the risk associated with bioidentical estradiol plus micronized progesterone is low, and the benefits to quality of life, bone density, cardiovascular health, and cognitive protection are well-established. Our providers conduct a detailed individual risk assessment before any prescription.

BHRT refers to bioidentical hormones — molecules that are structurally identical to the hormones your body produces naturally. Estradiol (not equine estrogens), micronized progesterone (not synthetic progestins), and bioidentical testosterone are all BHRT. At Tactus Health, our providers prescribe bioidentical hormones in both FDA-approved formulations and compounded formulations when a custom dose is clinically appropriate. Our medical team only prescribes through FDA-registered compounding pharmacies under standard prescribing guidelines.

Oral estrogen increases clotting risk because it undergoes first-pass liver metabolism, which activates clotting factors. Transdermal estrogen (patches, gels, creams) bypasses the liver and does not carry the same clotting risk. This is why our providers preferentially prescribe transdermal estrogen — especially for patients with any cardiovascular or clotting risk factors. Women with personal or family history of clotting disorders require evaluation before any estrogen is prescribed.

Yes — this is one of the strongest evidence-based benefits of HRT. Estrogen plays a central role in bone remodeling, and its decline during menopause is directly linked to the accelerated bone loss that leads to osteoporosis. HRT is considered the most effective intervention for preventing menopausal bone loss and fracture risk in appropriate candidates. DEXA scan at baseline and during treatment is recommended to track bone density.

Estradiol (transdermal patches, gels, creams, or compounded), micronized progesterone (oral Prometrium or compounded), and low-dose testosterone (compounded cream or gel). The specific formulation and dose are determined by your lab results and symptom picture. Our providers do not prescribe a one-size-fits-all protocol — the combination and dose are individualized and adjusted at every follow-up based on your response.

If you have had a complete hysterectomy (uterus removed), you do not require progesterone for uterine protection — estrogen alone can be prescribed safely. Our providers may still discuss progesterone for its non-uterine benefits (sleep quality, mood, neuroprotection) on an individual basis, but it is not mandatory without a uterus. If only your ovaries were removed with an intact uterus, progesterone is still indicated.

Testosterone is not just a male hormone — women produce and need it, primarily from the ovaries and adrenal glands. Female testosterone levels decline significantly during perimenopause and menopause. Low testosterone in women is associated with reduced libido, fatigue, brain fog, muscle loss, and low motivation. Our providers measure free and total testosterone in every hormone panel and address low levels when clinically indicated, using low-dose compounded testosterone cream or gel.

A full hormone panel including estradiol, FSH, LH, progesterone, total testosterone, free testosterone, SHBG, and thyroid (TSH, free T3, free T4). Also a comprehensive metabolic panel and lipid panel. Depending on your history, DHEA-S and cortisol may be included. Labs are ordered electronically to your nearest Quest or Labcorp — walk-in, no appointment needed at most locations.

Every 6-8 weeks for the first 6 months while our providers optimize your dose. Once your protocol is stable, follow-up labs every 6 months. Annual mammogram and bone density (DEXA) scan are also recommended while on HRT. Our providers will discuss appropriate screening intervals at your consultation.

Sleep improvement is often the first change — within 2-4 weeks. Hot flashes and night sweats typically improve within 4-8 weeks. Mood, energy, and cognitive clarity often take 6-12 weeks to fully stabilize as hormone levels reach therapeutic range. Libido improvements and vaginal tissue changes can take 3-6 months. Our providers check labs at 6-8 weeks to assess levels and adjust — most patients are not at their optimal dose on the first prescription.

Symptoms typically return when HRT is stopped, though they may not return as intensely as before — some benefit from the treatment period persists, particularly for bone density. There is no severe withdrawal effect, but a gradual taper (reducing dose over 3-6 months) is generally recommended rather than abrupt discontinuation, to minimize symptom recurrence. How long to stay on HRT is a personal decision our providers revisit with every patient regularly.

Yes. HRT prescriptions (patches, gels, creams, oral progesterone, testosterone cream) are fully managed via telehealth. Our providers order labs at your nearest Quest or Labcorp and medication ships to your address. We are actively expanding telehealth licensing — check our telehealth page for current state availability.

Tactus Health is a direct-pay practice and does not bill insurance. Pricing is transparent — you know what you’re paying before committing. HSA and FSA are accepted. Financing is available through CareCredit, Cherry, and AfterPay. Some FDA-approved HRT formulations may be covered by insurance through standard pharmacies — our providers can write a prescription you take to your own pharmacy if that’s your preference.