Which type of HRT is right for you?

Estrogen alone vs estrogen plus progestogen

If you've had a hysterectomy (no uterus), estrogen-alone therapy is typically used, since there's no uterine lining to protect. If you still have a uterus, estrogen is almost always combined with a progestogen (progesterone or a synthetic progestin), because estrogen alone can overstimulate the uterine lining and raise the risk of endometrial cancer over time. This is the single biggest branch point in choosing an HRT regimen.

The main delivery routes

Estrogen and progestogen can each be delivered several ways, and the route affects both how the hormone moves through your body and which side effects are more or less likely.

• Pills: taken orally, processed through the liver first. Convenient, but oral estrogen carries a somewhat higher blood clot risk than through-the-skin (transdermal) forms for some women.
• Patches: applied to the skin and changed once or twice a week, deliver estrogen (sometimes combined with progestogen) directly into the bloodstream, bypassing the liver. Often preferred for women with clot risk factors or migraine with aura.
• Gels and sprays: applied to the skin daily, also transdermal, offer flexible dosing but require care to avoid transferring hormone to others through skin contact.
• Vaginal estrogen (cream, ring, or tablet): treats vaginal dryness, irritation, and urinary symptoms locally, with minimal absorption into the rest of the body. Often used alone for genitourinary symptoms even in women who aren't candidates for systemic therapy.
• Progesterone is also available as an oral capsule taken at bedtime (common for its calming, sleep-supporting effect) or combined into a patch or intrauterine device.

"Body-identical" vs older synthetic forms

"Body-identical" (sometimes called micronized or bioidentical, when FDA-approved) hormone therapy uses hormones that are molecularly identical to what the ovaries produce, most often estradiol and micronized progesterone. These are now the most commonly prescribed FDA-approved options and are what most current research and updated FDA labels refer to.

Older synthetic forms, like conjugated equine estrogens (the type used in the original 2002 WHI study) and synthetic progestins, are still available and effective for many women, but they are structurally different from the hormones your body makes and were the formulations most closely tied to the original safety concerns.

Compounded "bioidentical" HRT is a separate category

Compounding pharmacies sell custom-mixed hormone preparations, often marketed as more natural. These are not FDA-approved, are not covered by the 2025-2026 label changes, and their dosing and purity aren't regulated the same way. Most major medical societies recommend FDA-approved body-identical products over compounded versions unless there's a specific medical reason (such as an allergy) to need a custom formulation.