Hormone Replacement Therapy: How it Works

You’ve probably heard about hormone replacement therapy (HRT). Maybe your best friend swears by it, or a coworker mentioned how it changed her life. Or perhaps you’ve been up late, scrolling through articles, looking for solutions to the brain fog, the weight gain, or the sleep that seems to elude you more often than not. If any of this sounds familiar, you’re not alone.

I’ve helped thousands of women just like you find balance and relief through hormone optimization. I specialize in longevity and women’s health, focusing on the power of bioidentical hormones to restore well-being. If you’re feeling the undeniable pains of non-balanced, non-optimal hormones, let’s talk about how HRT could be a game-changer for you.

What Is Hormone Replacement Therapy?

HRT is a treatment designed to supplement the hormones your body naturally produces but can be low for a number of reasons, namely perimenopause and menopause. But even women in their 20s can be found to have low hormones due to birth control, environmental toxins, or other factors. Hormone replacement therapy is a way to replenish what’s missing and restore equilibrium.

In Plain English:
Hormones are your body’s messengers. They regulate literally every process in the body — everything from metabolism to mood. When they decline, the messages get scrambled, leading to symptoms that can disrupt your daily life. HRT helps bring those messages back, allowing you to feel like yourself again and your body to function properly.

The Role of Hormones in Your Body

Hormones are the master regulators of the body, (What Do Hormones Do in Children, Men, and Women?) orchestrating nearly every physiological process—from metabolism and immune function to mood, sleep, and reproductive health. These chemical messengers, produced by glands like the ovaries, work in harmony to keep the body in balance. When hormones drop, as they do in perimenopause, due to environmental toxins, or chemicals or after being on birth control, the effects ripple across multiple systems, leading to symptoms like fatigue, weight gain, brain fog, anxiety and insomnia. Because hormones influence so many functions, addressing imbalances at the root—rather than just treating symptoms—is key to feeling your best.

The three key sex hormones in women are:

• Estrogen (estradiol) – Keeps your brain sharp, your skin plump, your hair long and lustrous, your body hydrated, your muscles, bones & heart healthy., Normal Testosterone and Estrogen Levels in Women.
• Progesterone – The calming hormone. It helps regulate sleep, mood, and brain function. But it also counteracts estradiol and plays a huge role in bone, heart, and muscle health.
• Testosterone – Often thought of as a “male” hormone, but it’s crucial for women, too. It supports libido, muscle strength, and motivation. Low Testosterone In Women: Causes, Symptoms & Treatment.

When these hormones are low, which they tend to all drop at the same time – women experience weight gain, brain fog, memory loss, hair loss, acne, dry skin, vaginal dryness, insomnia, anxiety, irritability, and irregular periods, fatigue and low sex drive. And this is just to name the most common symptoms! There can be many many more!

Hormone replacement therapy is when you simply restore the depleted hormones back to what they were before they declined.

Are Hormones Just For Symptoms?

Hormones are definitely effective at treating symptoms, but it’s not just about stopping symptoms. Hormones are not a bandaid treatment. Rather, they are foundational to good health, longevity, and well-being! If you want a healthy brain, heart, bones, and body — it starts with optimal hormones!

How Hormones Help Symptoms and Prevent Disease

By restoring hormone levels to closer to what they were when we were younger – Not only can we alleviate symptoms, but we can potentially increase our healthspan. Health span is how long we live while being healthy. Here’s examples of what symptoms HRT helps with:Hormone replacement therapy – Wikipedia

Here’s examples of what symptoms HRT helps with:

• Sleep Issues & Insomnia → Supports melatonin production, regulates body temperature, increases dopamine and serotonin – which promotes deeper, more restful sleep
• Irritability, Depression & Anxiety → Stabilizes neurotransmitters, improving emotional well-being
• Brain Fog & Memory Issues → Enhances cognitive function and mental clarity What your menopause symptoms could tell you about your dementia risk
• Low Libido & Vaginal Dryness → Restores sexual health, sensitivity & libido
• Fatigue & Low Energy → Improves overall energy levels and motivation
• Weight Gain → Critical for metabolic fitness, weight loss, and appetite suppression

How do you restore hormone levels effectively? Not all hormone replacement therapy is created equal! Most formulations are outdated and not as effective as they could be.

Types of Hormone Replacement Therapy

There are different types of traditional HRT, and finding the right one depends on your body’s unique needs. Here’s a quick breakdown: Hormone replacement therapy – Wikipedia

Why Vaginal HRT is Systemic and A Smarter Approach

Additionally, vaginal HRT may provide a more systemic effect due to its higher absorption through the vaginal mucosa, making it a preferred option for some women who need consistent hormone levels. Unlike topical creams, which may struggle to penetrate the outer skin barrier effectively, vaginal is absorbed efficiently through the rich vascular network of the vaginal tissue. This direct absorption allows for more stable hormone levels, avoiding lows that can contribute to symptoms like irritability, migraines, brain fog, or menstrual spotting.

Research has demonstrated that vaginal HRT provides a steady release of estrogen and progesterone into the bloodstream, leading to more consistent serum levels compared to oral or transdermal formulations. Additionally, because the vaginal mucosa is highly vascularized, absorption is more efficient, resulting in greater systemic bioavailability and improved symptom relief.

Another advantage of vaginal estradiol is its minimal impact on clotting factors and liver metabolism. Since it bypasses first-pass liver metabolism, it reduces the risks associated with oral estrogen, such as increased clotting factors and liver enzyme alterations. Additionally, vaginal estradiol may help alleviate vaginal dryness, urinary symptoms, and atrophic changes more effectively than systemic therapies alone, as research has shown that localized estradiol application directly improves vaginal tissue integrity, elasticity, and hydration while also providing systemic hormone benefits.For women seeking a more reliable and efficient method of estradiol delivery, vaginal estradiol offers a promising solution.

How to Use Vaginal HRT Cream for Maximum Benefit

While vaginal cream is a highly effective option, studies have shown that topical estrogen cream does not always penetrate the outer skin barrier efficiently. This can lead to contamination risks, especially if it transfers to other people through skin-to-skin contact. For women experiencing perimenopause and menopause symptoms, using vaginal cream as prescribed by a hormone specialist can provide significant relief.

• Pair with progesterone therapy to prevent side effects like migraines, skin sensitivity, irritability, or heavy uterine bleeding.

What About Supplements?

With so much wellness advice out there, it’s tempting to reach for supplements promising hormone balance and symptom relief. But the reality is, no single supplement can fully address the complex hormonal changes happening in your body. Unlike hormone replacement therapy (HRT), which directly replenishes declining hormones like estrogen and progesterone, most over-the-counter supplements lack the scientific backing to prove they truly work.Herbs and supplements do not boost production of hormones, replace hormones, or provide the same health benefits. They are also not natural — our bodies do not naturally make herbs like black cohosh. We
do
make hormones naturally.

Supplements are also unregulated, what’s on the label isn’t always what’s in the bottle. While lifestyle changes—like stress management, good nutrition, and exercise—can support overall health, they can’t reverse the hormonal decline driving your symptoms.

The wellness industry is quick to capitalize on women, marketing expensive supplements to women looking for solutions. The problem? These products often rely on weak or inconclusive research, and most don’t contain active ingredients at effective doses.Without proper regulation, companies can make big claims without accountability, leaving women to navigate a sea of misinformation. That’s not to say there’s nothing you can do — there’s a lot you can do — but relying on a supplement alone isn’t the answer.

If you’re struggling with symptoms, the most effective approach is evidence-based: bioidentical HRT, when appropriate, alongside targeted lifestyle changes. Perimenopause isn’t something you can “wellness” your way out of, and women deserve real, science-backed solutions — not just marketing hype.

Thinking About Getting Started with HRT?

If you’re considering HRT, here’s what to expect:

• Side Effects – Typically intermittent spotting and bleeding is very common when starting HRT — even if you haven’t had a period in many years. Breast tenderness is also a very common side effect and is easily treated with iodine.
• Timeline – Women start to notice improvements in as little as 14 days, but most need 4–6 months to adjust and find the right dose.
• Customized Treatment Plan – Although starting doses are typically given, you will want a tailored approach over time using bioidentical hormones suited to your body’s needs. This means that after you have started adjusting to having hormones onboard again, you will want your provider to work with you to further optimize how you feel. This can mean raising the dose after some time.
• Follow-Ups & Adjustments – Monitoring your progress and making necessary adjustments for optimal results. It is important to work with a specialist who knows how to make changes if something is off. Most physicians do not have training in HRT.

Before & After : Many women report significant improvements in sleep, mood, energy, and overall quality of life within weeks of starting treatment.

Take the Next Step

Fortunately, women now have an option other than suffering while aging! You don’t have to go through it anymore, and you don’t have to navigate symptoms alone. Be sure to work with a hormone specialist. OB/Gyns are excellent doctors at delivering babies, but they have zero training for hormones and treating symptoms of low hormone, identifying that they are low, and managing HRT after it is started. Endocrinologists also are not trained in longevity medicine. It is important to find someone who has experience working with women to get the best results. Follow me on social media for expert insights, or sign up for our newsletter to stay informed on the latest in hormone health.

Inner Balance: A Modern Take to Hormone Therapy

When it comes to managing menopause and perimenopause symptoms, estradiol cream is a safer, more effective option than oral estradiol. On top of that, vaginal estradiol cream has been shown to be safe — not increasing risk of cancer, stroke, or cardiovascular disease.By avoiding first-pass metabolism, it provides better symptom relief with fewer risks, making it the preferred choice for many women.At Inner Balance, we help women optimize their hormones with science-backed approaches to improve their skin, hair, and overall well-being.If you’re struggling with dry skin, mood swings, or sleep disturbances, consider discussing estradiol cream as a key part of your hormone therapy plan.

Ready to feel like yourself again?
Let’s find the best approach for you.