When is combination hormone replacement therapy best?

Estrogen vs. Combination Hormone Replacement Therapy: Choosing the Right Strategy

by Charlotte

In the past, the needs of women approaching menopause were often minimized, and uncomfortable realities considered an unavoidable right of passage. But in the twenty-first century, this need not be the case. With more resources than ever available to meet women’s treatment goals and improve their quality of life, there is no reason to struggle with unsettling symptoms like hot flashes, sleep disturbances, mood changes, low sex drive, and vaginal discomfort.

If menopause symptoms have become your new normal, you may be considering relief in the form of hormone replacement therapy (HRT). But before electing to undergo treatment, it is essential to fully understand your treatment options. This includes exploring whether estrogen alone is appropriate or if combination hormone replacement therapy is necessary to address your symptoms while protecting your health. 

When to Use Hormone Replacement Therapy

Estrogen and progesterone impact women throughout their lives. From birth through puberty and into the child-bearing years, the interplay of these key sex hormones is deeply tied to how we look, feel, and function. So when hormone levels decrease or their natural balance is disrupted, you may notice uncomfortable symptoms. But living with the distressing and disruptive effects of hormonal fluctuation and imbalance is not a foregone conclusion; today, women have the option of elevating and balancing critical sex hormones using hormone replacement therapy.

Two of the primary conditions for which HRT may be indicated are natural and surgical menopause. Natural menopause is defined as the point in a woman’s life when menstruation has stopped for a period of twelve months or longer due to a decrease in estrogen production. This typically occurs between the ages of 45 and 55. Surgical menopause, on the other hand, results from bilateral oophorectomy—the removal of both ovaries. Removing the body’s main source of estrogen causes a woman to enter menopause immediately regardless of her age. This procedure may be performed in combination with a hysterectomy—the removal of the uterus—or as a stand-alone procedure. Hormone replacement may also be beneficial during perimenopause, when the hormonal fluctuations leading up to menopause may cause the first symptoms to appear. Another condition that may warrant the replacement of female hormones is primary ovarian insufficiency, which occurs when the ovaries of a woman under 40 stop working. 

HRT is designed to bring hormone levels in line with those that yield comfort and optimal functioning. This may also have a protective effect on various body tissues, potentially preventing the onset or progression of conditions associated with estrogen decline, including osteoporosis, cardiovascular disease, and even type 2 diabetes. Women who experience surgical menopause, primary ovarian insufficiency, or premature menopause are particularly vulnerable to developing these conditions, making HRT even more critical.

Estrogen vs. Combination Hormone Replacement Therapy

While HRT can have profound benefits for many women struggling with hormonal change, achieving safe and effective symptom relief depends on developing the right treatment strategy. One of the most vital starting points for charting the course of treatment is considering whether or not a woman’s uterus is intact:

  • Estrogen replacement therapy is typically used to ease symptoms in women who have had their uterus surgically removed (hysterectomy).
  • Combination hormone replacement therapy – a combination of estrogen and progesterone – is typically prescribed for a woman whose uterus is intact. As in estrogen replacement therapy, the estrogen addresses menopausal symptoms while the addition of progesterone has a protective effect against endometrial cancer. Since one of estrogen’s primary functions is to thicken the endometrium—or uterine lining—to support the implantation of a fertilized egg, estrogen-only therapy stimulates this lining to continue to grow. But when menstruation has stopped, the endometrium is no longer shed each month. As a result, hyperplasia—or overgrowth of the uterine lining—is possible, which could lead to endometrial cancer. The addition of progesterone in combination therapy thins the endometrium offering a protective effect on the uterus.

In either case, the primary benefits of hormone replacement therapy are derived from the estrogen. Some physicians will make the choice between estrogen replacement and combination therapy based solely on a woman’s anatomical status—whether she has her uterus or not. However, there is evidence that the role of progesterone may go beyond protecting the uterus in postmenopausal women. Choosing the strategy that is best for you is therefore best done with the guidance of a trusted medical professional. 

Optimizing Quality of Life and Individualizing Comfort

If you have decided it’s time to address the hormone-related symptoms that are challenging your comfort and peace of mind, hormone replacement may be the solution for you. HRT has proven useful for improving quality of life and preventing disease, making it an invaluable tool for women who are approaching or have entered menopause.

Of course, hormonal health is complex. For optimal results, HRT should be customized to meet individual needs and regularly monitored. The best way to accomplish this is to seek the input of a hormone health specialist. The goal is finding a practitioner who will hear your needs and carefully analyze your hormonal status before creating a treatment plan tailored to your needs. Regardless of whether you choose estrogen-only treatment or combination therapy, they will continuously track your progress and fine-tune your treatment.

It is also essential to find a practitioner who is dedicated to helping each woman find not just symptom control, but overall health and balance. Connecting with a health care provider who utilizes a full range of hormone replacement products and lifestyle supports will ensure that treatment outcomes address your immediate needs, provide a protective effect against preventable future illnesses, and buoy your overall sense of well-being. 

If you are ready to find lasting relief from the uncomfortable symptoms associated with hormonal change, BodyLogicMD can help. The practitioners in the BodyLogicMD network are experts in hormone replacement therapy and dedicated to helping patients achieve hormonal balance. Using an integrative approach to medicine, each patient is treated as a whole individual, receiving nutrition and lifestyle counseling in addition to any necessary medications. To get started, contact a local practitioner today, or take the BodyLogicMD Hormone Balance Quiz to better understand the impact of hormones on your everyday life.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.