Hormone Replacement Therapy (HRT)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated May 14, 2026

Hormone replacement therapy (HRT) is the exogenous administration of estrogen, progesterone, or both, to address the decline in hormonal production that occurs during perimenopause, menopause, or in conditions such as premature ovarian insufficiency (POI). HRT reduces vasomotor symptoms (hot flashes, night sweats), slows bone loss, and may lower cardiovascular risk when initiated in the early postmenopausal window. Documented risks include venous thromboembolism and, with combined estrogen-progestogen therapy, a modest increase in breast cancer risk that varies by formulation, duration, and timing of initiation.¹

The clinical context matters. A 32-year-old with POI who has no functional ovarian estrogen production faces accelerated bone loss, cardiovascular risk, and neurological consequences without treatment. Guidelines recommend hormone replacement in POI until at least the average age of natural menopause, given the documented risks of untreated estrogen deficiency at a young age. This is physiological replacement for a documented deficiency. It is not the same as administering hormones to suppress normal reproductive function, which is a different clinical goal with a different risk-benefit calculation.

Restorative-aligned perimenopause and menopause care addresses symptoms first through lifestyle, nutrition, and targeted evaluation of the hormonal picture, and considers systemic hormone therapy when the clinical indication is established and the risk profile has been individually assessed. The route of administration, formulation, and duration are each relevant to that risk profile. Transdermal estrogen, for example, avoids the first-pass hepatic effects associated with oral preparations, which has implications for thromboembolism risk.

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.