My Philosophy on (HRT): It's About More Than Hot Flashes

One of the biggest issues I see with women who’ve previously tried hormone replacement therapy (HRT) is that the wide variety of delivery methods—creams, pellets, pills, patches, and injections—often leads to incomplete symptom relief or frustrating side effects. What works best truly depends on the individual. Some women don’t absorb creams well, while others experience unpleasant side effects with pellets. Finding the right method is personal and should be tailored to your body’s needs.

Most hormones prescribed today are bioidentical, meaning they’re chemically identical to the hormones your body naturally produces. This is important, but it’s only one piece of the puzzle.

For years, estrogen has been surrounded by fear, causing many providers to prescribe the lowest possible dose—just enough to ease symptoms like hot flashes or night sweats. But is that really “optimal” health?

When we’re younger and still cycling, estrogen naturally rises and falls to support key systems in the body—bones, brain, heart, and more. Progesterone is present only half the month. So why do we treat menopause with flat, daily doses of hormones? Shouldn’t we aim to replicate the body’s natural rhythms to promote true vitality?

Menopause symptoms go far beyond hot flashes. Many women struggle with joint pain, anxiety, depression, low libido, fatigue, brain fog, insomnia, dry skin and hair, and even heart palpitations. That’s because estrogen receptors exist throughout the entire body. Estrogen and progesterone don’t just ease symptoms—they support the health and function of nearly every system.

Yet, many modern HRT protocols rely on daily, static doses—often a patch plus progesterone every day. This “one-size-fits-all” method is designed to protect the uterine lining but doesn't reflect how our bodies are designed to function. And then there are pellets, which release hormones over time, and depending on how your body metabolizes them, can sometimes lead to levels that are too high and hard to control.

Instead, I focus on an individualized approach—one that mimics natural hormone fluctuations and considers your entire health picture. The goal is to get estrogen at physiologic levels—not just “high enough to stop symptoms”—in order to support optimal health.

Think about this: when men lose testosterone, we don’t give them “just enough”—we restore their levels so that they have a multitude of health benefits. So why don’t we do the same for women?

Ultimately, HRT is not just about symptom relief. It’s about restoring balance—optimizing the relationship between estrogen and progesterone (and eventually testosterone) to support your whole-body health through menopause and beyond.