Hormone Replacement Therapy: Side Effects, Alternatives, Cost

Written by Shivam Patel, PharmD, BSPS, RPh | Posted May 11, 2021

Before and during menopause, estrogen and progesterone hormones fluctuate quite a bit resulting in unpleasant symptoms, such as hot flashes and vaginal discomfort. Hormone replacement therapy replenishes these hormones providing relief. Some women are lucky and experience little to no symptoms that don’t resolve themselves on their own,  while others may need hormone replacement therapy (HRT) as a symptom savior. A bonus for women, a group notorious for being subject to osteoporosis: hormone replacement has also proved to prevent bone loss and reduce fracture in postmenopausal women.

Signs That You Might Need Hormone Replacement Therapy

Understanding when you may need to start HRT depends on the severity of perimenopause or menopause symptoms and the impact they have on your quality of life. Menopause occurs because the ovaries in female bodies stop creating estrogen and progesterone hormones. Menopause is official when women do not produce a period for one whole year; however, changes and symptoms can occur before this time. 

Menopause Symptoms

  • Noticeable change in periods like longer, shorter, heavier, lighter, infrequent, or more frequent

  • Hot flashes

  • Night sweats

  • Sleeping issues

  • Changes in mood

  • Vaginal dryness

  • Issues with focus

  • Hair loss

  • Development of facial hair

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Hormone Replacement Therapy Risks

Always discuss with your provider before starting HRT and remember HRT is not for all women.

Do not use HRT if you meet the following criteria: 

  • Pregnant or believe you could be pregnant

  • History of vaginal bleeding problems

  • History of blood clots

  • History of liver disease

  • History of heart attack

  • History of stroke

  • History of cancer

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How does Hormone Replacement Therapy work?

HRT works by balancing female hormone (estrogen and progesterone) levels that have become disrupted due to the occurrence of menopause.

  1. Estrogen - This hormone is used in estradiol, estriol, and estrone

  2. Progestogen - This hormone is a synthetic version of natural progesterone and is used in medroxyprogesterone, levonorgestrel, and norethisterone. 

HRT will often include one or both hormones. Most forms are pills you can easily take daily, but there are also skin patches, vaginal rings, creams, and gels.

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What is the safest hormone replacement therapy?

There isn't a one-size-fits-all option in terms of the safest HRT must be tailored to each woman where the benefits outweigh the risks overall. 

One major rule of thumb is estrogen-only HRT can increase the risk of endometrial cancer, which is why HRT is often combined with progestogen which reduces this risk, especially in women who haven’t removed their uterus. When taking estrogen alone it can also increase the risk of blood clots and strokes, so it's important to work with your provider and give your full medical history for a proper diagnosis.

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Hormone Replacement Therapy Side Effects

Common side effects of HRT include:

  • Changes in mood

  • Headaches

  • Nausea

  • Vaginal bleeding

  • Swelling of breasts

  • Bloating

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Does insurance cover hormone replacement therapy?

Yes, most HRT options available in the U.S. are covered by prescription insurance, but your copay or cost share will vary based on your insurance plan and if you have a deductible. 

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What is the success rate of hormone therapy?

The success of HRT will vary between women and you may have to work with your provider until you find an option that works best with your body. HRT is been shown to be effective in the treatment of hot flashes and other menopause symptoms, which include:

  • Issues with sleeping

  • Issues with focus

  • Overall irritable feelings

  • Vaginal itching and burning

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What kind of doctor do you see for hormone therapy?

The go-to doctor for an HRT plan is an endocrinologist, they are specialized in weighing the risks and benefits, prior conditions, and tailoring the most effective treatment for your hormones. 

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How much does hormone therapy cost for menopause?

Compare prices for common HRT options below.

Compare HRT Drug Prices

Drug Strength Quantity U.S. Pharmacy Retail Price  U.S. Discount Card Price Lowest International Pharmacy Price Greatest Percentage Savings
Premarin 0.625 mg 90 tablets $643.50 $557.48 $34.20 95%
Estrace 1mg 90 tablets $607.50 $490.90 $39.60 94%
Divigel 1mg 90 gel packets $539.02 - $159.30 70%
Combipatch 0.5mg/0.14mg 24 patches $762.54 - $132.95 83%

This price data is current as of April 2021. U.S. pharmacy retail price reflects a national average of out-of-pocket cost based on those listed on GoodRx.com and PharmacyChecker.com.

The lowest international pharmacy prices were based on those listed on PharmacyChecker.com. U.S. pharmacy discount price reflects lowest pharmacy price in the White Plains, NY area. 

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What are alternatives to hormone replacement therapy?

HRT is effective but, of course, there are side effects and risks to consider.; this is why natural alternatives may be a good option for some. Many natural options mostly aid with hot flash symptoms and are not all backed with scientific evidence so proceed with caution and always discuss a change in HRT with your provider. Below are some natural alternatives.

  • Quit smoking, quit smoking, quit smoking. Smoking messes with your hormones and hurts your entire body, so if you are ready call 1-800-QUIT-NOW.

  • Stay away from consuming spicy food, caffeine, and alcohol as they can worsen menopause symptoms.

  • Stay active and watch your weight as being overweight could result in more intense hot flashes.

  • Avoid tight-fitting clothes as these make it harder to cool your body once a hot flash starts.

  • Utilize vaginal moisturizers and lubricants for help with vaginal dryness throughout the day and during intercourse.

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