What Are the Signs that You Need Menopause Hormone Therapy?

3 minute read

By: Alloy Staff|Last updated: May 10, 2022
Medically reviewed by: Sharon D. Malone

No joke—menopause is not for the faint of heart. Also no joke—we’ve earned the right to feel good, to be free of symptoms, to be feeling more like ourselves. But we’ve got some good news. If perimenopausal or menopausal symptoms are currently impacting your life and preventing you from enjoying the little things, menopause hormone therapy could be your solution. 

This treatment goes by many names - hormone replacement therapy (HRT), hormone therapy, menopause hormone therapy (MHT), and estrogen replacement therapy, among others. However, despite the different names, the overall goal of MHT is the same. Menopause hormone therapy helps us supplement the estrogen that our bodies stop producing as we enter menopause.

Hormone Changes During Menopause

Our estrogen levels can begin to decline as early as our mid-30s. This often erratic decrease in estrogen production is a phase of our lives known as perimenopause, where our menstrual cycles grow increasingly irregular and we start to develop menopausal symptoms. (You know you are fully in menopause when you haven’t had a period in twelve consecutive months.)

Loss of Estrogen

Up until your 30s or 40s your ovaries produce high levels of estradiol (E2), which is the form of estrogen responsible for the maintenance of a regular menstrual cycle. Though there are other forms of estrogen, it is the presence of estradiol that determines whether we are in the reproductive phase of our lives, in perimenopause or in menopause.

During this time, estradiol levels will fluctuate between 30 pg/ml - 400 pg/ml. Estradiol levels trend down through perimenopause and find their lowest range during menopause, fluctuating between 0 pg/ml and 30 pg/ml. 

The good news: your perimenopausal and menopausal symptoms are directly tied to the amount of estradiol in your blood. MHT supplements your naturally depleted estrogen levels, leading to a reduction in the many symptoms associated with menopause. 

Symptoms of Menopause

Estradiol supplementation during the perimenopause and menopausal transition alleviates many of the symptoms associated with lowered or fluctuating estrogen levels.

Menopause hormone therapy can help treat:

Hot Flashes

Hot flashes are unpredictable rushes of intensely uncomfortable heat. Though the exact science behind hot flashes is still not well understood, we do know that they occur when estrogen levels are low. MHT helps reduce the frequency and intensity of hot flashes by elevating estradiol levels.

Mood Swings

Let’s lay it out there — the symptoms of perimenopause and menopause are not fun. Sleepless nights, unpredictable menstrual cycles, and fatigue would impact anyone’s mood. menopause hormone therapy, in helping to treat the primary symptoms of menopause, can alleviate secondary symptoms such as mood swings.

Irregular Periods

Our menstrual cycles are kept regular through a natural fluctuation of estrogen. So, in the years leading up to menopause, known as perimenopause, when estrogen levels fluctuate up and down, our periods go out of whack. For women in perimenopause, doctors prescribe a low-dose oral birth control pill which also supplies estrogen and progesterone, but in a sufficient dose to regulate her period and prevent an unwanted pregnancy. 

Vaginal Dryness

Vaginal dryness is a symptom of the genitourinary syndrome of menopause. This syndrome, formerly known as vaginal atrophy, causes the tissues of the vagina to become drier and thinner leading to dryness, itchiness, and irritation. Menopause hormone therapy boosts your body’s estrogen levels and helps prevent vaginal dryness.

For women who experience genitourinary symptoms of menopause (dryness, itching, tearing, and frequent UTIs), locally applied, non-systemic estradiol cream is a safe and effective treatment that alleviates these symptoms.  

Night Sweats

Hot flashes at night = sweaty, sweaty sleeplessness. Overnight hot flashes interrupt restful sleep which adds up night after night causing chronic exhaustion. It only makes sense; if you don’t sleep, you feel tired. MHT reduces the frequency and intensity of hot flashes, which helps us get the rest we need so that we can be at our best during the day.

Weight Gain

Estradiol helps us regulate more than just our menstrual cycles – it is also an important hormone for regulating metabolism and fat distribution. As estradiol levels decrease over time, many women report an increase in visceral fat, which is a dangerous type of fat that surrounds our vital organs and our bellies.  

Menopause hormone therapy may not be able to help you lose weight, but it does help with where that weight goes. This is important because not all fat is created equal.  Visceral or belly fat puts you at higher risk for Type-2 diabetes and heart disease. Weight distributed around the middle is much more unhealthy than weight in the hips and thighs.

Low Libido

There are many situational factors that affect our sex drives. Low sex drive is only considered a problem that needs to be addressed when it causes problems in your life or relationships. If you are experiencing a low sex drive, and that idea bothers you, then MHT can help treat some of the perimenopausal and menopausal symptoms that lead to a lower sex drive. 

There are many ways menopause can reduce our sex drives. It’s complicated. Some women report a lower sex drive because of vaginal dryness, painful intercourse, decreased sensation, and fear of urinary tract infections–all signs of the genitourinary syndrome of menopause. Other times, a lack of sleep and general exhaustion prevents us from getting in the mood. If your sexual desire isn’t what it used to be and that idea bothers you, menopause hormone therapy can eliminate the vaginal dryness, hot flashes, and fatigue that sap your drive.


A fluctuation of hormones, regardless of the phase of life, can trigger headaches. However, migraine symptoms can persist and worsen through perimenopause and menopause. 

Menopause hormone therapy can help treat hormonal migraines—-but it can also make migraines worse. This is due to your body’s sensitivity to different levels of estrogen. It might take you and your doctor some time to find the estradiol level that works best for you.

Painful Joints

Estrogen has another secondary effect on our bodies — it helps reduce inflammation. As our estrogen levels decline, inflammation in our joints increases. You’ve got to love inverse correlations.

Dry, Itchy Skin

Estrogen also helps regulate the production of skin oils and collagen. Estrogen helps cells retain moisture, which is why skin, including vaginal tissue, becomes drier in menopause.

Urinary Symptoms

In addition to a drier, itchier vagina, the lack of estrogen can lead to many bothersome urinary symptoms such as urgency (gotta go, gotta go), frequency (didn’t I just pee five minutes ago?), and frequent urinary tract infections.  The urethra, the bladder, and the vagina are all densely populated with estrogen receptors, so during perimenopause and menopause, these tissues are profoundly affected and not in a good way.  Using either topical (vaginal) estrogen or systemic estrogen therapy makes for a happier, healthier vagina and bladder. 

Hair Loss

All women experience hair loss to a certain degree as they age. Yep, you guessed it: lower estrogen levels are a factor. For us, hair loss appears generally over the entire head and is normally not localized to a bald spot as with men. This makes it easier for us to treat thinning hair. MHT can reduce hair thinning by normalizing your estrogen levels.


For women, bone loss and menopause go hand in hand. As a matter of fact, the most rapid phase of bone loss happens within the first 5-6 years after the last menstrual period. The bone loss is due to the lack of estrogen which accelerates the breakdown of bone. The disease is hard to detect because there is no physical pain associated with thinning bone mass, but the chances of painful fractures and breaks increase with age. 

We may not know we’re at risk for osteoporosis while we’re young, but we all know what it looks like when we’re older.  Loss of height, curvature of our spines, and hip fractures are all too common. Menopause hormone therapy is FDA approved to prevent osteoporosis. And given the timing of the bone loss, the sooner you get started on MHT after menopause, the more of your bone mass you can preserve.  


Just like anxiety, depression is more of a secondary symptom of menopause. Menopause and perimenopause don’t directly cause depression, but certain symptoms of menopause can lead to the emergence of depression in about 20% of women. Menopause hormone therapy treats some of the distressing, frustrating, and distracting symptoms of menopause, which can help promote a more positive mood overall. 


If night sweats are keeping you up at night and preventing you from getting the sleep you need, it's likely that you’ll feel fatigued during the day. As with mood swings, fatigue is a secondary symptom of perimenopause and menopause. Menopause hormone therapy can help treat this secondary symptom by addressing the primary symptoms that keep you up at night. 


Let’s put it out there—while overall we love this time in our lives, dealing with perimenopause and menopause is not fun. The unpredictability of symptoms, the sleepless nights, and the uncontrollable changes happening to our bodies all amount to quite a frustrating experience. This is made all the more frustrating by the fact that the demands of daily life don’t have the ability to wait for our symptoms to improve. MHT gives us back some control over the symptoms of perimenopause and menopause which would make any of us a bit less irritable. 

Painful Sex

One of the effects of the genitourinary syndrome of menopause is that sex might become painful or uncomfortable. With drier, thinner vaginal tissue, the activities we used to enjoy with our partners might now be too uncomfortable to bear. MHT can help treat these symptoms by restoring your vagina to its premenopausal glory.  Thicker and healthier vaginal tissue naturally lubricates better and is more resistant to trauma and pain caused by intercourse.


Ah, hormonal acne. Hormones regulate many of our body’s systems including our skin. Changes to the skin’s oiliness can cause dryness, itchiness, and outbreaks of acne. Luckily, hormonal acne can be treated like any other outbreak of acne – with over-the-counter products.

How Estradiol Impacts Menopause Symptoms

As you’ve noticed by now, menopause and perimenopause cause a whole bunch of complicated, interrelated primary and secondary symptoms. None of the 30+ symptoms of menopause occur in isolation. MHT, which involves regular supplements of estradiol (E2), helps treat the many primary and secondary symptoms of menopause and perimenopause. Correcting for low or no estrogen helps make the many, many symptoms more manageable. Simply put, menopause hormone therapy improves your overall quality of life and helps you fearlessly face all the challenges of menopause.

If You Need Menopause Hormone Therapy, Alloy Can Help

If you are seeking relief from the many—and we mean many—symptoms of menopause, trust Alloy to help you decide on a treatment plan that’s best for you. 


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Written by:

Alloy Staff

Who is Alloy? Alloy exists to help women age healthfully and feel like their best selves. We approach women’s health with radical honesty. We fuse together powerful medical expertise, science backed treatments, and the support of a community that knows how you feel. We don’t just get you - we are you.

Medically reviewed by:

Sharon D. Malone

Dr. Sharon Malone is among the nation’s leading obstetrician / gynecologists with a focus on the specific health challenges associated with menopause.