Hormone Replacement Therapy (HRT)
Hormone replacement therapy restores estrogen, progesterone and, where indicated, testosterone to physiologic levels in women whose own production has declined through perimenopause and menopause. Dosing is guided by your symptoms and your laboratory results together, never by either alone, so treatment begins with a full clinical evaluation and a baseline hormone panel. Common indications include hot flashes and night sweats, disrupted sleep, mood and concentration changes, vaginal dryness, low libido, and loss of bone density. A consultation with laboratory testing is required before any prescription is issued. Prescribed and managed under Medical Director Steven Freedman, MD.
HOW IT WORKS
Your first visit is a consultation with laboratory testing. We take a full history, review your symptoms, personal and family risk factors, and draw a baseline panel covering estradiol, progesterone, FSH, LH, total and free testosterone, SHBG, thyroid function, a complete metabolic panel, lipids and A1c. Results are typically back within a few days.
Once your results return we review them together and decide whether hormone therapy is appropriate for you. If it is, therapy is started at a conservative dose and titrated upward only as your symptoms and repeat bloodwork indicate. Route of delivery is chosen to suit you, and women with an intact uterus receive progesterone alongside estrogen to protect the endometrium.
WHAT TO EXPECT
Most patients notice improvement in sleep and vasomotor symptoms such as hot flashes and night sweats within two to six weeks. Mood, concentration, libido and vaginal symptoms generally take longer, often eight to twelve weeks, because tissue-level changes accumulate gradually.
Hormone therapy is a long-term treatment rather than a course with an end date. You are seen for follow-up with repeat labs at approximately three months, again at six months, and every six to twelve months once you are stable. Dosing is adjusted at those visits based on how you feel and what your bloodwork shows.
Hormone therapy is not appropriate for everyone. It is generally avoided in women with a history of breast cancer, estrogen-sensitive malignancy, unexplained vaginal bleeding, active liver disease, or a history of stroke or venous thromboembolism. Your consultation exists to determine which of these applies to you.
FAQs
What does hormone replacement therapy cost?
Laboratory fees vary by panel and by lab; we default to Quest, which is substantially less expensive than Labcorp for the same hormone assays.
How soon will I feel a difference?
Sleep and hot flashes usually improve first, often within two to six weeks. Mood, concentration, libido and vaginal symptoms typically take eight to twelve weeks. Dose adjustments made at your three-month follow-up are a normal part of treatment, not a sign that it is failing.
Do I need bloodwork before starting?
Yes. A baseline panel is required before any prescription is issued. Prescribing hormones on symptoms alone is not safe practice, because symptoms overlap substantially with thyroid disease, anemia, and metabolic conditions that need to be identified and treated on their own terms.
Is hormone replacement therapy safe?
For most healthy women who begin therapy within ten years of menopause, current evidence supports a favorable balance of benefit to risk, including improvement in symptoms and preservation of bone density. Risk rises with age at initiation, dose, and individual history. Your consultation is where we determine where you fall.
How often will I be seen?
Follow-up with repeat labs at approximately three months, again at six months, then every six to twelve months once your dose is stable. Additional visits are scheduled any time your symptoms change or your labs warrant a closer look.
What should I do before my appointment?
Bring a list of your current medications and supplements, any recent bloodwork, and your personal and family history of breast, ovarian and uterine cancer, blood clots, stroke and cardiac disease. If you are still cycling, note the date your last period began. No fasting is required unless you are told otherwise.
What should I know once I have started therapy?
Take your medication consistently, as levels are steady-state and inconsistent dosing produces inconsistent results. Report any unexplained vaginal bleeding, new breast lump, chest pain, shortness of breath, severe headache, or calf swelling and pain promptly. Keep your follow-up appointments even when you feel well, because dosing is confirmed by bloodwork.
Disclaimer: This information provided is for general informational purposes only. It is not intended as a substitute for professional advice from a qualified healthcare professional and should not be relied upon as personal health advice. The information contained in this content is not meant to diagnose, treat, cure, or prevent any disease. You are advised to consult with a qualified healthcare professional for any medical concerns. Use of this information is at your own risk. We are not responsible for any adverse effects, or consequences resulting from the use of any suggestions or information provided.