Hormone therapy for women: forms, routes & sources
Every hormone used in women’s midlife care, how it is given and where it comes from.
VIDEO LESSON
Estradiol for whole-body symptoms
• FDA-approved: patches (Vivelle-Dot, Minivelle, Dotti, Lyllana, Climara), gels (Estrogel, Divigel, Elestrin), spray (Evamist), tablets (Estrace and generics), a higher-dose vaginal ring (Femring) and injections (estradiol valerate or cypionate).
• Compounded: Biest and Triest creams, troches, capsules and pellets.
Estrogen for vaginal and urinary symptoms
• FDA-approved: creams (Estrace, Premarin), inserts (Vagifem, Yuvafem, Imvexxy) and a ring (Estring).
• Compounded: estriol or estradiol vaginal creams.
Progestogens for uterine protection
• FDA-approved: micronized progesterone capsules (Prometrium and generics), medroxyprogesterone tablets and norethindrone acetate. The levonorgestrel IUD is used off-label.
• Compounded: progesterone creams, troches and slow-release capsules. Creams are not reliable for protecting the uterus.
Combination products
• Capsule or tablet: Bijuva (estradiol with progesterone), Activella, Angeliq, Prempro, and Duavee (conjugated estrogens with bazedoxifene, no progestogen needed).
• Patch: CombiPatch, Climara Pro.
Testosterone
• No FDA-approved product for women. Used off-label for low desire after menopause as a small fraction of an approved male gel, or as a compounded cream. Pellets and injections are advised against because levels run high.
DHEA
• FDA-approved: vaginal prasterone inserts (Intrarosa) for painful sex. Oral DHEA is sold as a dietary supplement and is not FDA-reviewed.
Non-hormonal prescription options
• Fezolinetant (Veozah), elinzanetant (Lynkuet) and low-dose paroxetine for hot flashes. Ospemifene (Osphena) for painful sex.
Commercial or compounded: how to decide
FDA-approved products are tested for how much hormone they deliver and carry full safety labeling. Many are bioidentical: estradiol and micronized progesterone are the same molecules the body makes. Compounding has a clear role when you are allergic to an ingredient, such as the peanut oil in some progesterone capsules, or when you need a dose or form that is not sold, such as testosterone at female doses. If you use a compounded product, ask whether the pharmacy is accredited and how it tests potency.
AT A GLANCE
Class
Reference guide
Brand names
Estradiol, progesterone, testosterone, DHEA: commercial and compounded
Status
Reference guide
Reviewed by
Farhan Tahir, MD
Is this medicine right for you?
Prescription medicines need individual medical advice. Dr. Tahir’s team offers consults through Youthful Medicine.
MECHANISM
How it works
The route decides where a hormone goes first. Tablets pass through the liver, which raises clotting proteins, triglycerides and SHBG. Patches, gels and sprays enter the bloodstream directly and avoid that first pass. Vaginal products act locally with very little reaching the rest of the body.
THE EVIDENCE
What the research actually shows.
EVIDENCE SUMMARY
The Menopause Society’s 2022 position statement supports individualizing type, dose and route, and notes that observational data link transdermal estradiol to lower clot and stroke risk than oral estrogen. For compounded products, the National Academies (2020) and ACOG (2023) recommend FDA-approved formulations when one exists.
KEY TRIALS
Menopause Society 2022 · NASEM 2020 · ACOG 2023
TYPICAL RESULT
The right route is the one that fits your risks and that you will use
SAFETY
Risks, side effects and who should avoid it
Anyone with a uterus who takes systemic estrogen needs a progestogen. A history of breast or endometrial cancer, unexplained bleeding, blood clots, stroke, heart disease or active liver disease needs specialist review before any systemic hormone.
This summary is not a complete list of risks. Read the official prescribing information and discuss your own history with your clinician.
KEY REFERENCE
The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767–794.
Educational content only, reviewed by Farhan Tahir, MD. Not individual medical advice. Medicines named here require a prescription and medical supervision.