You are going through menopause or have already gone through it and are experiencing how much the symptoms are limiting your daily life. Hot flashes are robbing you of sleep, you lack energy, and your body no longer feels the same. Many Women come Exactly to this Point : What helps really ?
This article therefore focuses on specific treatment options for menopausal symptoms. You will learn how estrogen deficiency develops, the role of hormone replacement therapy, and how its benefits and risks are currently scientifically assessed. This will help you make informed decisions together with your doctor.
The most important points in brief
- Estrogen deficiency is the main cause of many typical menopausal symptoms.
- Hot flashes, sleep disturbances and concentration problems are among the most common symptoms.
- Hormone replacement therapy is currently the best-researched treatment and is considered particularly effective in treating pronounced symptoms.
- The benefits and risks of hormone replacement therapy depend heavily on the time of initiation, the method of administration, and the individual situation.
Estrogen deficiency during menopause: This is what happens in the body
Behind the typical bodily changes during menopause lies a key factor: estrogen deficiency. During the fertile years, the ovaries are the main producers of important hormones such as estrogen and progesterone. Their levels fluctuate throughout the monthly cycle. For example, estradiol (E2), the most potent form of estrogen, rises during the follicular phase, reaches its peak shortly before ovulation, and then declines again.
However, during perimenopause , which typically lasts 4 to 5 years before menopause, hormone levels begin to fluctuate significantly while showing an overall downward trend. After menopause, estrogen levels remain persistently low (1).
The course of menopause: From acute symptoms to a new equilibrium
How menopause is experienced varies from woman to woman. Some women find the symptoms mild, while others suffer considerably. At the same time, it's important to keep in mind long-term changes that often only become apparent over years.
Symptoms are typically most intense in the years leading up to and following menopause, the so-called perimenopause. The highly fluctuating hormone levels during this transition phase can noticeably impact daily life.
The good news: After menopause, a new hormonal balance is established. Estrogen levels are then permanently low, but stable. Many acute symptoms such as hot flashes, mood swings, or sleep problems subside, and the body gradually adapts to the new situation (3).
Treatment of menopausal symptoms
Mild to moderate symptoms can often be alleviated by targeted lifestyle measures: balanced diet, adequate protein intake, supplementation with calcium and vitamin D, omega-3 fatty acids, regular exercise, stress reduction and abstinence from tobacco use (4).
However, these measures are often insufficient in cases of severe symptoms or increased health risks. In such cases, medical therapy may be advisable. Hormone replacement therapy is the most scientifically studied treatment.
What is hormone replacement therapy?
Hormone replacement therapy (HRT), also frequently referred to as "hormone replacement therapy," aims to "replace" the hormones that the body no longer produces in sufficient quantities. The goal is to alleviate typical symptoms of estrogen deficiency and to mitigate health risks (5).
How does it work?
You take hormones in a form that suits your situation: either as tablets, gel, or patches. These are estrogen and, if you still have a uterus, also progestogen. These hormones compensate for the decline in your body's own hormone production and can help reduce typical menopausal symptoms.
Various options for hormone replacement therapy
-
With uterus – combination therapy (estrogen + progestogen)
If you still have a uterus, a combination of estrogen and progestogen is always prescribed. Why? Estrogen alone would cause the uterine lining to build up excessively and increase the risk of uterine cancer. The added progestogen protects the lining and reduces this risk. -
Without a uterus – estrogen alone
After a hysterectomy, estrogen can be used without progestogen because there is no risk of endometrial buildup (6).
How can you take the hormones?
Hormones can be administered in various ways. Each has its advantages and disadvantages, and your doctor will work with you to choose the most suitable method.
-
Transdermal (through the skin):
• e.g. plaster or gel
• Advantage: Absorbed directly into the bloodstream through the skin, lower risk of blood clots
• Often recommended for those with an increased risk of thrombosis -
Oral (tablets):
• Easy to use
• Hormones are absorbed through the digestive tract.
• Disadvantage: May have a slightly higher risk of blood clots than transdermal forms. -
Locally applied to the intimate area (creams, rings, vaginal tablets):
• Act directly at the site of the symptoms
• Particularly suitable for isolated vaginal dryness
• They usually have no noticeable effect on the whole body, but only locally (6)
When is hormone replacement therapy appropriate?
Hormone replacement therapy is primarily used today for the targeted treatment of menopausal symptoms when these significantly impair daily life and serves primarily to alleviate symptoms.
Conditions for which hormone replacement therapy is used
-
Severe hot flashes : Estrogen is the most effective treatment for pronounced vasomotor symptoms such as hot flashes and night sweats. In many cases, it can significantly reduce these symptoms and thus improve quality of life.
-
Severe sleep disturbances : If sleep problems are triggered by hot flashes or night sweats, HRT can help improve sleep quality. Studies show that as vasomotor symptoms are alleviated, sleep duration and quality often increase.
- In cases of premature menopause , HRT can replace important hormonal functions and is medically especially recommended to alleviate symptoms and support long-term health (7).
If you would like to learn more about typical symptoms of menopause, click here for further information.
The best time to start therapy
The timing of hormone replacement therapy is one of the most important factors for a favorable benefit-risk ratio. Ideally, you should start soon after the onset of significant symptoms, before the age of 60, or within 10 years of your last menstrual period.
In cases of early onset (shortly after menopause):
The blood vessels are still relatively healthy. Estrogen can:
- Keep the arteries elastic
- Slowing down the development of arteriosclerosis (hardening of the arteries).
- They have a protective effect on the vessel walls
In cases of late onset (many years after menopause):
After years without estrogen, deposits (plaques) may already have formed in the blood vessels. Taking estrogen at this point can be problematic.
- Estrogen can destabilize unstable plaques.
- The risk of heart attack and stroke increases.
- The protective effect on the blood vessels comes too late.
| A 2021 study showed that women aged 50-59 who started hormone replacement therapy had a tendency to have a reduced risk of coronary heart disease compared to women who started HRT more than 10 years after menopause (6). |
Duration of hormone replacement therapy
The basic rule is: as short as necessary and as low as possible. A typical guideline is approximately 3–5 years , depending on symptoms and personal risk (7).
With continuous use, it is recommended to regularly review the therapy (e.g. annually) together with the doctor and to regularly reassess the necessity.
Bioidentical vs. synthetic hormones: What is the difference?
Anyone researching hormone replacement therapy (HRT) will quickly encounter terms like bioidentical or synthetic, raising the question of where these hormones actually come from and what the difference is. This is important because not all available hormone preparations are regulated, tested, or scientifically evaluated in the same way. Examining the sources of supply helps to better assess the benefits and potential risks and to make informed decisions for one's own health.
Bioidentical hormones
These hormones have exactly the same chemical structure as the body's own hormones (e.g., estradiol or progesterone). They are industrially produced, mostly from plant-based raw materials, and are now the standard hormones in approved hormone therapies.
Synthetic hormones
These hormones are chemically modified and differ in structure from the body's own hormones (e.g., certain progestins). As a result, they can have different effects and also different side effects than bioidentical hormones.
Important: "Bioidentical" does not automatically mean "risk-free." Dosage, method of administration, and scientific testing are crucial. Approved, tested hormone preparations from the pharmacy offer significantly more safety than individually compounded prescriptions without long-term data.
Benefits and risks of hormone replacement therapy
Hormone replacement therapy (HRT) can help women in postmenopause with typical symptoms. Studies show that HRT can provide relief under certain conditions, but at the same time, there are risks that depend on age, duration of use, type of hormones, and route of administration.
The following overview roughly summarizes the main aspects based on current scientific findings.
| Potential benefits | Explanation / Study situation |
| Reduction of hot flashes and night sweats | Studies show that estrogen is very effective in relieving hot flashes and night sweats (7). |
| Support for sleep problems | HET is frequently associated with improved sleep quality in studies, especially when hot flashes interfere with sleep (5). |
| Bone metabolism | According to research, HET can influence bone metabolism and accompany age-related bone loss (6). |
| Influence on vascular and metabolic factors | Studies suggest that early initiation of HRT may affect blood vessels and cholesterol levels (6). |
| Potential risks | Explanation / Study situation |
| Blood clots (venous thrombosis) | An increased risk is observed with oral administration; transdermal application shows less evidence of increased thrombosis rates (6). |
| breast cancer | Data suggest an increased risk, but this depends on the type of HRT and the duration of use (6, 7). |
| stroke | Studies show a slightly increased risk, especially with later initiation or oral administration. |
| Gallbladder diseases | Oral administration may slightly increase the risk; transdermal routes show changes less frequently (6). |
Key findings from 2025:
After 20 years, the FDA has removed the blanket "black box" warnings for HRT products, with the exception of the risk of uterine cancer associated with estrogen-only therapy. This is because a growing body of scientific analysis shows that for women who begin HRT early in menopause (within 10 years or before age 60), the health benefits significantly outweigh the risks.
This is important because many women have previously refrained from treatment out of fear of risks, often based on outdated or distorted data. With the new recommendations, women can work with their doctor to weigh the individual benefits and potential risks and make an informed decision (8).
*FDA - Food and Drug Administration is a US government agency responsible for the approval and safety of drugs and other health products.
If HRT is not an option – alternatives that can provide support
Not every woman can or wants to use hormone replacement therapy, whether for health reasons, personal preferences, or after weighing the risks. Nowadays, there are natural approaches that work in different ways and can support health during menopause.
In addition to dietary adjustments and physical activity , herbal options such as soy isoflavones, black cohosh, shatavari, or red clover can be beneficial. They show potential to alleviate hot flashes or improve overall well-being. While they do not act directly like HRT, they can have positive effects through other mechanisms, such as mild hormone-like activity or by influencing certain signaling pathways in the body (9-11).
These measures work subtly and can help to alleviate or prevent many typical menopausal symptoms, even if they do not replace the direct effect of HRT.
Conclusion
The typical symptoms after menopause are treatable, and you don't have to simply endure them. Hormone replacement therapy is considered the most effective option for pronounced symptoms, especially when started early and tailored to your individual needs. However, it's not a one-size-fits-all solution, but rather a personal decision that should take into account the benefits, risks, and your specific life circumstances.
Whether it's hormone replacement therapy, supportive measures, or alternatives: the crucial thing is that you make informed decisions and take your symptoms seriously. Talk openly with your doctor about your symptoms and options.
Frequently Asked Questions (FAQ)
-
What is estrogen deficiency during menopause?
Estrogen deficiency describes the natural decline in the hormone estrogen during menopause. It occurs because the ovaries gradually cease their hormone production. -
What symptoms can result from estrogen deficiency?
Typical symptoms include hot flashes, night sweats, sleep disturbances, joint pain, mood swings, concentration problems and vaginal dryness. -
At what point does estrogen deficiency begin?
Estrogen deficiency usually begins in the perimenopause, several years before the last menstrual period, when hormone levels fluctuate greatly. -
Are severe menopausal symptoms normal?
Yes, many women experience symptoms, some of which are quite pronounced. The severity of these symptoms varies greatly from person to person. -
What is hormone replacement therapy (HRT)?
HRT replaces hormones that the body no longer produces sufficiently, usually estrogen and, if a uterus is present, additionally progestogen. -
For whom is hormone replacement therapy appropriate?
It can be useful in cases of severe symptoms that significantly impair quality of life, especially when therapy is started early. -
What are the risks of hormone replacement therapy?
Potential risks depend on factors such as age, duration of therapy, method of application and individual medical history, and should always be discussed with a doctor. -
When is the best time to start HRT?
A favorable benefit-risk ratio is particularly evident when treatment begins before the age of 60 or within 10 years of menopause. -
Are there alternatives to hormone replacement therapy?
This depends on the severity of the symptoms and varies greatly from person to person. There are other measures that can help alleviate symptoms. These include lifestyle changes such as diet, exercise, and stress reduction, as well as herbal remedies that can provide support. -
Does every woman need therapy?
No. Menopause is an individual experience. It's important to take your own symptoms seriously and explore suitable options with medical guidance.
literature
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2. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab 2021; 106(1):1–15. doi: 10.1210/clinem/dgaa764 .
3. Delamater L, Santoro N. Management of the perimenopause. Clin Obstet Gynecol 2018; 61(3):419–32. doi: 10.1097/GRF.0000000000000389 .
4. Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M et al. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients 2023; 16(1). doi: 10.3390/nu16010027 .
5. Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicine (Kaunas) 2019; 55(10). doi: 10.3390/medicina55100668 .
6. Mehta J, Kling JM, Manson JE. Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts. Front Endocrinol (Lausanne) 2021; 12:564781. doi: 10.3389/fendo.2021.564781 .
7. Hill DA, Crider M, Hill SR. Hormone Therapy and Other Treatments for Symptoms of Menopause. Am Fam Physician 2016; 94(11):884–9.
8. US Food and Drug Administration. HHS Advances Women's Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy: FDA; 2025 [as of January 8, 2026]. Available at: https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy.
9. Hedaoo K, Badge AK, Tiwade YR, Bankar NJ, Mishra VH. Exploring the Efficacy and Safety of Black Cohosh (Cimicifuga racemosa) in Menopausal Symptom Management. J Midlife Health 2024; 15(1):5–11. doi: 10.4103/jmh.jmh_242_23 .
10. Pingali U, Nutalapati C, Wang Y. Ashwagandha and Shatavari Extracts Dose-Dependently Reduce Menopause Symptoms, Vascular Dysfunction, and Bone Resorption in Postmenopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study. J Menopausal Med 2025; 31(1):21–34. doi: 10.6118/jmm.24025 .
11. Chen LR, Ko NY, Chen KH. Isoflavone Supplements for Menopausal Women: A Systematic Review. Nutrients 2019; 11(11). doi: 10.3390/nu11112649