Post Menopause Hormone Therapy Types

One of the questions most often asked in the clinic by those considering female hormone therapy after menopause is "do I really have to take a pill?" To say the conclusion first, hormone therapy has several branches besides oral pills—patches you apply, gels you rub on, vaginal formulations, and so on—and even with the same estrogen, the absorption, metabolism, and burden the body bears differ depending on which route it enters the body. Rather than the side effects of menopausal hormone therapy themselves, this article focuses on comparing and organizing what types and formulations there are and how the methods of administration are divided. It is good to also keep in mind that whether to treat and the specific choice of agent come after an individualized diagnosis through history-taking and examination.

At the foundation of most symptoms appearing after menopause and of osteoporosis lies a deficiency of female hormones, and among them estrogen. As ovarian function declines and estrogen secretion decreases, a wide range of changes follow, from vasomotor symptoms such as hot flashes, sweating, and sleep disturbance to vaginal dryness and decreased bone density. So it is reported that supplementing the now-deficient hormone helps in the prevention and relief of menopausal symptoms and related chronic diseases.

However, hormone therapy is not a prescription recommended identically to everyone. The Korean Society of Menopause and the North American Menopause Society (NAMS) recommend evaluating the type and severity of symptoms, whether one is in the menopausal transition, and cardiovascular and thrombotic risk factors together before starting menopausal hormone therapy (NAMS, 2022). In the clinic, even within the same word "menopause," the symptoms and risk factors each person complains of vary, so this evaluation becomes the starting point for choosing the formulation and route. For more detailed content on the starting point and examinations, you may refer to the article organizing in what cases hormone therapy is needed.

The first criterion dividing the broad branches of hormone therapy is the presence or absence of a uterus. If only estrogen is supplemented alone, in women who have a uterus the risk of endometrial hyperplasia, in which the endometrium thickens, and further of endometrial cancer, can rise. So when there is a uterus, combined therapy that administers progestogen (luteal hormone) together is used to protect the endometrium.

Conversely, women without a uterus, who have had a hysterectomy, benefit from estrogen-only therapy. However, even without a uterus, if there is a history of pelvic endometriosis surgery, surgery for endometrioid lesions of the ovary, a remnant left at the time of hysterectomy, or surgery for endometrial adenocarcinoma, progestogen combination may be needed, so individual judgment is important.

Among progestogens, micronized progesterone and the dydrogesterone series are reported to have endometrial-protective effects, and the society presents the combination of transdermal estrogen and these agents as a relatively unproblematic option (NAMS, 2022). What examinations are needed before hormone therapy can be further reviewed in the article organizing the tests to undergo before hormone therapy.

The most common and familiar method is oral administration in pill form. The hormone swallowed by mouth is absorbed in the stomach and intestines and then metabolized as it passes through the liver, a process commonly called first-pass hepatic metabolism. Because part of the component is altered while passing through the liver once, even at the same dose, the effect that actually acts on the body can differ.

Oral preparations have the advantage of being simple to take and diverse in type. The oral preparations used domestically also have several branches—solo and combined, cyclic and continuous—so they can be chosen to match symptoms and menopausal timing. However, due to the nature of the route passing through the liver, careful choice is needed when there are thrombosis-related risk factors. NAMS recommends prioritizing low-dose transdermal formulations in situations where there is concern about the risk of venous thromboembolism or stroke, in women long past menopause, and when risk factors such as diabetes and hypertension are accompanying (NAMS, 2022). Which agent is right must, in the end, be tailored individually through consultation.

Transdermal administration is a method of absorbing hormone through the skin in the form of a patch or gel. The biggest difference from oral preparations is that it enters the bloodstream directly from the skin and does not undergo first-pass hepatic metabolism. Because it bypasses the liver, it can act at a lower dose than a pill, and it is known to place a relatively smaller burden on the liver.

The difference in route also shows in the risk profile. In observational studies, transdermal formulations are reported to have lower risks of venous thromboembolism and stroke than oral, and there are reports that gallstone risk is also observed to be lower (NAMS, 2022). The Korean Society of Menopause likewise summarizes that, in high thrombosis-risk groups or those with a history of venous thromboembolism, transdermal agents may be considered instead of oral. Also, transdermal estrogen has little effect on sex hormone-binding globulin, so it is sometimes preferred when reduced sexual function or vitality is also a concern.

If the characteristics of transdermal formulations are briefly summarized, they are as follows.

• Because it does not undergo first-pass hepatic metabolism, it can act at a lower dose than a pill.
• In observational studies, it is reported to have lower thrombosis and stroke risks than oral.
• Depending on the formulation, it is applied 1 to 2 times a week or daily, and skin irritation or allergy may occur.

In exchange for a smaller systemic burden, caution about skin irritation is needed, so management such as rotating the application site is recommended. If you are hesitant about hormone therapy, first check your symptoms and risk factors through a chat consultation.

If genitourinary symptoms such as vaginal dryness, painful intercourse, and frequent bladder irritation are the main discomfort, a local formulation used directly in the vagina becomes an option. Vaginal cream and vaginal suppositories are reported to be effective for atrophic vaginitis and post-menopausal genitourinary syndrome (GSM) symptoms, and because systemic absorption is small, the systemic action is on the slight side.

Another characteristic of local low-dose vaginal estrogen is that, when used targeting only genitourinary symptoms, a separate progestogen combination is generally not needed even if there is a uterus (NAMS, 2022). This is because, unlike systemic therapy, its effect on the endometrium is small, but with long-term use, periodic checks are recommended. The safe use of local estrogen is organized in more detail in the article covering the usage and cautions of local estrogen.

Besides this, injection treatment is sometimes used auxiliarily, with the usage determined according to symptoms and condition. Whatever the route, since the pros and cons clearly differ for each method, one formulation cannot be the correct answer for everyone. For content that also compares non-hormonal and laser treatment of vaginal dryness itself, referring to the article comparing vaginal dryness treatment methods is helpful.

In clinical experience, even within the same word "hormone therapy," drawing the differences by route as a picture lets patients understand their own situation much faster. The table below organizes the characteristics of representative routes of administration in broad strokes. The specific agent and dose are determined individually through consultation.

As the table shows, route selection is not simply a matter of convenience but a medical judgment that weighs the type of symptoms and risk factors together. If you want to look at it together with overall menopausal changes, the article organizing menopausal body changes and symptoms/causes is also worth referring to.

Monotherapy using only estrogen is, as said earlier, suitable for women who have had a hysterectomy. For women who have a uterus, combined therapy adding progestogen to estrogen becomes the basis, and this combined therapy is in turn divided into two branches according to the administration schedule.

Cyclic therapy is a method of administering progestogen only for a certain period within a month, and the society summarizes that administering micronized progesterone sequentially for 12 to 14 days each month has an endometrial-protective effect (NAMS, 2022). This method may be accompanied by bleeding similar to menstruation. By contrast, continuous combined therapy is a method of administering estrogen and progestogen together every day, and is commonly used for those long past menopause as a form maintained without bleeding.

Which schedule to choose differs depending on the time elapsed after menopause, preference regarding bleeding, and symptom pattern. The question of when to start hormone therapy and how long to continue it is covered broadly in the article dealing with the start and maintenance timing of hormone therapy.

As we have seen, menopausal hormone therapy is a customized prescription determined by the interlocking of the presence of a uterus, the type of symptoms, risk factors, and the characteristics of the routes of administration—oral, transdermal, local, and injection. Since even the same estrogen differs in absorption and burden depending on which path it enters the body, the key is the process of finding the combination suited to your body and situation, rather than applying one standard answer to everyone.

If you have symptoms and are hesitant about hormone therapy, a consultation through history-taking and examination, rather than self-judgment, is the safest first step. If you are curious about hormone therapy after menopause, feel free to inquire by chat. Through medical care, we will design the type and method suited to you together.

Written by: Lee Dong-hee Director · Obstetrics and Gynecology Specialist · View medical staff profile

First published November 6, 2023 · Last reviewed May 30, 2026

References: North American Menopause Society NAMS Hormone Therapy Position Statement (2022), Korean Society of Menopause Menopausal Hormone Therapy Recommendations (2020)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through a medical visit.