HRT — What Partners Should Know About Hormone Therapy

Hormone replacement therapy (HRT, also called hormone therapy or HT) replaces the estrogen and progesterone that a woman's body produces less of during perimenopause and menopause. It's the most effective treatment for vasomotor symptoms (hot flashes, night sweats), and it also helps with sleep disruption, mood instability, brain fog, vaginal dryness, joint pain, and bone loss.

Your partner might be considering HRT because her symptoms are significantly affecting her quality of life. She may be barely sleeping, struggling to function at work through brain fog, experiencing debilitating hot flashes, or feeling like she's lost herself to mood changes. For many women, HRT gives them their life back.

HRT comes in various forms: patches, gels, pills, sprays, and vaginal preparations. The current gold standard for systemic therapy is transdermal estradiol (a patch or gel) combined with micronized progesterone — this combination has the best safety profile. The choice of formulation, dose, and duration is highly individual and should be made between her and a knowledgeable doctor based on her symptoms, medical history, and preferences.

You're likely thinking of the Women's Health Initiative (WHI) study from 2002, which caused widespread panic about HRT and led millions of women to abruptly stop treatment. The aftermath was one of the biggest public health communication failures in modern medicine. Here's what actually happened and what we know now.

The WHI study found a small increased risk of breast cancer in women taking a specific formulation: oral conjugated equine estrogen (derived from pregnant horse urine) combined with synthetic progestin (medroxyprogesterone acetate). The relative risk increase was about 8 additional breast cancer cases per 10,000 women per year — a risk smaller than that associated with drinking two glasses of wine daily or being obese.

Critically, the WHI studied women with an average age of 63 — many of whom had started HRT more than a decade after menopause. Modern guidelines recommend starting HRT during perimenopause or within 10 years of the final period and before age 60. When initiated in this window, the benefits — cardiovascular protection, bone preservation, symptom relief, and improved quality of life — substantially outweigh the risks for most women.

Today's preferred formulations (transdermal estradiol plus micronized progesterone) have a better safety profile than what was studied in the WHI. Twenty-plus years of follow-up data and subsequent research have dramatically clarified the picture. Every major menopause organization worldwide — NAMS, the British Menopause Society, the International Menopause Society — supports HRT for symptomatic women in the appropriate age window.

If she decides to start HRT, your support during the adjustment period matters. HRT isn't an instant fix — it can take 4-12 weeks to feel the full effects, and she may need dose adjustments along the way. During this period, she might experience some side effects (breast tenderness, spotting, headaches) that are usually temporary.

Practically, you can help by being patient during the adjustment period, tracking changes together if she'd like (is she sleeping better? Are hot flashes less frequent?), and remembering that finding the right formulation and dose is sometimes a process of trial and refinement.

Emotionally, be her sounding board. She may second-guess her decision, especially if she encounters judgment from others. She might worry about the risks, feel frustrated if the first formulation doesn't work perfectly, or feel pressure to explain or justify her choice. Having a partner who says 'I support whatever you decide, and I'll be here either way' is enormously stabilizing.

If HRT works well — and for many women it's transformative — don't make comments like 'you're so much better now' or 'I have my old wife back.' These well-intentioned phrases imply she was broken before, and they can sting. Instead, simply notice and appreciate the positive changes without framing them as a return to 'normal.'

HRT is the most effective treatment for many perimenopause symptoms, but it's not the only option, and the decision is entirely hers. Some women have contraindications (certain breast cancers, blood clotting disorders, liver disease), some are uncomfortable with the idea of hormone therapy, and some prefer to try other approaches first. All of these are valid choices.

Non-hormonal options with evidence include: SSRIs/SNRIs (certain antidepressants that help with hot flashes and mood), gabapentin (for hot flashes and sleep), CBT-i (cognitive behavioral therapy for insomnia), regular aerobic exercise, and lifestyle modifications like reducing alcohol, managing stress, and improving sleep hygiene.

Your role remains the same regardless of her treatment choice: informed support without judgment. If she chooses not to pursue HRT, don't say 'but I read it could really help' every time she has a bad day. If she tries alternatives that seem ineffective, don't say 'I told you, you should have tried HRT.' Trust her to navigate her own medical decisions. Be the partner who makes the journey easier regardless of which path she takes.

Navigating conversations about medical treatment for your partner's body requires genuine emotional intelligence. The key is offering information and support while fully respecting her autonomy. This is about her body, her symptoms, and her risk tolerance — you are a stakeholder in her wellbeing, not a decision-maker about her healthcare.

A good opening might be: 'I've been reading about treatment options for perimenopause because I want to understand what's available. I'm not pushing anything — I just want you to know I'm here if you want to talk through the options.' This communicates investment without pressure.

If she asks your opinion, be honest but humble: 'From what I've read, the evidence for HRT seems strong when it's started at the right time and with the right formulation. But I know you're the one living in your body, and I trust you to make the right call. I'll support whatever you decide.'

Avoid framing the conversation around how her symptoms affect you. Even if her hot flashes wake you up at night or her mood changes are hard on you, the HRT conversation should center her experience. There are other times to discuss how perimenopause is affecting you as a couple — but the treatment decision is hers to own.