A Reframe That Will Help Us All
Menopausal Hormone Therapy (MHT) for Perimenopause & Menopause
For too long, women have been left to navigate hormonal changes with incomplete information, conflicting advice, and care that often overlooks their lived experience.
At Ember, we believe hormone therapy should be personalized, evidence-based, and designed around the realities of a woman’s changing physiology. Our approach combines expert clinical guidance with comprehensive hormone care to help women feel strong, supported, and like themselves again.
HORMONES
Why We Use MHT
Hormone therapy has become increasingly confusing for women trying to navigate midlife health.
Many women in their 30's and 40's identify with perimenopause, but "menopause"? That can feel distant, irrelevant, or like a word meant for someone older.
For women in their 50's and beyond, menopause may feel like something long behind you, which can make it seem you are not included in the conversation about hormonal therapy.
The real problem is that we’ve been given a terrible definition of menopause. Right now, it’s described as the day it’s been one full year since your last period. A single day. As if this life‑altering transition can be reduced to a date on a calendar.
But menopause isn’t a day, it’s a process. It’s ovarian aging, hormonal depletion, and a biological shift that unfolds over years, sometimes decades. And therefore, my dear sisters, we are connected by the word “menopause” far longer, and far earlier, than we’ve ever been taught to realize.
And this is why, at Ember, we use the term Menopause Hormone Therapy (MHT).
Because MHT is for all of us, no matter where we are in the transition.
Hormone therapy is not new.
Understanding The Past
In fact, physicians have been successfully using estrogen, progesterone, and testosterone to treat peri- and postmenopausal symptoms for nearly a century.
The modern hesitation around hormone therapy largely stems from the 2002 Women's Health Initiative (WHI) study. The preliminary findings suggested increased risks associated with hormone use, and the resulting media coverage dramatically changed public perception.
Almost overnight, hormone therapy prescriptions declined, and many women were left without access to treatments that had previously helped them feel better.
Years later, additional analysis revealed a far more nuanced picture. Researchers found important limitations in the original interpretation and highlighted significant differences between older synthetic hormone formulations and many of the therapies used today.
Unfortunately, the fear remained.
The result was a generation of women who were taught to distrust hormone therapy while simultaneously receiving little education about what menopause actually does to the body.
Where We Are Today
Today, the conversation is finally changing.
Women are talking openly about menopause. Books are becoming bestsellers. Social media has amplified voices advocating for better education and better care. Providers are becoming more engaged in the conversation than ever before.
This progress matters.
But access to information has also created a new challenge: information overload.
Women are often left sorting through conflicting opinions, contradictory advice, and countless treatment recommendations without the guidance needed to make sense of it all.
Hormone therapy is rarely as simple as a single prescription.
Doses change. Delivery methods change. Symptoms evolve. What works beautifully today may need adjustment six months from now.
This is why individualized care remains so important.
Women deserve more than information.
They deserve partnership, expertise, and ongoing support.
Cardiovascular & Circulatory Changes:
-Heart palpitations
-Increased resting heart rate
-Blood pressure changes
-Cholesterol changes
-Increased inflammation
Immune & Inflammatory Symptoms:
-Increased inflammation
-Autoimmune flares
-Increased or new allergies/sensitivities
-Heightened histamine response
Cognitive & Neurological Symptoms:
-Brain fog
-Word-finding difficulty
-Memory lapses
-Trouble concentrating
-Slowed processing
-Migraines or worsening headaches
-Sensory sensitivity (light, sound)
Metabolic & Weight Changes:
-Weight gain (especially abdominal)
-Insulin resistance
-Slowed metabolism
-Difficulty losing weight
-Changes in body composition
-Increased carb cravings
Energy & Vitality Changes:
-Fatigue
-Afternoon crashes
-Decreased stamina
-Loss of motivation
-Feeling "flat" or depleted
Mood & Mind
Symptoms:
-Anxiety
-Irritability
-Depression or low mood
-Feelings of rage
-Loss of resilience
-Emotional volatility
Gut Symptoms:
-Bloating
-Constipation/motility issues
-New food sensitivities
-IBS-like symptoms
Musculoskeletal Symptoms:
-Joint pain
-Muscle Aches
-Stiffness
-Loss of muscle mass
-Ostopenia
-Osteoporosis
Sexual & Genitourinary Symptoms:
-Vaginal dryness
-Pain with intercourse
-Decreased libido
-Decreased arousal
-Decreased orgasm intensity
-Urinary urgency
-Recurrent UTIs
-Pelvic floor changes
Skin, Hair & Tissue Changes:
-Dry skin
-Thinning skin
-Hair shedding
-Hair texture changes
-Brittle nails
-Loss of collagen
-Slower wound healing
Sleep Disturbances:
-Difficulty falling asleep
-Difficulty staying asleep
-Waking up in the middle of the night
-Non-restorative sleep
-Increased nightime anxiety
Vasomotor Symptoms:
-Hot Flashes
-Night Sweats
-Temperature Dysregulation
What Every Woman needs to hear
VALIDATION
SYMPTOMS
It's not just hot flashes. Nor does the absence of hot flashes mean treatment is not warranted. So much, we have never been told.
Here is a longer list of peri/menopausal symptoms broken up into categories. Many you may be familiar with; some may surprise you.
Which can you relate to?
What you are experiencing is real, and you deserve to feel better. Gone are the days of suffering needlessly. Years of experience has taught us this, if a woman says "I think it's my hormones", it is her hormones. Treat her.
Just as importantly, what is true for your experience may be different for your friends. Or what worked for you at one point, may no longer work for you now. This does not mean your story, or your friends, is any less valid. This simply highlights that while we are experiencing a common journey, your unique symptoms and treatment response may be entirely different. That is normal, and that is the job of your provider to navigate wisely with you.
LET'S FOCUS ON YOU
What Does Each Hormone Do And
How Could It Help Me?
At Ember, we take a functional-health approach, considering the whole woman-includina hormones like thyroid. insulin. and cortisol. But wher we talk about MHT specifically, we're focusing on three key hormones: estrogen. progesterone. and testosterone.
Understanding these hormones empowers you to become an active participant in your care, ask better questions, and make intormed decisions alongside your provider.
THE MASTER COMMUNICATOR
ESTROGEN
Estrogen is the best known "female" hormone, but in reality, women produce far smaller absolute amounts of estrogen than progesterone or testosterone. What makes estrogen so influential is not its quantity, but its reach: virtually every tissue in the female body contains estrogen receptors.
Estrogen receptors are found in the:
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brain
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gut
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bones
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cardiovascular system
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skin
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pelvic floor
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reproductive organs
Because of this widespread receptor presence, estrogen has a profound impact on how the body functions day to day.
Estrogen doesn’t just act on its own receptors, it also modulates how other receptors and neurotransmitters behave as a powerful neuromodulator. This is why estrogen plays a major role in:
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sleep regulation
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mood stability
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cognitive clarity
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sexual function
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pain perception
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autonomic balance
When estrogen declines, these systems lose a key stabilizer.
Ember believes estrogen therapy is preventative medicine.
These specific symptom patterns suggest estrogen depravation:
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waking in the middle of the night (especially 2–4 a.m.)
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inability to orgasm or reduced sexual sensation
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frozen shoulder
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diffuse body achiness or new musculoskeletal pain
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heightened anxiety or a sense of internal “revving”
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hitting a sudden “wall” where something feels profoundly off
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hot flashes and night sweats
These symptoms are not random they are classic manifestations of estrogen deprivation affecting the brain, connective tissue, and autonomic nervous system, and often can hit hard with sudden impact.
Estrogen therapy is available in transdermal applications, oral, and injectable.
THE HORMONE OF CALM
PROGESTERONE
Progesterone is often the first hormone to decline in early perimenopause, long before estrogen changes become obvious. Because of this early drop, many women experience progesterone‑related symptoms years before they recognize they are in the menopausal transition.
Progesterone plays a central role in neuromodulation, acting directly on GABA receptors, the brain’s primary calming system. This is why progesterone is so closely tied to:
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sleep quality
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ease and emotional steadiness
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anxiety regulation
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premenstrual mood stability
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overall sense of internal “calm”
When progesterone falls, these systems lose one of their key stabilizers.
Previously progesterone was only used for uterine protection, but modern research shows that progesterone has neuroprotective, metabolic, and systemic benefits that extend far beyond the uterus. For this reason, progesterone should be considered a core component of comprehensive menopausal hormone therapy for most women, not simply an add‑on for endometrial protection.
Progesterone contributes to:
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sleep architecture (especially sleep initiation and maintenance)
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mood regulation and emotional resilience
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bone formation, through direct stimulation of osteoblasts
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autonomic balance, reducing the “wired‑but‑tired” feeling
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counterbalancing estrogen, maintaining a healthy hormonal ratio
This estrogen‑progesterone ratio is delicate. When progesterone drops disproportionately, women often feel it immediately, even if estrogen remains normal.
A trained clinician recognizes the characteristic pattern of progesterone deficiency, which may include:
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difficulty falling asleep or staying asleep
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increased anxiety or internal restlessness
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mood swings or emotional volatility
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worsening PMS, sometimes progressing to PMDD‑like symptoms
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heightened sensitivity to stress
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early perimenopausal “instability” despite normal estrogen levels
These symptoms often appear years before cycle irregularity.
A subset of women experience progesterone intolerance, often due to genetic variations in progesterone receptor sensitivity or neurosteroid metabolism. These women may feel:
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agitation
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mood worsening
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breast tenderness
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irritability
In these cases, clinicians may adjust the dose, timing, or formulation. Interestingly, both very low and very high doses can sometimes overcome intolerance , a pattern well‑recognized in clinical practice.
Progesterone is most commonly prescribed in oral form, which allows for conversion into calming neurosteroids that support sleep and mood. For women with intolerance or specific clinical needs, vaginal suppositories can be an effective alternative.
the hormone of vıtalıty
TESTOSTERONE
Testosterone is routinely labeled online as “the male hormone,” which is both outdated and misleading. Women produce ten times more testosterone than estrogen and rely on it for essential metabolic, neurological, and sexual functions. As Dr. Abdulmaged Traish, former editor‑in‑chief of the Journal of Andrology, passionately states: “Testosterone is a human hormone.”
Historically, clinicians understood this. As early as the 1930s, testosterone was successfully used to treat peri‑ and menopausal symptoms in women. Progress was being made until the 2002 WHI study halted nearly all hormone research and clinical innovation for two decades. Only recently has the field begun to correct course.
Most people can easily understand why estrogen and progesterone are important for women but testosterone? Dr. Rachel Rubin, urologist and sexual‑health expert, reframed the conversation with a simple observation: Men with low testosterone experience fatigue, body‑composition changes, low libido, brain fog, mood shifts, the exact symptoms her menopausal patients were reporting. This led her to describe menopause as an Androgen Deficiency Syndrome , a state of reduced estrogen and reduced testosterone. This framing restored clinical clarity and opened the door for the appropriate use of testosterone therapy in peri‑ and menopausal care.
Testosterone is the hormone of drive, vitality, and creation. It has a unique, almost intangible quality, as Dr. Kyle Gillett puts it, “Testosterone makes effort feel good.”
Testosterone receptors are found throughout:
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skeletal muscle
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the brain
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the cardiovascular system
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the pelvic floor
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connective tissue
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the vulva and vaginal tissues
Because of this, testosterone influences:
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muscle mass and strength
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motivation and energy
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sexual desire
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arousal, and orgasmic function
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vaginal lubrication and tissue integrity
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neurological clarity and cognitive stamina
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body composition
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and metabolic health
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It is not a “bonus” hormone, it is foundational.
A trained clinician recognizes the characteristic pattern of low testosterone in women.
Common symptoms include:
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extreme fatigue or loss of stamina
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reduced libido or loss of sexual interest
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difficulty achieving orgasm
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depressed or flat mood
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loss of muscle tone or strength
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changes in body composition
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sensory disturbances (itching skin, tingling, ringing in the ears)
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aversion to touch or reduced sensory pleasure
These symptoms often coexist with estrogen and progesterone changes, but testosterone deficiency has its own distinct signature.
Women respond exceptionally well to topical testosterone gels and creams, which allow for physiologic dosing and steady absorption. Some women prefer injectables, especially if they have absorption issues or want more predictable pharmacokinetics.
Other Hormone Solutions
You Need to Know About
EMBER SUPPORT
Vaginal Estrogen: Small Dose, Life‑Changing Impact
As hormone levels decline during menopause, vaginal and urinary tissues can become dry, irritated, and more prone to infections. Symptoms may include dryness, discomfort, urinary urgency, burning, incontinence, and recurrent UTIs.
A simple solution exists: low-dose vaginal estradiol cream. Used just twice weekly, it helps restore tissue health, reduce UTIs, improve bladder function, and support long-term wellbeing.
Many experts, including Dr. Rachel Rubin, consider vaginal estrogen a foundational part of menopausal care. At Ember, we agree—because caring for these tissues isn't just about comfort, it's about protecting health and quality of life.
Topical Estrogen for Your Face: A Gentle Boost With Real Benefits
Your skin contains estrogen receptors, which help support collagen production, repair, hydration, and overall skin health. As estrogen declines, many women notice changes in texture, elasticity, and radiance.
In addition to systemic hormone therapy, topical estriol creams can provide targeted support for the skin. These formulations are designed to improve texture, luminosity, and resilience, helping skin appear smoother, healthier, and more vibrant.
Available through our compounding pharmacy, this option offers a safe, evidence-informed way to support skin health as part of your overall wellness journey.
FAQ
Hormone therapy replaces the estrogen, progesterone, and testosterone your body stops producing during menopause. It's used to relieve hot flashes, night sweats, vaginal dryness, and other symptoms, and it comes in several forms including patches, pills, creams, and injectables.
Common signs include hot flashes, night sweats, irregular or missed periods, trouble sleeping, mood swings, vaginal dryness, low libido, and brain fog. If these symptoms are affecting your daily life, it's worth discussing hormone therapy with a provider.
The most common side effects are breast tenderness, bloating, headaches, and irregular spotting, especially in the first few months. These usually settle down as your body adjusts, and a provider can change the dose or delivery method if they don't.
Hormone therapy isn't a weight loss treatment on its own, but it can improve insulin sensitivity, sleep, and energy, which makes it easier to manage weight during menopause. It's often combined with nutrition, strength training, or GLP-1 medications for better results.
Risk depends on the type of hormone therapy, how long it's used, and individual health history. Combined estrogen and progesterone therapy carries a small increase in breast cancer risk with longer use, while estrogen-only therapy for women without a uterus does not show the same increase. Most healthcare organizations, including ACOG, agree the benefits outweigh the risks for healthy women who start within ten years of menopause.
There's no universal stop date. Many women stay on hormone therapy for three to five years, but some continue longer if symptoms persist or if it's helping protect bone density, as long as it's reviewed regularly with a provider.