Hormone Therapy Cheat Sheet: Estrogen, Progesterone and Testosterone Explained

Hormone therapy can get confusing fast. Estrogen, progesterone, testosterone, creams, patches, pellets, lozenge, injections, vaginal estrogen, lab levels, perimenopause, menopause. Lions and tigers and bears, oh my!

Fortunately, hormone therapy does not have to be complicated.

The right treatment depends on which hormones are changing, what symptoms you are experiencing, your medical history, and what you actually want to improve.

Here is the Flow Wellness hormone therapy cheat sheet.

Estrogen

Think: hot flashes, sleep, mood, brain fog, vaginal health, and bones

Estrogen levels begin fluctuating during perimenopause, which is the transition leading up to menopause and can last for several years. Eventually, estrogen levels plummet after menopause.

As estrogen changes, you may notice:

• Hot flashes and night sweats
• Sleep disruption
• Brain fog
• Mood changes
• Vaginal dryness
• Pain with sex
• Urinary symptoms
• Changes in skin and hair
• Bone loss

At Flow Wellness, we have several ways to replace estrogen, including patches, gels, creams, and pellets, and we’ll help you choose the option and dose that best fits your symptoms, health history, and lifestyle.

For many women who need whole-body estrogen therapy, transdermal estrogen, which is absorbed through the skin using a patch or cream, is a common choice. It provides steady hormone delivery without first passing through the liver.

Quick cheat: If hot flashes, night sweats, or other whole-body menopause symptoms are the problem, think systemic estrogen. In contrast, if your symptoms are primarily vaginal or urinary, local vaginal estrogen may be all you need.

Progesterone

Think: uterus protection + better sleep

If you have a uterus and use systemic estrogen, progesterone becomes part of the conversation too.

Most importantly, progesterone helps protect the uterine lining from becoming too thick when you take estrogen.

Many women take micronized progesterone orally at bedtime. In addition, most women find that it helps with sleep, too.

Possible side effects include:

• Sleepiness
• Dizziness
• Bloating
• Breast tenderness
• Mood changes

However, there is not one progesterone schedule that works for everyone. Your provider may adjust the dose or schedule depending on whether you still have periods, where you are in the menopause transition, and how you use estrogen.

Quick cheat: Estrogen + uterus means you need to talk about progesterone too.

Testosterone

Think: libido, sexual function, and overall wellbeing

Women make testosterone too.

Testosterone levels generally peak in a woman’s 20s and gradually decline with age, often dropping significantly by midlife. Along the way, some women notice changes in sexual desire, arousal, or sexual function.

Testosterone can be prescribed as a cream, gel, pellet, lozenge, or injection.

Still, more testosterone is not necessarily better. Too much can cause:

• Acne
• Oily skin
• Increased facial or body hair
• Scalp hair thinning
• Voice changes
• Clitoral enlargement

Importantly, some of these changes can become permanent. Therefore, thoughtful dosing and monitoring matter.

Quick cheat: Low energy + low libido? Let’s talk about low-dose testosterone.

Vaginal Estrogen

Think: vaginal dryness, painful sex, urinary urgency or frequency, and recurrent UTIs

Vaginal estrogen deserves its own category because it works differently from systemic estrogen therapy. It acts primarily right where you put it, with very little absorbed into the bloodstream. Think healthier, more youthful vaginal tissue with better moisture, elasticity, comfort, and even urinary health. Therefore, some women who do not need systemic hormone therapy may still benefit from local treatment.

As a result, it can be especially helpful for:

• Vaginal dryness
• Burning or irritation
• Pain with sex
• Tissue thinning
• Some urinary symptoms
• Recurrent urinary tract infections in appropriate patients

Vaginal estrogen is available most often as a cream with a special applicator.

Quick cheat: Vaginal estrogen works locally, right where you need it.

Estrogen Patch vs. Cream vs. Pellet

There is no universally “best” way to take hormones. Instead, the best option depends on your symptoms, preferences, medical history, lifestyle, cost, and how much dosing flexibility you want.

Patches: Convenient, consistent, easy to adjust, and commonly used for systemic estrogen. Prescriptions can be filled at a regular retail pharmacy.

Creams and gels: Offer flexible dosing and can work well when a topical approach makes sense. However, consistent application matters. Typically ordered patient-specific from compounding pharmacies.

Pellets: Placed just under the skin during a brief office procedure, pellets slowly release hormones and typically last about 3–4 months. They are convenient because there is nothing to remember day to day, although the dose cannot easily be changed once the pellet is placed.

Ultimately, the delivery method matters less than finding a safe, effective treatment that fits your needs.

What About Bioidentical Hormones?

The word “bioidentical” gets used a lot in hormone therapy.

Simply put, a bioidentical hormone has the same molecular structure as the hormone your body naturally produces.

For example, FDA-approved estradiol and micronized progesterone are bioidentical hormones.

Compounded hormone preparations can also contain bioidentical hormones. However, bioidentical and compounded do not mean the same thing.

Compounded medications may be useful when you need a dose, combination, or formulation that is not commercially available. However, compounded medications do not go through the same FDA approval process as commercially manufactured prescription drugs. Therefore, your provider should discuss the benefits, limitations, and potential risks with you.

Do You Need Hormone Testing?

Sometimes. However, we do not make hormone treatment decisions based on a lab number alone.

This is especially important during perimenopause, when estrogen and progesterone can fluctuate dramatically from one day or week to another.

As a result, a hormone level that looks “normal” does not automatically mean your symptoms are unrelated to hormonal changes.

Instead, your provider should look at the whole picture, including:

• Your symptoms
• Menstrual history
• Age and menopause stage
• Medical history
• Family history
• Medications
• Treatment goals
• Relevant laboratory testing

For testosterone therapy, lab monitoring becomes particularly important because it helps your provider avoid excessive levels.

Quick cheat: We treat the person, not just the hormone panel.

Perimenopause vs. Menopause

Perimenopause is the transition leading up to menopause. During this time, hormones can fluctuate significantly, and periods may become irregular.

In fact, symptoms can begin years before your final period.

Menopause, on the other hand, is reached after 12 consecutive months without a menstrual period when there is no other explanation.

Most importantly, you do not necessarily have to wait until menopause to discuss treatment. If symptoms are affecting your sleep, sexual health, mood, or quality of life, it may be worth talking with a provider.

Is Hormone Therapy Safe?

For many appropriately selected women, hormone therapy can be a reasonable and effective treatment for bothersome symptoms of perimenopause and menopause.

However, hormone therapy is still medication. Every medication has potential benefits and risks.

Your individual risk depends on factors such as:

• Age
• Time since menopause
• Personal and family medical history
• Type of hormone
• Dose
• Route of administration
• Whether you have a uterus
• History of blood clots, cardiovascular disease, certain cancers, or other medical conditions

Therefore, hormone therapy should be individualized rather than treated like a one-size-fits-all anti-aging prescription.

Your Hormone Therapy Cheat Sheet

Hormone Therapy Should Make Sense for Your Life

Ultimately, the goal is not to get every hormone to a magical “optimal” number.

Instead, the goal is to understand what has changed, what is bothering you, what is worth treating, and how to get the benefit you want without taking more medication than you need.

At Flow Wellness, we take a personalized approach to hormone therapy. We look at your symptoms, health history, labs when appropriate, lifestyle, sexual health, body composition, and long-term health goals. Then, we use that information to build a treatment plan that actually makes sense for you.

Because feeling different does not mean you have to shrug your shoulders and assume it is “just hormones” or “just aging.”