By Dr. Greg Costello, MD | The Wellness at Ridgewood
Somewhere in your 40s or early 50s, things start to shift in ways that are hard to name at first. Sleep becomes unreliable. Moods feel less predictable. Energy that used to be there in the morning simply isn’t. Many women spend months attributing these changes to stress, a busy schedule, or just getting older, when the real driver is often hormonal.
Perimenopause and menopause produce measurable changes in estrogen and progesterone that affect nearly every system in the body. The experience varies widely from one woman to the next, but for those dealing with significant symptoms, Hormone Replacement Therapy is often the most effective treatment available and, in many cases, one of the most underused.
This article covers what HRT is, what it can address, what the current research actually shows, and what to expect if you come in for a consultation.
What is HRT?
Hormone Replacement Therapy restores hormones the body is no longer producing in sufficient amounts. For women going through perimenopause or menopause, that primarily means estrogen, progesterone, or both.
The two main types are estrogen-only HRT, which is typically prescribed for women who have had a hysterectomy, and combined HRT, which pairs estrogen with progesterone to protect the uterine lining in women who still have their uterus.
Beyond type, there’s the question of hormone source. Synthetic hormones are lab-created compounds designed to mimic the body’s natural hormones. Bioidentical hormones are chemically identical to what your body produces. Many providers and patients prefer bioidentical HRT for this reason, and the evidence base supporting it continues to grow. Both approaches have a strong track record, and the right choice depends on the individual patient.
At The Wellness at Ridgewood, we work with each patient to determine which approach fits their symptom picture, health history, and personal goals.
What HRT can help with
Estrogen influences far more than reproduction. When levels fall during menopause, the effects show up across multiple systems, which is why the symptom list can feel so wide-ranging and disorienting.
Hot flashes and night sweats are the most frequently reported symptoms of menopause, and HRT is the most effective treatment available for them. Research consistently shows meaningful reductions in both frequency and intensity for women who use it.
Sleep disruption is closely tied to night sweats but is also a direct result of hormonal changes affecting sleep architecture. Many women find themselves waking repeatedly throughout the night. HRT addresses the underlying hormonal driver rather than just the symptom itself.
Mood changes and anxiety during perimenopause are often hormonal in origin. Fluctuating estrogen affects serotonin and dopamine, the neurotransmitters that regulate mood and emotional stability. A significant number of women going through this transition are initially treated for depression when the root cause is actually hormonal.
Brain fog, described by patients as difficulty concentrating, forgetfulness, or mental fatigue, is closely linked to declining estrogen levels. Restoring those levels often produces noticeable improvement in cognitive clarity.
Decreased libido is common during and after menopause. HRT, sometimes supplemented with testosterone depending on the patient, can help restore sexual interest and function.
Vaginal dryness and recurring urinary symptoms are direct results of estrogen loss causing vaginal tissue to thin. Both localized and systemic HRT can address this effectively.
Bone density loss is the most medically serious consequence on this list. Estrogen plays a central role in maintaining bone mass, and its decline significantly accelerates bone loss, raising long-term risk for osteoporosis and fractures.
What the research actually shows
The 2002 Women’s Health Initiative study cast a long shadow over HRT, and its influence is still felt today. The study linked HRT to increased risks of breast cancer and heart disease, and the resulting media coverage caused millions of women to stop treatment almost overnight.
What the headlines failed to communicate was that the study used a specific synthetic hormone formulation, administered it to women with an average age of 63 (well past the typical onset of menopause), and did not account for pre-existing cardiovascular conditions. The findings were real within that study population, but applying them broadly to all women considering HRT misrepresented what the data actually showed.
Subsequent research has provided a substantially more complete picture. A 2019 analysis published in The Lancet examined data from across the globe and found that while some breast cancer risk exists with certain formulations, the magnitude and context had been misrepresented in prior coverage. Separately, the North American Menopause Society has updated its position statements to reflect the current understanding of HRT’s benefits and risks.
On symptom relief, HRT remains the most effective treatment for hot flashes, night sweats, and vaginal atrophy. That finding has held consistently across decades of research.
On bone health, women who begin HRT around the time of menopause maintain significantly higher bone density than those who do not, making it one of the most effective tools for osteoporosis prevention.
On cardiovascular health, the ELITE trial, published in the New England Journal of Medicine in 2016, found that estrogen therapy started within six years of menopause onset slowed the progression of atherosclerosis compared to later initiation. Researchers now refer to this as the “timing hypothesis” or “window of opportunity,” and it represents a meaningful shift from how HRT and heart health were understood after 2002.
On cognitive health, the research is still developing, but early menopause and sustained low estrogen have been linked to increased Alzheimer’s risk in multiple studies. There is growing evidence that estrogen-based HRT initiated early may have a protective effect on cognitive function over time.
Whether HRT is right for you
HRT is not appropriate for every patient, which is exactly why a thorough medical evaluation is the right starting point before beginning any hormone therapy.
Women who tend to be strong candidates are experiencing moderate to severe menopause symptoms, are under 60 or within 10 years of menopause onset, and have no personal history of hormone receptor-positive breast cancer, blood clots, or stroke.
Women with certain cancer histories, uncontrolled hypertension, or specific cardiovascular conditions may not be candidates for systemic HRT. In some situations, localized estrogen therapy remains appropriate even when systemic treatment is not.
There is no formula that applies universally. A full health history, a clinical conversation with a qualified provider, and in most cases lab work are all part of arriving at the right answer for your specific situation.
How we approach this at The Wellness at Ridgewood
Dr. Greg Costello, MD brings over 25 years of experience in aesthetic and wellness medicine to his practice and serves as a Clinical Educator for the American Board of Aesthetic Medicine. His approach to hormone health is detailed and individualized.
At your initial consultation, we review your full symptom picture and health history, order lab work to assess your current hormone levels, and have a direct conversation about your options, including HRT type, delivery method, dosing, and what you can realistically expect from treatment.
If HRT is appropriate, your protocol is built around your specific hormone profile and adjusted over time based on how you respond. The clinical goal is the lowest effective dose that produces meaningful, sustained relief.
Managing menopause symptoms is not optional maintenance. It is a legitimate and often underaddressed part of long-term health.
Common questions
How long before I notice a difference? Most patients see improvement in hot flashes and sleep within a few weeks. Mood, cognitive clarity, and libido often take closer to 6 to 12 weeks to respond.
How long will I need to stay on it? There is no single answer that fits everyone. Some women use HRT for 2 to 5 years during the most intense phase of the transition. Others continue longer under regular monitoring. This is something to revisit with your provider at each follow-up appointment.
What is the difference between bioidentical and synthetic hormones? Bioidentical hormones are structurally identical to the hormones your body produces naturally. Many providers and patients prefer them for this reason, and the supporting evidence base continues to develop. We walk through the specifics at every consultation so that patients can make an informed choice.
Book a consultation
If you have been navigating menopause symptoms and want to understand whether HRT might be the right approach for you, a consultation is the most productive place to start.
The Wellness at Ridgewood offers personalized wellness consultations for women going through perimenopause and menopause. Dr. Costello and the team will take the time to understand your full clinical picture before making any recommendations.
Call 201-857-4444 or book online at thewellnessatridgewood.com.
We see patients in Ridgewood, NJ and throughout Bergen County, including Paramus, Glen Rock, Wyckoff, Fair Lawn, and Ho-Ho-Kus.
The Wellness at Ridgewood | 60 W Ridgewood Ave (Ground Floor), Ridgewood, NJ 07450