Types of HRT: A Complete Guide to Hormone Therapy Options for Women

Walking into the world of hormone replacement therapy for the first time can feel like stepping into a foreign language class. Estrogen-only, combined, bioidentical, synthetic, cyclical, continuous, compounded — the vocabulary alone is overwhelming. But once you understand the core distinctions, the options become much less intimidating.

This guide breaks down every major type of HRT so you can have an informed, empowered conversation with your provider — and understand exactly what you're putting in your body and why. For a broader overview, start with our guide on what HRT is and what it treats.

Estrogen-Only vs. Combined HRT

The first and most fundamental distinction in HRT is whether you're taking estrogen alone or estrogen paired with progesterone (or a progestin).

Estrogen-only HRT is generally prescribed for women who have had a hysterectomy (surgical removal of the uterus). Since they no longer have a uterus lining to protect, progesterone isn't medically necessary in their protocol.

Combined HRT — estrogen plus progesterone — is the standard approach for women who still have their uterus. This is because estrogen alone, taken without progesterone to balance it, stimulates growth of the uterine lining (endometrium) and raises the risk of endometrial cancer. Progesterone counteracts this effect, protecting the uterus and adding its own benefits: better sleep, reduced anxiety, and improved mood. Read more in our full guide to progesterone.

Bioidentical vs. Synthetic Hormones

This distinction has become one of the most important in modern hormone medicine. Bioidentical hormones are chemically identical to the hormones your body naturally produces. Synthetic hormones are structurally different — they may bind to hormone receptors, but they don't behave in exactly the same way your body's own hormones do.

The most important example is progesterone vs. progestins. Micronized progesterone (sold as Prometrium) is bioidentical — it's the same molecule your ovaries make. Medroxyprogesterone acetate (MPA), used in the famous WHI study, is a synthetic progestin. The two have measurably different effects on breast tissue, mood, sleep, and cardiovascular risk. These differences matter clinically, not just philosophically.

Similarly, 17-beta estradiol — the form of estrogen used in most modern HRT — is bioidentical to what your ovaries produce. Conjugated equine estrogens (Premarin), derived from horse urine, are not. For a deeper exploration of this topic, see our complete guide to bioidentical hormones.

The Hormones Available in HRT Protocols

Modern, comprehensive HRT is not limited to estrogen and progesterone alone. A full hormonal protocol may include:

• Estradiol (E2) — The primary estrogen. Addresses hot flashes, sleep, mood, bone density, vaginal health, and cognitive protection.
• Progesterone — Balances estrogen, protects the uterus, promotes sleep, reduces anxiety. Oral micronized progesterone taken at bedtime is the current gold standard for most women.
• Testosterone — Often overlooked in women's care, testosterone supports libido, energy, muscle mass, mood, and cognition. Women produce it too — and lose it during the menopause transition. See our guide to testosterone for women.
• DHEA (dehydroepiandrosterone) — A precursor hormone that converts to both estrogen and testosterone in the body. It supports energy, immune function, bone density, vaginal health, and mood. Learn more in our DHEA benefits guide.

Cyclical vs. Continuous Regimens

For women who still have their uterus and are taking combined HRT, there are two main scheduling approaches:

Cyclical (sequential) HRT involves taking estrogen every day and adding progesterone for part of the month — typically the last 10–14 days. This usually produces a monthly withdrawal bleed and is often recommended for women in perimenopause who are still having irregular periods. It mimics a more natural hormonal rhythm.

Continuous combined HRT involves taking both estrogen and progesterone every day, with no break. This typically results in no monthly bleeding after an initial adjustment period of a few months and is generally preferred for women who are fully postmenopausal. It simplifies the regimen and eliminates the inconvenience of monthly bleeds for women who've already gone through the transition.

The right choice depends on where you are in your hormonal transition, your personal preferences, and your provider's recommendation.

Compounded vs. FDA-Approved HRT

There are two sources for bioidentical hormones: FDA-approved pharmaceutical products and compounded preparations made by specialty pharmacies.

FDA-approved bioidentical options include estradiol patches (Vivelle-Dot, Climara), estradiol gels (Divigel, EstroGel), estradiol sprays (Evamist), and micronized progesterone capsules (Prometrium). These have been through rigorous clinical testing, have standardized dosing, and are covered by most insurance plans.

Compounded hormones are custom-prepared by a compounding pharmacy, typically to achieve a dose or formulation not available in a commercial product. They offer flexibility — for example, a specific dose of injectable estradiol, a combined cream, or a formulation for someone with sensitivities to commercial product fillers. The tradeoff is that compounded products are not FDA-approved and can have more variability in potency and sterility. When used by a knowledgeable provider with appropriate oversight, compounded hormones can be highly effective. Learn more about how delivery methods affect your HRT experience in our guide to injectable vs. cream, pill, and patch HRT.

Finding the Right Protocol for You

No single type of HRT is right for everyone. The best protocol depends on your age, menopausal stage, symptoms, hormone levels, medical history, and personal preferences. A personalized approach — starting with thorough lab work and a detailed symptom review — is essential. A comprehensive protocol that considers all your hormones, not just estrogen, is explored in our guide to combining hormones in HRT.

At LumiVera, we don't believe in one-size-fits-all hormone care. We believe in understanding your body, your biology, and your goals — and crafting a protocol that actually works for you.