Ideally, these women can begin HRT when the FSH level exceeds 30 as measured on day 6 of the pill-free week. There's less bleeding or none at all when progesterone is used daily. It's unnecessary for women without a uterus to take progesterone, because the risk of endometrial cancer is no longer an issue. While the HRT regimen recommended by ACOG is the one most commonly used, there are many available products and dosages. Estrogen can be delivered in tablets, patches, vaginal rings, injections, and creams.
Progesterone comes in tablets, vaginal gels, and an intrauterine device.
Although 60 million prescriptions are written for estrogen products annually, less than half are filled. 13 Of those who start HRT, less than 40 percent continue after the first year. 14 Taking estrogen makes sense for relief of perimenopausal symptoms for many women. But for others, long-term use of estrogen seems unwarranted when its benefits of reducing the risk of heart disease and osteoporosis may not be seen for years after menopause. These activate estrogen receptors in bones and the cardiovascular system but not in the uterus or breast.