Is HRT Right for You? A Clearer Path to Feeling Well in Midlife

I didn’t realize I was fatigued until I wasn’t.

Looking back, my first two signs of perimenopause weren’t the classic hot flashes or cycle changes. They were insulin resistance and a low-grade exhaustion that I had adapted to so well, I didn’t even see it for what it was.

What I did see was that the nutrition strategies I’d used for years to stabilize my blood sugar—clean eating, regular movement, mindful timing—were suddenly less effective. I was gaining weight, losing energy, and wondering why my body no longer responded to the tools that had always worked.

I started estrogen therapy at 43. And within days, it felt like someone had turned the lights back on.

That clarity, that lift in energy and resilience—I hadn’t realized how far I’d drifted from feeling like myself. And I see this all the time in practice: the shifts in energy, stress tolerance, sleep, and cognitive clarity that show up in your forties are often not just “aging” or “stress.” They’re hormonal.

And for many women, the right kind of hormone therapy changes everything.

Understanding Hormone Therapy

Hormone Replacement Therapy (HRT) refers broadly to the use of prescription hormones to address the symptoms of hormonal decline—especially during perimenopause and menopause.

It’s important to understand that HRT can include a wide range of pharmaceutical options: from synthetic progestins and conjugated estrogens to bio-identical formulations that match the hormones your body naturally produces.

At Aurelia, we exclusively use bio-identical hormones—estradiol, progesterone, and sometimes testosterone or DHEA—in forms that your body can actually recognize and utilize effectively. These can be delivered transdermally, orally, by injection, or vaginally, depending on the woman and the goal.

We also tailor how the hormones are given.

For some women, a phasic or physiologic approach (pHRT)—where hormones are delivered in rhythms that mimic the natural cycle—is ideal. For others, a static regimen (same dose daily) may be more appropriate. The point is, there’s no one-size-fits-all approach.

Every prescription we write is based on a woman’s full story, her lab work, her goals, and her preferences. That’s what personalized care should be.

Why HRT Can Be a Game Changer

When used thoughtfully, bio-identical hormone therapy can address the most disruptive symptoms of midlife, including:

• Chronic fatigue

• Night sweats and sleep disturbances

• Mood swings or increased anxiety

• Loss of libido or vaginal dryness

• Brain fog and forgetfulness

• Increased abdominal fat or insulin resistance

Many women tell me, “I just don’t feel like myself anymore.”

And more often than not, it’s not just stress or overwhelm. It’s hormones.

Replacing what your body is no longer producing at optimal levels can restore your clarity, calm, and capacity in ways that feel foundational—because they are.\

Hormones Are Powerful—But Timing Matters

Hormone therapy is one of the most effective interventions we have for supporting women through perimenopause and menopause.

And the evidence is clear: the vast majority of women are candidates for HRT.

Not just some. Not only those with unbearable symptoms. Most women—when appropriately evaluated—are eligible, and benefit greatly.

True medical contraindications are rare. And misconceptions persist. For example, a family history of breast cancer, on its own, is not a contraindication to using HRT.

That said, timing and context matter.

In perimenopause, hormones are declining—but they’re not gone. And while many women benefit from beginning HRT during this window, it’s essential to evaluate the whole picture first. Adrenals, thyroid, detox pathways, blood sugar regulation—these systems shape how hormone therapy is received, and how sustainable the benefits are.

In menopause, where hormones have flatlined, initiating treatment is more straightforward. A transdermal estrogen patch paired with oral micronized progesterone is safe and effective for most women. But here’s the truth: you can get that prescription almost anywhere.

What’s missing from the standard model—and what we insist on—is strategy.

Because while hormones are essential, they are not the whole story.

If all a woman can access is basic HRT, we still believe that’s better than doing nothing. But what we offer at my practice, Aurelia, is a far more comprehensive approach. One that evaluates, listens, tests, and treats the whole woman.

Hormone therapy is powerful.

But it works best in a body that’s been supported.

What Else Needs to Be in Place

A truly integrative approach means looking at the terrain your hormones live in. That includes:

• Adrenal Health: Chronic stress and poor sleep dysregulate your cortisol rhythm, leaving you wired, tired, and inflamed. HRT can’t correct that on its own.

• Thyroid Function: Suboptimal thyroid hormones are often missed by traditional labs. If your thyroid isn’t dialed in, energy, metabolism, and mood will struggle—regardless of your estrogen levels.

• Nutrient Status: Magnesium, selenium, iodine, zinc, B vitamins—all crucial for hormone production and detoxification. Without them, HRT won’t land well.

• Mitochondrial Health: Your cells need energy to repair, regenerate, and respond. When mitochondria are struggling, you’ll feel it in every system.

• Detoxification & Bile Flow: Hormones have to be metabolized and cleared. If the liver and gut aren’t working efficiently, you risk recycling hormones your body meant to eliminate—leading to fatigue, inflammation, and resistance to treatment. We often insist on supporting bile and detoxification in a woman on HRT, and it’s often a reason someone isn’t feeling well if they’ve tried it before unsuccessfully. 

This is why we don’t chase symptoms.

We create strategies. We build foundations. We help women become good hosts for their hormones.

What We Use—and Why

We individualize every prescription, but here’s a quick overview of the therapies we use most:

Estradiol

Typically delivered transdermally (via cream, gel or patch) to reduce clotting risk and mimic natural hormone levels more safely than oral versions.

Micronized Progesterone

Bio-identical, often prescribed in oral form for sleep and endometrial protection. For some women, we cycle it. For others, we use it continuously—depending on labs, symptoms, phase of hormone decline and goals.

Testosterone & DHEA

Prescribed selectively, based on testing and symptoms—often used to support libido, energy, and strength.

We almost never prescribe synthetic progestins or conjugated estrogens (there are isolated uses for medroxyprogesterone, but we never prescribe it for an ongoing HRT plan). 

And we never guess. Every treatment plan is backed by testing, context, and ongoing support.

Because you’re not just a hormone panel. You’re a woman in midlife, holding so much. You deserve care that reflects that.

The first month of HRT for me was incredibly eye-opening. I started at the exact right time, in the exact right way. I had no regrets about my own treatment, and the way it went down. 

What I did have regrets about was that I hadn’t understood hormones sooner. I wish I’d learned how essential they are for every organ system in graduate school. I wish more providers and women knew what was possible. 

The Hormone Club: Built for Women Like You

We created The Hormone Club because women deserve more than a rushed prescription and a “see you in six months.”

Our program is the antidote to the transactional, non-integrative model that’s become the norm. It’s care that honors the whole woman. Your story. Your labs. Your goals. Your pace.

Yes, we use hormone therapy—but only in a body that’s been supported.

Yes, we optimize hormones—but we also look at gut health, adrenal resilience, nutrient repletion, mitochondrial repair, and more.

Because the goal isn’t just symptom relief.

It’s vibrancy.

You don’t have to guess, Google, or go it alone.

We’re here to support you—fully, personally, and with the depth of care you deserve.