Physiologic HRT: A New Approach to Hormone Therapy for Midlife Women
Understanding the Basics: Static Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) has long been the standard of care for women navigating menopause and its associated symptoms. The conventional model of HRT, often referred to as basic or static HRT, relies on providing a consistent, low-dose of estradiol daily, paired with continuous oral progesterone (typically in 100-200mg doses per day).
Alternatively, a phasic static approach administers progesterone for only 12-14 days per month—an attempt to mimic the natural cycle but without achieving true physiological cycling.
The goal of traditional static HRT is straightforward: to relieve menopausal symptoms such as:
Vasomotor symptoms (hot flashes, night sweats)
Vulvovaginal atrophy (vaginal dryness, painful intercourse)
Bone density loss (osteoporosis prevention)
These are the three primary indications that The Menopause Society endorses HRT for. As a result, most healthcare providers stick to this approach—prescribing static hormone regimens only for these symptoms and rarely considering hormonal restoration beyond symptom relief.
But what if we moved beyond symptom suppression and focused on full-body health restoration? This is where Physiologic Hormone Replacement Therapy (pHRT) comes in.
What Is Physiologic HRT (pHRT)?
Physiologic HRT (pHRT) is an upgraded approach to hormone replacement therapy that prioritizes optimal dosing and optimal rhythm of hormones, especially estradiol. At Aurelia, we see estradiol as a vital life hormone, not just a means to stop hot flashes.
Women spend nearly half their lives in a menopausal state, and the loss of estradiol plays a key role in the onset of chronic degenerative diseases like osteoporosis, heart disease, and Alzheimer’s. If your goal is simply to feel a bit better and stop hot flashes, a low-dose estradiol product can help. But if you want your hormone plan to be part of your longevity plan, pHRT goes further.
The concept was first introduced by TS Wiley in her book, Sex, Lies, and Menopause (Amazon). She proposed that mimicking the body's natural hormone fluctuations—rather than suppressing them—could be more beneficial in maintaining long-term health. While pHRT remains largely theoretical, it is backed by decades of clinical experience from providers practicing this method.
How pHRT Differs from Static HRT:
Dynamic dosing: Instead of a flat, daily dose, pHRT mimics the natural menstrual cycle with fluctuating estradiol and progesterone levels.
Higher peak estradiol: Estradiol peaks around day 12 of the cycle, priming progesterone receptors and improving hormone synergy.
Monthly menstruation is maintained: Unlike static HRT, which aims to suppress the cycle, pHRT maintains it, supporting better hormone receptor function.
Potentially broader health benefits: Beyond just symptom relief, pHRT aims to restore hormone levels to those of a naturally cycling younger woman, with peaks of hormones on specific days of the month. These peaks initiate a cascade of important physiologic events like bone turnover, blood vessel regeneration, and more.
Many telehealth companies offer the basics—low-dose transdermal estradiol with nightly progesterone—which can provide relief. But true optimization requires more.
pHRT is about living not just longer, but better—staying sharp, strong, and disease-free for decades to come. If that’s the future you want, pHRT might be an option to consider.
Why Does Cycling Matter? The Science Behind Ovulation and Health Protection
A growing body of research suggests that cyclical hormone production, particularly ovulation, is a critical factor in long-term health. Women who continue to ovulate later in life tend to have lower risks of osteoporosis, cognitive decline, and cardiovascular disease.
Key Studies Supporting the Role of Ovulation in Health:
Ovulation and Bone Health
Research has shown that ovulating women have greater bone density than those who do not, suggesting that rhythmic estradiol and progesterone exposure may be protective against osteoporosis (European Heart Journal).Brain & Cognitive Health
Estradiol is neuroprotective. Studies show that women who maintain higher levels of estradiol (particularly in cyclical rhythms) tend to have lower risks of Alzheimer's disease and cognitive decline (Circulation Journal).Cardiovascular Benefits of Rhythmic Hormones
A Danish study found that cyclic HRT regimens—as opposed to continuous, static HRT—were more protective against cardiovascular risk factors. Women on rhythmic hormone therapy had lower rates of heart disease and better metabolic markers.
The Future of Hormone Therapy: Individualized, Rhythmic, and Restorative
pHRT represents a paradigm shift in how we approach hormone therapy. However, there are very few pHRT providers nationwide. Due to the high-touch nature required to successfully manage this approach, accessing this method can be difficult. Many pHRT providers operate within elite concierge medical programs that cost well into the six figures annually.
At Aurelia, we’ve created a more accessible path to expert-level pHRT care, offering high-level expertise without the exclusivity barrier.
Why Choose Aurelia for pHRT?
We have cultivated our education in this space by working with seasoned providers across the country, many of them in California, where the highest concentration of pHRT practitioners exists. As a result, we’re now considered experts in this technique.
We’ve achieved this status through our team-based model, which leans heavily on the partnership of our pHRT-trained RNs and clinical pharmacists. This ensures that our patients receive the highest-quality care in the field, while providing a level of personalized support rarely found elsewhere.
Key Takeaways:
✔ Static HRT is focused on symptom relief—but may not fully support long-term health.
✔ Physiologic HRT aims to restore natural hormone rhythms, which may offer greater benefits for brain, bone, and cardiovascular health.
✔ Cycling hormones may be more protective than continuous hormones, as shown in research on ovulation and cardiovascular risk.
✔ Estradiol peaks are crucial for receptor function, and proper cycling may reduce negative side effects from progesterone.
✔ Supervision is essential, as pHRT requires careful dosing and monitoring.
In my practice, Aurelia Health, we believe in a hormones-first™ approach to menopause care—where women are seen, heard, and given the tools to thrive. If you’re curious about pHRT and whether it’s right for you, partner with a provider who understands this approach and can personalize your care.
Because midlife isn’t just about getting by. It’s about feeling your best—and doing midlife better™