💫 Estrogen, Progesterone, Testosterone: Meet the (Not-So) Magical Potions of MHT
Hormone therapy can feel like alphabet soup. This guide decodes what each hormone actually does, how we use it at Coven, and which myths need to retire already.
“In perimenopause, we’re not ‘replacing’ so much as smoothing the roller coaster.” — Dr. Michelle Jacobson
✨ First, a quick vibe check
💡 MHT = Menopausal Hormone Therapy (today’s term for what many still call HRT)
🧠 The goal is individualized care — your symptoms, history, and preferences drive the plan
🔄 Follow-up isn’t a nice-to-have — it’s where the magic (fine-tuning) happens
🌷 Estrogen 101 | Your primary smoother
What estrogen helps
🔥 Hot flashes & night sweats
😵💫 Perimenopausal mood swings (anxiety, irritability, rage-that-chewing-sound)
💤 Sleep, energy, and brain fog
🦴 Bone health support
💧 Vaginal & urinary symptoms (local options available)
How we deliver it
💧 Transdermal estradiol (gel or patch) keeps levels steady and body-friendly.
💊 Oral forms exist, but aren’t our default for most patients.
⚠️ Myth to retire: “Estrogen is dangerous for everyone.”
✅ Reality: Risk depends on type, dose, route, timing, and your personal health profile.
Coven takeaway: Estrogen is the workhorse for many symptoms — especially in perimenopause — when it’s paired with the right safety partner.
🌙 Progesterone 101 | Your uterine protector (and often your calm)
If you have a uterus and take systemic estrogen, you also need a partner hormone to protect the uterine lining — usually micronized progesterone (bioidentical).
Why it matters
🛡️ Prevents uterine lining overgrowth
😴 Can help sleep and reduce anxiety
But every body is different
Some feel amazing ✨; others feel PMS-y 😬 — that’s normal, and we can adjust.
⚖️ Myth to retire: “Progesterone is always the problem.”
💗 Reality: For many, the right progesterone (and timing) restores calm and sleep.
Coven takeaway: With estrogen on board, progesterone is your non-negotiable seatbelt — and often your gentle sedative for an overworked brain.
🔥 Testosterone 101 | The misunderstood
We naturally make testosterone (in smaller amounts than men). Interest spikes when libido dips — and yes, that’s valid.
What it’s actually for
💞 Helps women with low desire that’s distressing
⚡ Evidence for “energy” or “focus” is mixed, but some feel benefits
🩺 Requires precise dosing + monitoring to stay safe
💬 Myth to retire: “Testosterone will fix everything.”
🎯 Reality: Desire is bio-psycho-social. Testosterone can help, but context matters.
Coven takeaway: Think of testosterone as a targeted add-on, not the foundation.
🧩 How we build your plan (the Coven way)
🎯 Start with your loudest symptom. Treat the thing that bothers you most first — so you can finally hear what’s second.
🪄 Keep it simple. Most start with transdermal estradiol + micronized progesterone.
⏳ Review in ~12 weeks. Fine-tune dose, route, or timing.
🔁 Reassess often. Perimenopause changes — your plan should too.
“Relief is often iterative, not instant.”
🧠 Common misconceptions (and quick fixes)
🙅♀️ “I still get my period, so it can’t be perimenopause.”
→ You can have regular cycles and perimenopausal symptoms worth treating.
🧪 “Bioidentical means compounded is safer.”
→ Pharmacy-grade estradiol & micronized progesterone are bioidentical.
📉 “Estrogen causes cancer for everyone.”
→ Risk is nuanced — depends on type, route, dose, and timing.
🕰 “If it doesn’t fix everything in two weeks, it failed.”
→ Nope. It’s a process — and follow-up is part of treatment.
🩺 What to ask your clinician
📋 “Would transdermal estradiol be appropriate for my symptoms?”
📋 “What’s our plan for endometrial protection (e.g. micronized progesterone)?”
📋 “When will we follow up and adjust?”
📋 “If we try testosterone, how will we dose, monitor, and reassess?”
💬 If you hit a wall, you’re not the problem — your care pathway is. There are options.
🌿 How Coven can help
💬 Just want direction?
→ 30-Minute RN Health Navigation Consult — compassionate triage + clear next steps.
🩺 Ready to build a plan?
→ Hormonal Health Assessment (or Total Hormonal Health + MD Consult) — personalized MHT plan with follow-up.
🎧 Prefer to learn first?
→ Listen to Hysterical Women right here.
