Hormone therapy · Sponsored

Estradiol and Progesterone, Explained: How Menopausal Hormone Therapy Works

Most menopausal hormone therapy comes down to two hormones. Here is what each one does and why they are often prescribed together.

Updated October 9, 2026

Sponsored. This article features a product from Vea Health. We have a financial relationship with Vea Health. How we make money.

What you'll learn

Estradiol is the main form of estrogen the ovaries make before menopause.¹
Women with a uterus who take systemic estrogen generally also need a progestogen to protect the uterine lining.²
Hormone therapy comes as pills, patches, gels, creams and vaginal products.^2,1
Velora, from Vea Health, is an estradiol and progesterone cream prescribed after a clinician's review.³

Estradiol

Estradiol is the main estrogen made by the ovaries during the reproductive years, and the decline in estrogen is behind many menopause symptoms. Estrogen therapy replaces some of it.¹ The Menopause Society describes it as the most effective treatment for hot flashes and night sweats.²

Progesterone

Progesterone is the other main ovarian hormone. In hormone therapy its key job is protective: estrogen on its own stimulates the lining of the uterus, which raises the risk of endometrial cancer. Adding a progestogen counters that, so women who still have a uterus are generally prescribed one alongside systemic estrogen.² Women who have had a hysterectomy usually do not need it.²

This is why intake questionnaires for hormone therapy ask whether you still have a uterus.

Forms

Hormone therapy comes as pills, skin patches, gels, sprays, creams and low-dose vaginal products.^2,1 Estrogen absorbed through the skin avoids a first pass through the liver; The Menopause Society notes that transdermal estrogen may carry a lower risk of blood clots than oral estrogen, though the evidence comes mainly from observational studies.²

Benefits and risks

For healthy women under 60, or within 10 years of menopause, The Menopause Society says the benefits of hormone therapy generally outweigh the risks for those with bothersome symptoms.² Risks depend on age, time since menopause, the type and route of hormones, and personal history, including breast cancer, blood clots, stroke and heart disease.^2,1

Velora

Velora Hormone Balance, from Vea Health, is an estradiol and progesterone cream. It is prescribed only after a licensed clinician reviews an online intake covering symptoms, menstrual history and whether you have a uterus, and ongoing care includes a scheduled clinician check-in.³ It is compounded for the individual patient, and compounded hormone preparations are not FDA-approved.^4,5

Important safety information. Estrogen therapy is not appropriate for everyone. Women with a history of breast or uterine cancer, blood clots, stroke, heart attack, liver disease or unexplained vaginal bleeding need specialist advice, and estrogen should not be used during pregnancy.¹ Women who still have a uterus are generally prescribed a progestogen such as progesterone alongside systemic estrogen to protect the uterine lining.² Report any unexpected bleeding, breast changes, leg swelling, chest pain or sudden headache to a clinician right away.¹ Only a licensed clinician who knows your health history should decide whether hormone therapy is appropriate for you.

Your questions, answered

Why is progesterone prescribed with estrogen?

For women with a uterus, estrogen alone stimulates the uterine lining and raises the risk of endometrial cancer. A progestogen protects against that.

Do I need progesterone if I have had a hysterectomy?

Usually not. Progesterone in hormone therapy is mainly to protect the uterine lining, so women without a uterus generally take estrogen alone. A clinician confirms what is right for you.

Is hormone therapy safe?

For healthy women under 60 or within 10 years of menopause with bothersome symptoms, The Menopause Society says the benefits generally outweigh the risks. It depends on personal history.

Keep learning

References

Estrogen. MedlinePlus Drug Information, U.S. National Library of Medicine.
The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022. PubMed 35797481.
Vea Health. Velora Hormone Balance intake. Accessed October 9, 2026.
National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy. 2020.
U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers.