You asked the questions and we got the expert to answer them for you!
Dr. Jessica Yearwood is a board-certified physician and Menopause Society Certified Practitioner with nearly 20 years of clinical experience. After training at the University of Puget Sound, Medical College of Wisconsin, and Yale Emergency Medicine, she returned home to the Pacific Northwest where she now specializes in evidence-based midlife women’s health, hormone therapy, metabolic health, and longevity-focused care. Through her practice, she helps women navigate perimenopause and menopause with personalized, thoughtful, and empowering care focused on time, clarity, partnership, and long-term wellbeing.
Women’s Midlife Health & Menopause Specialist | Dr. Jessica Yearwood, MD, PLLC
1. What is the difference between the different HRT like pellets vs. patches vs. pills and creams and how to know which delivery method to use?
Hormone therapy is not one-size-fits-all. The “best” option depends on a woman’s symptoms, medical history, lifestyle, goals, and personal preferences. It also depends on the type of hormone being used and a woman’s stage and timing within the menopause transition.
It is important to work with a trained healthcare provider who will perform a thorough review of your symptoms, medical history, and overall health goals, while thoughtfully discussing risks, benefits, and appropriate monitoring over time. Hormone therapy often requires ongoing reassessment and dose adjustments as symptoms, priorities, and health needs evolve.
There are many qualified provider types who may offer menopause and hormone therapy care, including physicians, physician assistants, nurse practitioners, certified nurse midwives, and naturopathic providers. Each has a different path of education, training, and clinical experience. It is absolutely appropriate to do your research, ask questions, and seek a provider whose approach, expertise, and communication style feel like the right fit for you.
In general, transdermal (through-the-skin) estradiol—such as patches, gels, sprays, or certain vaginal rings—is often preferred because it delivers estrogen steadily while bypassing the liver, which may lower certain risks compared with oral estrogen. Oral estrogen can still be an excellent choice for some women depending on their symptom profile, preferences, and overall health picture.
Progesterone also comes in different forms. Micronized progesterone—the bioidentical form most commonly used in menopause hormone therapy—is an oral capsule. Because this molecule is too large to be reliably absorbed through the skin, topical progesterone creams have not been shown to provide adequate protection of the uterine lining when used alongside systemic estrogen therapy. There are also synthetic progestins, similar to those used in some birth control formulations, which may be delivered orally or through combination transdermal patches.
Vaginal estrogen is specifically used to treat Genitourinary Syndrome of Menopause (GSM), a common but underrecognized condition that can cause vaginal dryness, irritation, discomfort, pain with intercourse, urinary frequency, urgency, and recurrent urinary tract infections.
Pellet therapy, most commonly used for testosterone, has become increasingly popular, but many formulations are not FDA-regulated and can result in hormone levels above physiologic ranges, with less flexibility for dose adjustment over time.
Currently, there is no FDA-approved testosterone formulation specifically designed for women in the United States. When testosterone therapy is prescribed for carefully selected women, clinicians often utilize male transdermal formulations at much lower, female physiologic doses with close monitoring to help optimize symptom benefit while minimizing unwanted side effects.
The most important thing is thoughtful, individualized care—not trends or marketing. Hormone therapy should be tailored to the individual woman, with ongoing reassessment as symptoms, priorities, and health needs evolve.
The goal is not simply to “replace hormones,” but to support long-term health, symptom relief, vitality, and quality of life in a precise, evidence-based, and sustainable way.
2. When should a woman start getting her hormones tested? Who should she see for this type of treatment?
These are excellent questions—and understandably confusing ones for many women.
Many women begin noticing symptoms related to hormonal shifts in their late 30s to mid-40s, often well before their periods become irregular. Sleep disruption, anxiety, brain fog, fatigue, mood changes, weight redistribution, subtle cycle changes, and metabolic shifts such as insulin resistance or cholesterol changes can all be early signs of perimenopause.
At the same time, many medical and mental health conditions can mimic these symptoms, which is why it is important to work with a healthcare provider who can evaluate the broader clinical picture rather than focusing on hormones alone. The age at which symptoms begin also matters. Loss of menstrual regularity or cessation of periods before age 40 may signal conditions such as Premature Ovarian Insufficiency or other endocrine disorders that require different evaluation and treatment approaches than typical menopause management.
Many women begin these conversations with their primary care provider or OB/GYN. Over the last two decades, however, menopause education within healthcare training programs has often been limited. Fortunately, awareness and education are rapidly expanding, but not every clinician will be an expert in this area—and that is okay. A good provider should recognize when additional expertise is needed and help guide patients appropriately.
Women should seek a clinician who is experienced and up to date in menopause and midlife health—not simply hormone prescribing. Ideally, care should include discussions around cardiovascular, metabolic, bone, cognitive, sleep, and lifestyle health in addition to symptom management. The Menopause Society website is an excellent place to begin searching for certified menopause practitioners.
Hormone testing can sometimes be helpful, but perimenopause and menopause care is largely guided by symptoms and clinical history—not a single lab value. Hormone levels fluctuate significantly during perimenopause and may take time to stabilize even after the final menstrual period, so “normal” lab results do not necessarily override the symptoms a woman may be experiencing.
There are situations where hormone testing and laboratory trends can provide meaningful clinical insight. However, I would encourage women to ask thoughtful questions when they are being advised to obtain frequent, short-interval, cash-pay hormone panels, particularly if the results are unlikely to meaningfully change management or improve outcomes. Thoughtful care should be individualized, evidence-based, and transparent.
3. Are there specific labs to ask your doctor to run?
There is no universal hormone panel that every woman needs. Laboratory evaluation should be individualized based on symptoms, age, treatment considerations, medical history, and overall health goals.
That said, midlife and the menopause transition represent an important inflection point in cardiovascular, metabolic, bone, cognitive, and sexual health. Hormonal changes certainly contribute, but lifestyle, genetics, environmental exposures, and the normal aging process all play significant roles as well.
A thoughtful midlife evaluation should include assessment of metabolic and cardiovascular risk factors and may include laboratory markers such as cholesterol, ApoB, lipoprotein(a), glucose or hemoglobin A1c, thyroid function testing, iron studies and ferritin, inflammatory markers such as hs-CRP, vitamin D, and, in select situations, reproductive hormone levels when clinically appropriate.
It is also important for women to remain up to date on recommended preventive screenings such as HPV/Pap testing, mammography, colon cancer screening, bone density evaluation when appropriate, skin checks, and routine primary care health maintenance. Menopause care should not occur in isolation—it should be part of a comprehensive, proactive approach to long-term health and aging well.
The bigger picture matters. Midlife is not simply about hormone levels—it is a pivotal opportunity to better understand long-term health risks, optimize prevention strategies, and support vitality and quality of life for the decades ahead.
4. What are the key perimenopause symptoms women should be on the lookout for that would prompt them to speak with their doctor?
Perimenopause is often far more than hot flashes. In fact, hot flashes and night sweats tend to become more prominent in the years surrounding the final menstrual period, while many perimenopausal symptoms can begin 7–10 years earlier.
Some of the most common symptoms women report include:
- Sleep disruption
- Anxiety, mood changes, or increased irritability
- Brain fog or difficulty concentrating
- Fatigue and low motivation
- Weight, metabolic, or body composition changes
- Joint aches and muscle loss
- Irregular, heavier, or changing menstrual cycles
- Night sweats or temperature dysregulation
- Decreased libido
- Vaginal dryness, discomfort, or recurrent urinary tract infections
Many women are surprised to learn that these symptoms can begin years before menopause itself and are often mistakenly attributed to stress, aging, burnout, or simply “being busy.”
If something feels different in your body, energy, mood, sleep, or overall resilience, it is worth having a conversation. Women should not have to simply “push through” symptoms that are affecting their quality of life and long-term health.
5. How do you know when to adjust the dose of estradiol or progesterone?
Hormone therapy should be adjusted based on symptoms, side effects, goals, and overall response—not by chasing a “perfect” lab number.
Your prescribing provider should help set clear expectations around when medications are likely to be most effective, what side effects may be expected, when symptoms warrant reassessment, and how to communicate questions or concerns. Structured follow-up and ongoing monitoring are important, and the timeline and approach will look different for each woman.
If symptoms such as hot flashes, sleep disruption, mood instability, brain fog, or other concerns persist—or recur after a period of improvement—the regimen or dose may need refinement. Likewise, side effects such as breast tenderness, bloating, spotting or unusual vaginal bleeding, headaches, or excessive sedation may signal that adjustments are needed.
Sometimes the hormone delivery system itself may need to change. A woman may do better transitioning from a patch to a gel or spray based on skin sensitivity, lifestyle, convenience, personal preference, absorption, cost, or even medication availability and supply issues. The “right” regimen is often one that is not only clinically effective, but also realistic and sustainable for a woman’s day-to-day life.
The right hormone therapy regimen often requires thoughtful follow-up and fine-tuning over time. It should feel supportive, individualized, and sustainable—not confusing or reactive.
6. Will HRT cause weight gain?
This is one of the most common misconceptions in menopause care. Hormone therapy itself is not typically the primary driver of weight gain.
What many women experience during perimenopause and menopause is a shift in metabolism, muscle mass, insulin sensitivity, body composition, sleep quality, stress physiology, and activity patterns—all of which can contribute to increased abdominal fat and changes in how the body responds to nutrition and exercise. Aging itself also contributes to some of these changes.
I often hear women say, “I haven’t changed anything about how I’m eating or exercising, and my weight is increasing or my body composition is changing.” In many cases, that is true. Even without major lifestyle changes, internal hormonal and metabolic shifts are occurring that can lower resting metabolic rate, alter how energy is utilized and stored, and contribute to changes in fat distribution and muscle preservation.
For many women, appropriately prescribed hormone therapy may actually help support sleep, energy, recovery, muscle preservation, and overall metabolic health. However, some women may notice temporary fluid retention, bloating, or mild weight fluctuations when first starting or adjusting hormone therapy. This is often transient as the brain and body adapt to changing hormone levels and delivery patterns.
It is important to remember that hormone therapy is a journey, not an overnight transformation. It often takes at least 8–12 weeks—and sometimes longer—for the body to adjust to new medications and for the full symptom response to become clear.
The focus should be less on the number on the scale and more on strength, body composition, metabolic health, vitality, and long-term health trajectory.
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