Hormone replacement therapy is the treatment women were told to fear for twenty years and are now, finally, being told the truth about. For hot flashes, night sweats, the sleep that falls apart in perimenopause, vaginal dryness and the bone loss that follows menopause, it is the most effective treatment there is. Started within ten years of the last period, the randomized data show fewer fractures and lower overall mortality, and in November 2025 the FDA began removing the boxed warnings about heart disease, breast cancer and dementia that had hung on every estrogen product since 2003, approving the new labels in February 2026.
Med spas and wellness clinics have moved into this space fast, and the version they most often sell is not the one with the best evidence. This page explains the treatment, the label change, what “bioidentical” actually means, what pellets are, and how to get the good version.
Who HRT is for
The clearest candidates are women under 60, or within ten years of menopause, with bothersome vasomotor symptoms (hot flashes, night sweats), sleep disruption from them, genitourinary symptoms (vaginal dryness, painful sex, recurrent urinary infections), or bone loss, and no history of breast cancer, blood clots, stroke or unexplained bleeding. For that group The Menopause Society’s position statement calls the benefit-risk ratio favorable. Perimenopausal women, still cycling but irregularly, are candidates too, with regimens tailored to bleeding pattern and contraception needs.
Starting later, more than ten years past menopause or after 60, the balance is less favorable because absolute risks of coronary disease, stroke, clots and dementia are higher at that age. Symptoms alone are not the whole decision; timing is.
What the label change means
The fear came from the 2002 Women’s Health Initiative, which studied women averaging 63 years old on an oral formulation no longer in common use and found a small, statistically non-significant rise in breast cancer diagnoses. The result was a boxed warning on every estrogen product and a generation of women who went untreated. Twenty years of reanalysis showed that age at start, hormone type and route change the picture entirely. In February 2026 the FDA approved labels that drop the boxed warnings on cardiovascular disease, breast cancer and probable dementia, citing reduced mortality and fracture risk in women who start within ten years of menopause onset.
What stays: oral estrogen raises clot and stroke risk more than transdermal (patch, gel, spray), long use of combined estrogen and progestogen carries a small breast cancer increase, and estrogen without a progestogen in a woman with a uterus raises endometrial cancer risk, which is why progesterone is always paired. These are label facts, not reasons to avoid treatment, and a prescriber should walk through them.
Approved hormones versus “bioidentical” compounding
Here is the distinction that matters at a med spa. FDA-approved estradiol (patches, gels, sprays, tablets) and micronized progesterone are body-identical molecules, manufactured to a known dose, cheap and covered by most insurance. They are, in every meaningful sense, bioidentical.
The word “bioidentical” in clinic marketing usually means compounded: creams, troches, or pellets made by a compounding pharmacy from the same molecules, sold as more natural or more personalized. Compounded drugs are not FDA-approved, and the agency does not check their safety, effectiveness or quality before sale. In 2020 the National Academies of Sciences, Engineering, and Medicine, at the FDA’s request, reviewed the evidence for compounded hormone therapy and found it came mostly from anecdote, patient reports and prescriber testimony, with limited oversight of quality, and called its widespread use a public health concern. Their recommendation, echoed by The Menopause Society, is to use approved products unless a patient genuinely cannot.
Pellets deserve their own paragraph because they are what many med spas actually sell. Compounded estradiol and testosterone cylinders are implanted under the skin of the hip every three to four months, $350 to $800 a time. They are convenient and many women like them. The problems are dose control (the pellet cannot be adjusted once in), hormone levels that often run far above what approved products deliver, testosterone added by default at doses that cause acne and hair growth, and re-implantation when symptoms return before the pellet is spent, which stacks levels higher still. They are not first-line therapy in any major guideline.
What it costs
Approved patch or gel plus progesterone: $30 to $200 a month at a pharmacy, often far less with insurance, from any prescriber. Wellness clinic programs are cash: $100 to $300 a month with approved products, $150 to $500 with compounded creams, $350 to $800 per pellet insertion, plus initial labs of $150 to $400. The gap between the first number and the last is not a quality gap. Ask any clinic what the same program costs with a patch.
Choosing a clinic
Ask who the prescriber is and whether they are trained in menopause care (The Menopause Society certifies practitioners; the credential is worth asking about). Ask whether they offer FDA-approved estradiol and progesterone, or only compounded products; a clinic that only sells pellets has made your decision for you. Ask what labs they run and, for pellets, what levels they target. Ask about your bleeding history and your family history before anything is prescribed. Many of the clinics that run women’s hormone programs also offer vaginal rejuvenation treatments, medical weight loss and men’s testosterone therapy; the labs overlap, the decisions should not.
Where to compare HRT
Women’s hormone programs are among the most common wellness services on med spa menus. Compare clinics in Houston, Atlanta, Phoenix, Miami and Austin, or browse hormone replacement therapy providers in your city.