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Combined HRT (Estrogen + Progesterone)
genericMultiple FDA-approved combination products available; individual components also available as generics
Est. Cost
$30 - $200/mo depending on formulation and insurance
/month
Combined HRT refers to treatment plans that include both estrogen and progesterone — the standard approach for menopausal women who have an intact uterus. While estrogen addresses vasomotor symptoms, vaginal changes, and bone loss, progesterone is added to protect the uterine lining. Combined HRT can be prescribed as a single combination product (like Bijuva or Activella) or as separate estrogen and progesterone medications taken together. The choice between continuous combined therapy (taking both hormones daily) and cyclical therapy (progesterone taken only part of the month) depends on the woman's stage of menopause and preference.
Dosage Format
Combination products vary. Bijuva is a single capsule containing estradiol 1mg + progesterone 100mg taken once daily. Other combinations may use separate pills or a patch plus oral progesterone. Dosing is determined by the provider based on symptoms and individual health factors.
Type
Generic
Best For
Women with an intact uterus who want the convenience of a single combined product or a coordinated estrogen-progesterone regimen
Key Benefit
Bijuva was the first FDA-approved combination capsule containing bioidentical estradiol and bioidentical progesterone in a single pill, simplifying the HRT regimen for many women.
Where to Get Combined HRT (Estrogen + Progesterone)
Compare providers offering combined hrt (estrogen + progesterone) — ranked by our editorial team
Evernow
Clinicians prescribe individualized combination regimens. May use separate estradiol and progesterone or combination products based on patient needs.
Varies by prescription (insurance may apply)
/month
Alloy Health
Offers combination plans with estradiol and progesterone in various delivery formats. Free quarterly delivery included.
Varies by formulation (quarterly billing)
/month
Winona
Combination plans available with estrogen and progesterone in cream, oral, or mixed delivery formats. *Some formulations are compounded and not FDA-approved.*
$150 - $238/mo
/month
Hers
Combined estradiol + progesterone plans available in oral and patch + pill formats. Unlimited provider access included.
From $79/mo (12-month plan)
/month
How Combined HRT (Estrogen + Progesterone) Works
Combined HRT works through two complementary mechanisms. The estrogen component (typically estradiol) supplements declining hormone levels to help alleviate hot flashes, night sweats, vaginal dryness, and other estrogen-deficiency symptoms. The progesterone component counteracts estrogen's growth-stimulating effect on the uterine lining, reducing the risk of endometrial hyperplasia. In continuous combined regimens, both hormones are taken daily, which may eventually stop monthly periods. In cyclical regimens, progesterone is taken for 12-14 days per month, which may produce a predictable monthly withdrawal bleed.
Side Effects
Common
- • Breast tenderness
- • Headache
- • Nausea or bloating
- • Irregular spotting or bleeding (especially in early months of continuous therapy)
- • Mood changes
- • Drowsiness (from progesterone component, especially at bedtime)
Serious (Rare)
- • Increased risk of blood clots — discuss personal risk factors with your provider
- • Increased risk of stroke
- • Potential breast cancer risk with long-term use — an important topic to discuss with your provider
- • Gallbladder disease
- • Unusual or heavy vaginal bleeding — report to your provider promptly
Who Is Eligible
Combined HRT is generally prescribed to menopausal or perimenopausal women with an intact uterus who are experiencing moderate to severe symptoms. It may not be appropriate for women with a history of breast cancer, blood clots, stroke, liver disease, or unexplained vaginal bleeding. A comprehensive health evaluation is essential before starting any HRT regimen. Women who have had a hysterectomy typically do not need the progesterone component and may take estrogen alone.