Around 4.7% of women in the US are using menopausal hormone replacement therapy (HRT), with women younger than 52 having the highest prevalence of this type of HRT between 2005 and 2020. They do so primarily to alleviate the symptoms associated with menopause, including hot flashes, night sweats, anxiety, low mood, vaginal dryness, and sleep issues. HRT has its pluses and minuses. For instance, it is known to help maintain bone density, increase the sex drive, positively affect skin aging, and create an improved sense of well-being. Many vegans are curious to know if they can opt for HRT, as some forms of the treatment have animal-derived products. The good news is that provided your doctor believes that HRT is right for you, there are vegan forms of the treatment that hit the mark without impacting the animal kingdom.

Non-Vegan Medications

When discussing HRT with your provider, ask about vegan options. Most oral HRT tablets contain lactose or gelatin. The medication called Premarin contains conjugated estrogens that are derived from the unit of pregnant mares. This medication is often prescribed for menopausal symptoms such as vaginal dryness, hot flashes, and night sweats. Another medication, Utrogestan, contains micronized progesterone, which is identical to a naturally produced hormone. However, it contains gelatin (typically derived from cows) and glycerol (which can be obtained from animal sources)  in its capsule shell. Utrogestan additionally contains soybean lecithin, which some vegans prefer not to consume or use. Although soybean lecithin is extracted from soy oil, it has a significant environmental impact. Most soy grown today is genetically modified in environmentally hazardous plantations. Soy is one of the leading causes of deforestation and destruction of natural habitats. The vast majority of it is used to produce animal feed. 

Vegan-Friendly Options

There are numerous vegan HRT treatments to consider, including transdermal estradiol products in the form of gels and patches. These products deliver estradiol (a form of estrogen) directly into the bloodstream. Estradiol patches are usually placed on the stomach or buttocks and slowly release their main product over a period of days or weeks. Gels, meanwhile, are directly applied to the skin in areas like the thighs, shoulders, or arms. Their estradiol content is absorbed through the skin and delivered to the blood. These options have many advantages. For instance, they bypass the liver, thus reducing the risk of side effects such as blood clots. They also provide consistent delivery of estradiol while being well-tolerated by a majority of patients. 

Additional Vegan Options

Patients have other vegan options for HRT, including estradiol implants. These are small pellets that are inserted into the skin via a small incision, usually in the buttocks or abdominal zone. They then release small amounts of estradiol over a matter of months. Some patients opt for vaginal pessaries and gels, which are tablet-like capsules that can be inserted into the vagina. These capsules are often combined with estrogen to reduce the thickening of the uterine lining. Yet another choice is levonorgestrel intrauterine systems (LNG-IUS), which are T-shaped devices inserted into the uterus. There, they release levonorgestrel—a synthetic progestogen, a class of natural or synthetic steroid hormones that are similar to progesterone. These systems can help alleviate symptoms such as vaginal dryness, hot flashes, and osteoporosis. They are also used to manage heavy menstrual bleeding in perimenopause and to alleviate endometrial-related issues. Finally, there are so-called “combined patches,” which deliver both estrogen and progestogen through the skin. These patches were developed for postmenopausal women who have not had a hysterectomy. They release a small amount of estradiol and progestogen via the skin, and they are worn without breaks. Like many of the medications mentioned above, they are used to treat symptoms such as hot flashes, night sweats, and vaginal dryness. They can also help prevent osteoporosis and reduce the risk of endometrial cancer.

If you are interested in knowing more about HRT, ensure you speak to an experienced medical team that can inform you of the pros and cons of hormone replacement. Discuss vegan options and weigh the pros and cons of each method. Veganism and HRT can be perfectly compatible, so long as you are prescribed the very best treatment or combination of treatments for your symptoms and state of health.