Insurance-Covered Hormone Replacement Therapy

HRT is the most effective treatment for relieving menopausal hot flashes, night sweats, vaginal dryness, and recurrent urinary tract infections, according to the most recent guidelines from The North American Menopause Society (NAMS). Clinically, hormone replacement therapy has also been shown to be highly effective in relieving symptoms of insomnia, mood changes, and brain fog.

Additionally, a large body of recent research shows that if women start hormone therapy within 10 years of their last period, they enjoy a significant reduction in menopausal symptoms and a lower risk of heart disease and bone loss.

This depends on your insurance and the type of HRT prescribed. However, insurance is more likely to cover the full or partial cost of FDA-approved bioidentical hormones (the type that Balmbare prescribes) compared with other forms of hormone therapy, like compounded preparations, which are not regulated by the FDA.

Generally, insurance covers generic FDA-approved bioidentical hormones, and in many cases insurance will pick up some of the cost of brand-name HRT when necessary or recommended by a clinician. Balmbare’s care coordinators offer guidance in getting HRT covered if your clinician prescribes it as part of your holistic Care Plan.

Hormone replacement therapy came under fire after a 2002 Women’s Health Initiative study linked it to an increased risk of breast cancer and heart disease. Women panicked and many doctors stopped prescribing HRT altogether.

That study was conducted over 20 years ago. These days, we know much more about HRT and guidelines have changed. A large body of recent research shows that if women start hormone therapy within 10 years of their last period, they experience a significant reduction in menopausal symptoms and a lower risk of heart disease and bone loss.

Research shows that when patients kick off treatment within 10 years of their last period, the benefits of HRT tend to outweigh the risks. But for some women, it makes sense to start earlier: You can begin hormone replacement therapy at the first sign of menopause symptoms, even if you’re in perimenopause and still getting your period.

For women who start HRT outside of that 10-year window, there’s a null effect on cardiovascular disease risk, meaning that you won’t get the heart-bolstering benefits from HRT, but it may not increase your chance of heart trouble either.

Doctors once believed that women should stop hormone replacement therapy by age 65, but there’s actually no science supporting that idea. Newer research and the latest guidelines state that the length of HRT treatment should be a shared decision between the patient and their provider.

Some Balmbare patients prefer to take HRT for the shortest amount of time that it takes to get over the worst of their menopause symptoms. Others feel so fantastic on HRT that they never want to stop treatment. Both can be good options.

Your Balmbare clinician can help you figure out if you’ve landed on the appropriate dose and delivery method. First, we’ll make sure that you don’t have any breast tenderness or bleeding—those are signs that your dose might need to be lowered. Next, we’ll look at whether you’re feeling enough benefit from your current dose. If not, we can tweak your prescription until you experience relief.

Yes, women who have had their uterus removed (via hysterectomy) don’t need progesterone to guard against uterine cancer, so they are prescribed estrogen-only HRT. Research shows that women 60 and younger without a uterus who take estrogen hormone replacement therapy within 10 years of menopause have a lowered risk of breast cancer, among other health benefits.