Quick answer

What is hormone replacement therapy (hrt) used for?

Hormone replacement therapy (HRT) replaces the hormones — oestrogen and progestogen — that fall during menopause, relieving hot flushes, night sweats, mood changes, and vaginal dryness. It also protects bone health. HRT is available as tablets, patches, gels, and sprays. Combined HRT (oestrogen plus progestogen) is needed if you have a womb. Body-identical HRT is available on NHS prescription. Individual risk assessment before starting is essential.

HRT — replacing hormones through menopause

Hormone replacement therapy (HRT) replaces the oestrogen (and usually progestogen) that falls during perimenopause and menopause. For many women, it is the most effective treatment for bothersome menopausal symptoms and offers bone protection.

HRT is available on NHS prescription in multiple forms. A GP assesses your individual risks and benefits before prescribing.

What symptoms does HRT treat?

  • Hot flushes and night sweats
  • Sleep disturbance
  • Mood changes, irritability, and low mood
  • Vaginal dryness, discomfort during sex, and recurrent UTIs
  • Joint aches and stiffness
  • Reduced bone density — osteoporosis prevention

HRT works best when started for moderate to severe symptoms affecting quality of life.

Types of HRT

Systemic HRT — treats whole-body symptoms

Oestrogen forms:

  • Skin patches — changed once or twice weekly
  • Gels and sprays — applied daily to skin
  • Tablets — taken orally

Patches and gels may carry a lower blood clot risk than tablets — NICE and NHS guidance favours transdermal routes for many women.

Combined vs oestrogen-only

Combined HRT — oestrogen plus progestogen — for women with a womb. Progestogen protects the womb lining from oestrogen-driven overgrowth.

Oestrogen-only HRT — for women who have had a hysterectomy (womb removed).

Local (vaginal) oestrogen

Creams, pessaries, or rings applied directly to the vagina — treat dryness and discomfort with minimal absorption into the bloodstream. Can be used alone or alongside systemic HRT. Safe for most women, including many who cannot take systemic HRT.

Body-identical HRT on the NHS

Body-identical HRT uses hormones chemically identical to those your body produces:

  • 17-beta oestradiol — patches (Estradot, Evorel), gel (Oestrogel), spray (Lenzetto)
  • Micronised progesterone — Utrogestan capsules

These are standard NHS prescriptions — not private or unregulated.

Avoid compounded bioidentical hormones from private clinics — they are unregulated, not proven safer, and not recommended by NICE.

Benefits

  • Rapid relief of hot flushes and night sweats — often within days to weeks
  • Bone protection — reduces osteoporosis and fracture risk
  • Improved sleep, mood, and quality of life
  • Vaginal health — systemic and local oestrogen

Particularly important if menopause occurs before age 45 (premature or early menopause) — HRT is recommended until at least the average menopause age of 51 unless contraindicated.

Risks — individual assessment

For most women under 60 or within 10 years of menopause, benefits outweigh risks:

Combined HRT:

  • Slightly increased breast cancer risk with long-term use — returns to baseline after stopping
  • Small increase in blood clot risk with tablets — lower with patches/gels

All systemic HRT:

  • Stroke risk slightly increased with tablets in older women — transdermal preferred

Your GP reviews personal and family history — breast cancer, blood clots, stroke, liver disease — before prescribing.

Starting and stopping HRT

Starting — lowest effective dose for the shortest time needed. Review at 3 months — most side effects (breast tenderness, bloating, spotting) settle.

Bleeding on HRT — common in the first months on combined HRT. Report persistent or heavy bleeding after 6 months — needs investigation.

Stopping — taper gradually when possible. Symptoms may return temporarily. Discuss timing with your GP.

Alternatives when HRT is not suitable

  • Vaginal oestrogen alone — for genitourinary symptoms
  • Cognitive behavioural therapy — reduces hot flush frequency
  • SSRIs (venlafaxine) or clonidine — non-hormonal hot flush treatment
  • Lifestyle — cool sleeping environment, regular exercise, reduced caffeine and alcohol

See menopause for the broader menopause experience and osteoporosis for bone health beyond HRT.

Common questions

What is hormone replacement therapy?
HRT is medicine that replaces the hormones oestrogen and progestogen, which fall during perimenopause and menopause. It relieves menopausal symptoms and protects bone density. It is available on NHS prescription in several forms including tablets, patches, gels, and vaginal creams or pessaries.
Who can take HRT?
Most women with bothersome menopausal symptoms can consider HRT after individual risk assessment. Benefits generally outweigh risks for women under 60 or within 10 years of menopause onset who have no contraindications. Women with a history of breast cancer, blood clots, stroke, or liver disease may not be suitable — alternatives exist.
What is the difference between oestrogen-only and combined HRT?
Oestrogen-only HRT is for women who have had a hysterectomy (womb removed). Women with a womb must take combined HRT — oestrogen plus progestogen — because oestrogen alone stimulates the womb lining and can increase endometrial cancer risk. Progestogen protects the lining.
What are the benefits of HRT?
Effective relief of hot flushes, night sweats, mood changes, sleep disturbance, and vaginal dryness. Protects against osteoporosis and reduces fracture risk. May improve joint aches and dry skin. Started before age 60, it may also reduce cardiovascular risk in some women.
What are the risks of HRT?
Combined HRT slightly increases breast cancer risk with long-term use — risk returns to baseline after stopping. Tablet HRT slightly increases blood clot and stroke risk — patches and gels carry lower clot risk. Individual risk depends on age, medical history, type, and duration of HRT. Your GP discusses your personal risk before prescribing.
How long can I take HRT?
There is no fixed time limit. Many women take HRT for several years while symptoms persist. Review benefits and risks with your GP at least annually. When stopping, taper gradually if possible — symptoms may temporarily return.
What is body-identical HRT?
Body-identical (bioidentical) HRT uses hormones chemically identical to those the body produces — such as 17-beta oestradiol and micronised progesterone (Utrogestan). These are available on standard NHS prescription and are recommended by NICE. Compounded bioidentical hormones from private clinics are not recommended — they are unregulated and not safer.
Are there alternatives to HRT?
Yes. Vaginal oestrogen alone (low-dose cream, pessary, or ring) treats vaginal dryness with minimal systemic absorption. Non-hormonal options include cognitive behavioural therapy for hot flushes, clonidine, and lifestyle measures. SSRIs such as venlafaxine help hot flushes when HRT is not suitable.

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