Hormone replacement therapy (HRT) replaces hormones that decline during perimenopause and menopause. It can help ease symptoms such as hot flushes, night sweats, and vaginal dryness.
HRT comes in different forms, including tablets, patches, gels, sprays, and vaginal treatments. The right option depends on your symptoms and health needs.
It may also help protect bone health after menopause. A healthcare professional can advise whether HRT is suitable for you.
The main hormones used in HRT are oestrogen and progestogen. Some people may also be offered testosterone by a specialist in specific circumstances.
Oestrogen is the main hormone used to treat many menopause symptoms.
As oestrogen levels fall, symptoms such as hot flushes, night sweats, vaginal dryness, and mood changes may develop. HRT replaces some of this lost oestrogen.
Progestogen is usually prescribed alongside oestrogen if you still have your womb. It helps protect the lining of the womb from becoming too thick, which can increase the risk of womb cancer.
People who have had a total hysterectomy may generally use oestrogen-only HRT, depending on their individual circumstances.
Testosterone may sometimes be prescribed by a specialist when low sexual desire continues despite HRT. It is not routinely used for every menopause symptom.
HRT may be suitable for people experiencing troublesome perimenopause or menopause symptoms. It can be considered before periods have completely stopped, during menopause, or after menopause.
It may also be particularly important for people who experience premature menopause or early menopause, because replacing hormones can help manage symptoms and support bone health.
However, HRT is not automatically suitable for everyone. A healthcare professional should consider your symptoms, age, medical history, family history, and individual risk factors before recommending treatment.
HRT can help relieve many symptoms linked to falling oestrogen levels. Common symptoms that may improve include:
HRT can also help prevent bone loss and reduce the risk of osteoporosis while you are taking it.
The response varies from person to person, so finding the right dose and type may take some adjustment.
HRT can be delivered in several ways. The main difference is how the hormones enter the body and whether treatment contains oestrogen alone or a combination of oestrogen and progestogen.
Oral HRT comes as tablets or capsules that are taken by mouth, usually once a day. Depending on your circumstances, it may contain oestrogen alone or both oestrogen and progestogen.
Tablets can be convenient, but oral oestrogen has a different risk profile from oestrogen delivered through the skin, particularly regarding blood clots.
HRT patches are placed on the skin and gradually release hormones into the body. They are changed according to the product’s instructions.
Transdermal HRT, including patches, can be useful for people who may have an increased risk of blood clots because oestrogen delivered through the skin does not carry the same clot risk as oral HRT.
Oestrogen gels and sprays are another form of transdermal HRT. They are applied to the skin, where the hormone is absorbed into the bloodstream.
They can be an alternative for people who do not want to take tablets or use patches. The correct amount and application method should be discussed with a healthcare professional.
Vaginal oestrogen is designed mainly for symptoms affecting the vagina and urinary area, including dryness, soreness, and discomfort.
It is available in forms such as creams, pessaries, and vaginal rings.
Because the dose is low and very little oestrogen enters the rest of the body, it has a different safety profile from systemic HRT and can often be used for longer periods when needed.
Hormone implants are inserted under the skin and release hormones gradually over time. They are used less often than tablets, patches, gels, sprays, or vaginal preparations.
Because hormone delivery can be less easily adjusted once an implant has been inserted, your hormone replacement therapy clinic will consider whether this approach is appropriate for you.
For people who are suitable candidates, HRT can provide significant symptom relief.
Its main benefits include reducing hot flushes and night sweats, improving vaginal symptoms, and helping with some menopause-related sleep and mood problems.
Another important benefit is bone protection. Lower oestrogen levels after menopause can contribute to bone loss, while HRT can help reduce this effect.
The benefits are different for every person. Your healthcare professional can help balance the potential benefits against your individual risks.
Like any medication, HRT can cause side effects. Common effects may include:
These effects are often mild and may improve as your body adjusts to treatment.
HRT also has some longer-term risks that depend on the type of treatment, dose, duration, age, and individual health factors.
Combined HRT is associated with a small increase in breast cancer risk, while oral HRT can increase the risk of blood clots and may slightly increase stroke risk. Transdermal oestrogen has a different risk profile.
This is why HRT should be reviewed regularly rather than treated as a one-size-fits-all treatment.
HRT is not suitable for everyone. Certain medical conditions or risk factors may mean that HRT is unsuitable, requires specialist advice, or needs a different type of treatment.
For example, people with a history of certain hormone-sensitive cancers, unexplained vaginal bleeding, blood-clotting problems, or particular cardiovascular or liver conditions may need careful assessment before starting HRT.
This does not mean everyone with a medical condition is automatically unable to use HRT. Your fertility clinic should review your individual circumstances and discuss suitable alternatives where necessary.
HRT is usually prescribed after discussing your symptoms, menstrual history, medical history, previous treatments, and personal risk factors.
Your gynaecology clinic will consider:
Treatment often starts with a suitable dose, which can be adjusted if symptoms continue or side effects occur.
A review is commonly recommended around three months after starting or changing treatment, followed by regular reviews.
HRT does not always provide immediate relief. Some people notice improvements within days or weeks, while the full effect can take up to around three months.
If symptoms have not improved after about three months, or side effects remain troublesome, your healthcare professional may adjust the dose or recommend another form of HRT.
There is no single fixed length of time that everyone must take HRT. The decision should be reviewed regularly based on your symptoms, benefits, risks, and individual circumstances.
Hormone replacement therapy can be an effective way to manage many perimenopause and menopause symptoms by replacing hormones that the body produces in lower amounts.
From tablets and patches to gels, sprays, and vaginal oestrogen, there are several treatment options available.
The right HRT depends on more than your symptoms alone. Your age, menstrual status, whether you have a womb, medical history, risk factors, and personal preferences all matter.
Because HRT has benefits and potential risks, a qualified healthcare professional should prescribe and review it.
