HRT: Hormone Replacement Therapy Explained

Hormone replacement therapy, or HRT, is the most effective treatment for menopause symptoms and has helped millions of women. It was long surrounded by confusing and sometimes alarming headlines, but current guidance is far more reassuring: for most women under 60 who are recently menopausal, the benefits outweigh the small risks. This guide explains what HRT is, the types and what to discuss before you start.

What HRT is

HRT replaces the oestrogen your ovaries stop making during the menopause. That treats hot flushes and night sweats, improves sleep, protects bone density and can help mood and vaginal dryness. It is not taken forever, and the dose and type are tailored to you. HRT is prescription-only in the UK, so it always starts after an assessment with a GP or menopause clinic.

The two main types

If you still have your womb, you are given oestrogen together with a progestogen, because oestrogen alone would thicken the womb lining and raise the risk of womb cancer. This is combined HRT. If you have had a hysterectomy, you need oestrogen alone. The progestogen can be taken daily or in a set pattern, and newer preparations use a progestogen-releasing coil alongside oestrogen.

Tablets, patches, gels and more

Form	How you use it	Considerations
Tablets	Swallowed daily	Simple, but slightly higher clot risk than skin forms
Patches	Stuck to the skin, changed once or twice a week	Steady levels, lower clot risk, can irritate skin
Gel	Rubbed into skin daily	Flexible dosing, lower clot risk, mind the dose
Vaginal oestrogen	Cream, pessary or ring used in the vagina	Treats dryness and urinary symptoms with minimal absorption

There is no single best form; the right one depends on your symptoms, your preferences and your medical history, and it is common to switch until you find what suits you.

The benefits

For women with moderate to severe symptoms, HRT is dramatically effective. Flushes and night sweats usually settle within weeks, sleep improves, and many report their mood and energy returning to normal. HRT also reduces the risk of osteoporosis and fractures. It only makes sense if you actually have symptoms that bother you.

Risks and considerations

HRT is not risk-free, and the honest picture matters. Combined HRT is associated with a small increase in the risk of breast cancer, roughly in the same region as being overweight or drinking alcohol regularly, and the risk falls again once you stop. Oestrogen tablets slightly raise the risk of blood clots, which is why patches and gels are often preferred for women at higher risk. The absolute risk is small for most women under 60, but your prescriber should weigh your individual history with you.

How to decide and start

Start with a list of your symptoms and how they affect your life. If flushes, sweats, sleep or mood are significantly disrupting things, HRT is worth discussing. Treatment is reviewed at least annually and the dose can be adjusted. If you had an early menopause before age 45, HRT is generally recommended until the age of natural menopause to protect bones and the heart.

Talking to your GP

Some GPs are more menopause-savvy than others, so read the menopause overview and the perimenopause signs guide first. Ask whether HRT might suit you, what form is recommended and what review schedule is planned. If your GP is unsure, ask for a referral to a menopause clinic. The risk of osteoporosis is another reason to raise HRT early.

HRT is a well-understood treatment with real benefits for most women who choose it. Weigh the pros and cons with someone who knows your history, start at a dose that helps, and review it regularly.