What is HRT?
Hormone Replacement Therapy (HRT) replaces the hormones your body stops producing during perimenopause and menopause, including oestrogen, progesterone, and sometimes testosterone.
How do I know if I need HRT?
If menopause symptoms are affecting your quality of life — whether that’s hot flushes, sleep problems, low mood, or vaginal discomfort — HRT may be worth considering. The decision is personal and should be based on your symptoms, medical history, and treatment goals. Talking with a clinician is the best way to explore whether HRT is right for you¹². They can help you weigh up benefits and risks based on your age, health, and preferences. Keeping a symptom diary can also help guide the discussion and track progress.
What are the key benefits of HRT?
The British Menopause Society³ and NICE² highlight several well-established benefits: 1) Relief from symptoms — HRT is the most effective way to ease common menopause symptoms, including hot flushes, night sweats, mood changes, sleep problems, and joint discomfort. By restoring hormone balance, it can help you feel more like yourself again. 2) Protection against osteoporosis — Oestrogen maintains bone strength. Its decline during menopause increases the risk of thinning bones and fractures. HRT helps preserve bone density, reducing osteoporosis risk. 3) Cardiovascular health support — When started before age 60 or within 10 years of menopause, HRT may reduce cardiovascular disease risk by improving cholesterol balance and helping keep arteries healthy.
How long does HRT take to work?
Many women notice symptom improvement within a few weeks — especially for hot flushes and night sweats. Mood, energy, and cognitive benefits may take up to three months. Adjustments to dose or type may be needed along the way⁵⁶.
What is HRT made from?
Most modern HRT uses “body-identical” hormones — chemically identical to those naturally produced by your body. Examples include oestrogen patches, gels, sprays containing 17β-estradiol, and micronised progesterone capsules (e.g., Utrogestan). These differ from older synthetic hormones and are considered to have a better safety profile⁷³.
What are the types of HRT?
There’s no one-size-fits-all approach: Oestrogen-only HRT for women without a womb, combined HRT (oestrogen + progesterone) for women with a womb, and testosterone, occasionally added for low libido, fatigue, or brain fog⁸. HRT can be taken as tablets, patches, gels, sprays, or vaginal creams/rings. Transdermal options are often preferred for their lower blood clot risk⁹.
How safe is it?
HRT is considered safe for most women when it is individually prescribed, started before age 60 or within 10 years of menopause, and regularly reviewed. Combined HRT carries a small increased breast cancer risk after long-term use. Oral oestrogen slightly increases clot risk, while patches, gels, and sprays do not. Oestrogen alone can increase endometrial cancer risk, which is prevented with progesterone in women with a womb. Lifestyle factors such as obesity, alcohol, and inactivity can influence risk more than HRT itself. An individual assessment with a menopause-informed clinician ensures treatment is safe and tailored to you.
Are there any common side effects?
Possible short-term effects include breast tenderness, bloating, or mood changes, which usually settle as your body adjusts.
What is the best HRT?
The best HRT is the one that controls your symptoms, fits your lifestyle, and minimises risks based on your health history. Body-identical hormones are often better tolerated, transdermal oestrogen reduces clot risk, and micronised progesterone may carry fewer risks than synthetic forms. Regular reviews are essential.
Are there alternatives to HRT?
Yes — lifestyle changes (exercise, nutrition, sleep optimisation), CBT, non-hormonal medications such as certain SSRIs/SNRIs, oxybutynin, or fezolinetant, and vaginal moisturisers or lubricants. These can be used alone or alongside HRT, depending on your needs²⁰²³.
The bottom line
Most of the risks of HRT are small. For many women, the benefits — symptom relief, stronger bones, better mood, and improved long-term health — outweigh them, especially when treatment is reviewed regularly. A menopause specialist can guide you through your options so you can make an informed, confident decision that fits your health goals.
¹Hamoda H., Panay N., Pedder H., Arya R., Savvas M. (2020). The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women
. Post Reproductive Health, 26(4), 181–209. doi:10.1177/2053369120957514
²National Institute for Health and Care Excellence (NICE). (2015). NG23: Menopause: diagnosis and management. https://www.nice.org.uk/guidance/ng23
³StatPearls. (2023). Hormone Replacement Therapy. https://www.ncbi.nlm.nih.gov/books/NBK493191/
⁴NICE Clinical Knowledge Summaries. (2022). Menopause. https://cks.nice.org.uk/topics/menopause/
⁵British National Formulary (BNF). (2023). Sex hormones – treatment summary. https://bnf.nice.org.uk/treatment-summaries/sex-hormones/
⁶Vinogradova Y., Coupland C., Hippisley-Cox J. (2019). Use of hormone replacement therapy and risk of venous thromboembolism. BMJ, 364:k4810. https://www.bmj.com/content/364/bmj.k4810
⁷Rossouw J.E., et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomised controlled trial. JAMA, 288(3):321–33. doi:10.1001/jama.288.3.321
⁸Asi N., Mohammed K., Haydour Q., et al. (2016). Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Systematic Reviews, 5:121. https://doi.org/10.1186/s13643-016-0294-5
⁹Dydjow-Bendek D.A., Zagożdżon P. (2021). Early Alcohol Use Initiation, Obesity, Not Breastfeeding, and Residence in a Rural Area as Risk Factors for Breast Cancer: A Case-Control Study. Cancers, 13(16), 3925. https://www.mdpi.com/2072-6694/13/16/3925
¹⁰British Menopause Society. (2021). BMS menopause specialists and resources. https://thebms.org.uk/
¹¹British Heart Foundation. (2023). Risk factors for cardiovascular disease. https://www.bhf.org.uk/informationsupport/risk-factors
¹²Patient.info. (2023). Hormone Replacement Therapy – including benefits and risks. https://patient.info/doctor/hormone-replacement-therapy-including-benefits-and-risks
¹³Patient.info. (2023). HRT – initial consultation. https://patient.info/doctor/hrt-initial-consultation
¹⁴Medscape. (2023). Menopause – overview. https://emedicine.medscape.com/article/264088-overview
