HRT Explained: Benefits, Risks & Different Types

Hormone replacement therapy (HRT) is an effective treatment for many menopause symptoms, but it is not a one-size-fits-all medicine. The appropriate hormones, route and treatment pattern depend on symptoms, whether you have a womb, where you are in the menopause transition and your individual health history.

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What symptoms can HRT help?

HRT can help symptoms including hot flushes, night sweats, sleep problems, mood changes and vaginal dryness. It can also help protect against osteoporosis while it is being taken.

What types of HRT are there?

Oestrogen can be delivered in several ways, including tablets, patches, gel and spray. If you have a womb and use systemic oestrogen, progestogen is generally also required to protect the womb lining. The appropriate regimen depends partly on whether periods are still occurring.

What is local vaginal oestrogen?

Local vaginal oestrogen is used for vaginal dryness and irritation and some urinary symptoms. It is available in forms such as tablets, pessaries, creams, gels or rings. Because the dose is low and absorption into the rest of the body is limited, it has a different risk profile from systemic HRT.

What are the benefits and risks?

The balance is individual and varies with factors including age, medical history, type of HRT and duration of use. NICE recommends discussing benefits and risks so decisions reflect the person's circumstances and preferences. For people aged 45 or over, NICE states that overall combined or oestrogen-only HRT is unlikely to affect life expectancy.

Can HRT be started during perimenopause?

Yes. You do not necessarily need to wait until periods stop completely. The type and pattern of HRT need to match the stage of menopause and individual circumstances.

Is there a fixed time limit?

There is no single fixed duration that applies to everyone. Treatment should be reviewed and continued while its benefits outweigh its risks for the individual.

What if I do not want HRT?

HRT is not the only approach. Non-hormonal medicines, menopause-specific CBT, lifestyle measures and symptom-specific treatments may be appropriate depending on the problem.

Read How Do I Know If I'm in Perimenopause? and our complete menopause guide.

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This guide is educational. HRT and other prescription treatments require individual clinical assessment and may need GP or specialist care.