What is HRT?
Hormone Replacement Therapy or HRT refers to the hormone medication used during the menopause transition to help with symptoms and it contains one or more of the hormones estrogen, progesterone and testosterone.
HRT has been shown to offer the most effective relief from perimenopausal and menopausal symptoms and NHS guidelines recommend HRT as the first choice for women who have symptoms caused by low or fluctuating hormone levels.
For the majority of women, the benefits of taking HRT outweigh any potential risks.
What is in HRT?
HRT can be made up of one, two or three hormones in any combination depending on your needs.
- Estrogen – the type of estrogen mostly used in HRT is 17 beta-estradiol and it is derived from the yam root vegetable. This has an identical biological structure to the estrogen produced in our bodies. Estrogen can be given in the form of a sticky patch, gel or spray delivered across the skin, or as a tablet taken orally.
- Progestogen
- All women who still have a womb who take estrogen will also need to take progestogen in some form. This is because taking estrogen on its own causes the lining of the womb to thicken and this increases the risk of abnormalities including cancer. Taking a progestogen keeps the lining of the womb thin and helps prevent abnormalities occurring. You can take a natural progesterone branded as Utrogestan or Gepretix, or unbranded as progesterone micronised in the UK (also derived from the yam vegetable). This is taken orally as a capsule.
- The other common way to receive progestogen is via an intrauterine system that releases a type of progestogen called levonorgestrel such as the Mirena or Levosert coil. This is a small T-shaped device inserted into the womb to prevent the lining from thickening and this can remain in place for 5 years before it needs to be changed. It is also an effective contraceptive and can help reduce heavy periods which may happen in perimenopause. Other types of progestogens are available in combination skin patches that also contain estrogen or in other tablet form. Read more about The Benefits of Progesterone Treatment.
- Testosterone – less commonly used as part of HRT is the hormone testosterone, particularly for women experiencing symptoms of low libido, low arousal and poor sexual satisfaction despite taking estrogen. If you have low testosterone, you may also experience fatigue, low mood and brain fog. Testosterone therapy can be trialled for these reasons and this is given via a gel or cream that you rub into the skin. Prescribing this medication is often ‘off license’ and is generally used by doctors with a special interest and/or additional training in menopause. Read more about Testosterone Supplementation for Women.
- Local vaginal estrogen – this isn’t the same as the other hormones we have described so far as part of HRT where estrogen, progesterone and testosterone enter the bloodstream and circulate around the body (systemic HRT). There is another type of estrogen medication used for changes affecting genital and urinary functions and this is placed directly in the vagina and around the vulva to improve symptoms of vaginal dryness, pain on intercourse, soreness of the vulva and vagina, recurrent urinary tract infection and changes to how urgently and often you need to wee. This medication can be used on its own or alongside systemic HRT. Vaginal estrogen can be given in the form of a pessary, cream or gel, or a soft silicon ring that is inserted into the vagina to slowly release estrogen lasting for 90 days. Read more about Vaginal Dryness in Menopause.
You can read more about all these types of HRT in our guide here.
When should I begin HRT?
HRT can be started when you notice changes or symptoms are having a negative impact on your quality of life. For many women this is in perimenopause when you are still having periods, especially if they’re changing in nature. It is often (but not always) the emotional and psychological symptoms that present in perimenopause such as anxiety, low mood, mood swings, and irritability. HRT can be started even if these are the only type of symptoms you have. There is no need to wait until your periods have changed or stopped or you have other physical symptoms such as hot flushes or muscle aches before you start taking HRT.
Read more about what to expect when you start HRT our starting hrt what to expect
What benefits will HRT bring?
- Relief of your symptoms. This is the primary reason women use HRT. You may need some dose adjustment in the first few months, but generally hot flushes, night sweats and body aches and pains are relieved within a few weeks of starting. Low mood, anxiety and sleep disturbance take longer to settle but have usually improved within 3 months.
- Reduced risk of osteoporosis. In late perimenopause and menopause, the density and strength of our bones diminish. Taking HRT reduces this bone loss and lowers the chance of the bone weakening disease osteoporosis developing, as well as lowering the risk of breaking bones.
- Reduced risk of cardiovascular disease. There is evidence that HRT started within 10 years of the menopause or below the age of 60 reduces the risk of developing cardiovascular disease. (Cardiovascular disease is the second most common cause of death in postmenopausal women).
- Possible reduced future risk of other conditions such as type 2 diabetes, depression and bowel cancer. HRT may also help protect against osteoarthritis.
Are there any risks from taking HRT?
Taking HRT is a very personal decision and you can discuss this with your doctor considering your symptoms and how they are impacting your life, your personal and medical history, any pre-existing medical conditions, your family history and whether or not you still have a womb (uterus).
Historically, there have been two risks associated with older types of HRT.
Breast Cancer
This appears to be the most common worry for women when thinking about taking HRT but the reality is your personal breast cancer risk depends on many factors including age, family history, your weight, if you smoke, how much alcohol you drink and whether you exercise regularly.
Studies have shown that women who take estrogen-only HRT do not have any increased risk of breast cancer.
Women who take HRT containing estrogen and progestogen, may have a very small increased risk of breast cancer, but this risk can be minimised further by using micronised progesterone (e.g. Utrogestan).
Blood Clots
HRT taken orally as a tablet is associated with a small increased risk of a blood clot so it is generally not prescribed often these days. HRT taken across the skin as an estrogen patch, gel or spray does not increase the risk of a blood clot.
There are many lifestyle factors that do increase your risk of blood clot however, such as smoking, obesity and prolonged periods of inactivity, so efforts should be made to minimise these wherever possible to avoid a clot developing.
Bottom Line on HRT
For the majority of women who start HRT below the age of 60, the benefits to your symptoms and future health outweigh any potential risks. The long-term health benefits of HRT are best achieved if HRT is started below the age of 60 or within 10 years of the menopause.
HRT is safe for most women but it is always best to make a well-informed decision that reflects your own concerns and priorities and in discussion with your doctor.
If you are struggling with symptoms that are having a negative impact on your quality of life, speak to a healthcare professional with an interest in menopause to understand the right combination for you. Or with one of our specialist clinicians.
Last updated: August 2026
