To mark World Menopause Month, Health in Menopause specialists, Dr Alice Duffy, Dr Sarah Ball and breast specialist, Dr Alison Macbeth share their approach to helping women during menopause as they give clear and evidence based advice about HRT.

October has become a fixture in the global calendar to raise awareness about menopause and its treatments, culminating on October 18th as World Menopause Day, hosted by The International Menopause Society. This year its focus is on HRT or Menopause Hormone Therapy/MHT, as it’s known in many other countries. 

It’s great that more women than ever are taking action to improve their perimenopause or menopause experience and their future health through lifestyle adjustments and by taking HRT. 

Professional bodies such as NICE (National Institute for Health and Care Excellence) and The British Menopause Society (BMS) have updated guidelines on prescribing HRT according to the latest available evidence. Menopause experts agree that body identical HRT is safe and effective for the vast majority of women when prescribed according to these guidelines. However, recent coverage in the media has understandably left some women confused and concerned (yet again) about whether their HRT is going to harm them in any way.

Public perception of HRT often takes positive strides forward and then takes a few steps back according to the latest cultural conversation at the time.

Health in Menopause approach

The doctors at Health in Menopause follow all regulatory guidelines and recommendations from NICE and the BMS, each holding certification to practise as BMS accredited menopause specialists and this framework informs how they prescribe HRT and make recommendations through shared decision making with their patients.

Alongside this, Alice, Sarah and Alison are all keen advocates of using a holistic and individualised approach that recognises the uniqueness of every woman – including her medical history, her lifestyle, her genetics and hormone sensitivities, her personal and professional circumstances, her mental health and experience of trauma, and a multitude of other factors.

Concerns about HRT

Concerns have been raised in recent times in the media around HRT. What is a ‘safe’ dose of estrogen – followed up by how much progesterone should be taken to counteract any womb thickening on higher doses – and what about the link between HRT and cancer and is it ever safe to take HRT if you’ve had cancer in the past?

Estrogen dose

Dr Alice Duffy explains more:

“The majority of women in consultation with their doctor can find a combination of HRT that balances relief of symptoms with the avoidance of unwanted side effects, while still staying within licensed dosing ranges.

However, some women still experience symptoms when they’re already taking the maximum licensed dose and this would usually prompt a review of their symptoms and explore whether menopause is the main issue at play. If it is, lifestyle measures including modifications to diet, stress management, and exercise can often help and this is the core of the type of individualised care we practice at Health in Menopause.

A very small number of women will be doing everything they can to improve symptoms but still don’t feel enough relief and, in these cases, a discussion will take place to suggest the option of taking a dose of HRT that is above the licensed dose or is considered ‘high’. (These women often absorb medication poorly through the skin but for valid medical reasons do not wish to take HRT orally). In this scenario, a full discussion will take place around the benefits and any potential risks of using a higher dose, the medical history will be taken into account as well as the impact symptoms are having on her quality of life. She will then be supported to make an informed decision about her HRT regime.

We monitor all our patients closely when they start HRT or have a dose change, so any adverse effects are responded to promptly once we’re informed. It can be difficult to spot possible side effects of ‘too much’ estrogen, as they are often similar to symptoms caused by low estrogen and they also vary greatly from woman to woman.”

Progesterone dose

Alongside the dose of estrogen in HRT comes the issue of progesterone and the need to protect the lining of the womb from any thickening caused by estrogen.

Dr Sarah Ball elaborates:

“When estrogen replacement is started or the dose is changed, the level of progesterone needed to keep the womb lining thin and healthy will also be reassessed. We will also look at other risk factors for thickening of the womb lining, such as obesity or being overweight, and advise on diet and lifestyle factors to support women to reduce excess weight and lower any risks for their womb health.

Progesterone is a useful hormone in its own right of course, and there are times when a woman, particularly in perimenopause, shows signs of low or falling progesterone and we may recommend progesterone replacement on its own, before estrogen is suggested.”

Treating menopause in women after cancer

Dr Alison Macbeth is a breast cancer specialist menopause doctor who works in the NHS and provides specialist menopause care for Health in Menopause patients that have had breast cancer or have a high-risk family history of breast cancer.

October is also Breast Cancer Awareness Month. You can find more information about checking yourself Breast Cancer Now or read our range of resources on menopause and breast cancer here.

Dr Alison Macbeth explains the Health in Menopause approach for women affected by cancer:

“Many women believe or have been told that HRT is totally ‘off the table’ for them and they struggle, often for years, with troubling menopause symptoms. We want to help all women finding menopause difficult so we ensure we give the best evidenced based menopause care that we can for women who have had cancer or have a high risk of cancer and those with complex medical histories. Dr Duffy, Dr Ball, and myself follow recent guidance from the BMS on Management of Menopausal Symptoms after Gynaecological Cancer, for example.

Prescribing HRT in women affected by cancer only happens after very careful consideration and a full discussion of any risks and potential benefits. If possible, we will endeavour to communicate with the individual’s cancer care team although women often come to us many years after they have been discharged from cancer services. All women are monitored closely if HRT is started, so we can respond swiftly to any adverse effects should they arise.”

If you are concerned about your HRT regime and any associated peri/menopause symptoms, contact your GP or the doctor that prescribed your HRT. If you would like to have a consultation with a Health in Menopause specialist doctor, you can find out more visit our homepage.

Last updated: June 2026