HRT for Menopause: Complete UK Guide to Options, Risks & Benefits

by Goldman Labs Team

Hot flushes disrupting your work meetings? Night sweats keeping you awake? You're not alone—80% of women experience these troublesome symptoms during menopause, and HRT treatments are becoming the go-to solution for relief [13]. The numbers tell the story: NHS prescribed 13 million HRT items to 2.6 million patients in England during 2023/24, up from just under 11 million items for 2.3 million women the previous year [13].

HRT tackles those bothersome symptoms like hot flushes and night sweats head-on, often bringing relief within weeks [13]. But the benefits go beyond symptom control—HRT options available in the UK help prevent bone loss and reduce fracture risk [13] [12]. While concerns about breast cancer risk exist [13], extensive research shows that for most women, HRT benefits far outweigh the potential risks [12].

This guide covers everything you need to know about HRT benefits, side effects, and your options in the UK. Whether you're just starting to notice perimenopause symptoms or already exploring treatment choices, you'll find evidence-based information to help make the right decision about hormone replacement therapy during this important life change.

What is HRT and how does it work?

Diagram showing shared and distinct risk factors and biological effects of cardiovascular disease and osteoarthritis across community, body, and cellular levels.

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Hormone replacement therapy (HRT) works by replacing the hormones your body produces less of as you approach and enter menopause. This medical treatment addresses the root cause of menopausal symptoms by restoring hormone levels that have naturally declined during this major life transition.

Understanding hormone changes during menopause

Your ovaries start producing fewer hormones as part of the natural ageing process. This typically happens to women between ages 45 and 55 [13], though some experience premature menopause or induced menopause earlier due to medical procedures like hysterectomy.

During perimenopause, your ovaries become less responsive to control signals from the pituitary gland—specifically follicle-stimulating hormone (FSH) and luteinising hormone (LH) [9]. The result? Declining oestrogen and progesterone production, which creates the hormonal fluctuations behind those troublesome physical and emotional symptoms.

Dropping oestrogen levels trigger multiple changes throughout your body:

Increased central abdominal fat storage
Insulin resistance, raising type 2 diabetes risk
Impaired blood vessel function and adverse cholesterol profiles
Accelerated bone loss, starting even before your final period [9]

Research shows 40% to 60% of women seek treatment for menopausal symptoms, while 20% delay treatment for over a year [9]. Even older women aren't immune—42% of those aged 60 to 64 and 33% aged 65 to 79 still experience hot flushes and night sweats [9].

What hormones are replaced in HRT?

HRT focuses on two key hormones: oestrogen and progesterone. Beyond reproduction, these hormones support crucial functions including bone strength and heart health [13].

Your treatment options include:

Oestrogen-only HRT: Designed specifically for women who've had their womb removed through hysterectomy [13]. Since there's no uterus to protect, oestrogen alone effectively manages symptoms.

Combined HRT: Essential for women with an intact uterus, combining oestrogen with progestogen [13]. The progestogen prevents abnormal womb lining growth that oestrogen alone might cause [10].

Different oestrogen forms are available:

Conjugated equine oestrogen (mixed oestrogens from natural sources)
Synthetic conjugated oestrogens (including oestrone sulphate)
Micronized 17β-oestradiol (identical to your ovaries' natural oestradiol) [9]

Testosterone may also be prescribed, though it's not currently licensed specifically for menopausal symptoms in the UK. A specialist can prescribe it when clinically appropriate [13].

How HRT helps with menopause symptoms

HRT delivers impressive results by restoring hormone levels close to what your body previously produced. Most women experience significant symptom relief once supplementation begins [10]. HRT effectively addresses:

Hot flushes and night sweats, often improving within weeks of starting treatment [18]
Vaginal dryness and painful intercourse
Mood swings, depression and irritability
Sleep disturbances and insomnia
Brain fog and cognitive symptoms
Urinary issues, including leakage

The benefits extend beyond symptom control. HRT protects bone health by preventing osteoporosis and fractures—crucial since declining oestrogen can cause women to lose up to one-fifth of their bone density within five to seven years after menopause [9].

HRT may also protect against cardiovascular health problems [9]. Studies indicate the most favourable risk-benefit profile occurs when starting HRT before age 60 or within 10 years of menopause [13].

Most women take HRT for 2 to 5 years, though duration varies based on individual needs [13]. Healthcare providers regularly monitor and adjust dosages to maximise benefits while minimising potential risks.

HRT Options Available in the UK

Multiple HRT choices exist to tackle menopause symptoms, from convenient tablets to skin patches and gels. No single approach works for everyone—understanding your options helps you choose the right treatment with your doctor's guidance.

Tablets and Oral HRT

Oral HRT offers a straightforward, cost-effective approach that many women prefer. These daily tablets contain either oestrogen alone or combined hormones, though they carry a slightly higher risk of blood clots and stroke compared to skin-based options [12].

Two main tablet types are available:

Continuous combined tablets work best for women who haven't had a period for at least 12 months. Each tablet contains both oestrogen and progestogen, taken daily without breaks. Popular UK brands include Kliofem, Kliovance and Femoston Conti [11].

Sequential combined tablets suit women still having periods or whose last period occurred within 12 months. You take oestrogen daily, with progestogen added for 10-14 days each cycle. Common options include Elleste Duet, Femoston and Novofem [11].

Patches and Skin Applications

Patches deliver hormones gradually through your skin, avoiding the digestive system entirely. This means no increased blood clot risk—making them safer than tablets for many women [4].

Doctors particularly recommend patches for women with higher venous thromboembolism (VTE) risk, including those with a BMI over 30 kg/m² [4]. UK options include Evorel, Estradot, Estraderm, FemSeven and Progynova [12].

Apply patches to clean, dry skin below the waist, steering clear of breast areas [4]. Most women find them convenient, though some experience mild skin irritation or occasional detachment during exercise [13].

Gels and Sprays

Gels and sprays are becoming popular choices for hormone replacement therapy. Applied once daily to your skin, they let hormones absorb gradually into your bloodstream.

Your main options include:

Gels (Oestrogel, Sandrena) applied to upper arms or thighs [12]
Sprays (Lenzetto) sprayed onto inner arm or thigh [13]

Like patches, these skin treatments don't increase blood clot risk [13]. Allow 5 minutes for gels and 2 minutes for sprays to dry before dressing [13]. Avoid skin-to-skin contact with others at application sites for about 60 minutes to prevent transferring medication [12].

Vaginal Oestrogen Treatments

Women experiencing mainly vaginal dryness can benefit from targeted vaginal oestrogen. This low-dose treatment focuses on local symptoms with minimal effects elsewhere, making it suitable even for women who can't take systemic HRT [9].

Available forms include:

Tablets/pessaries (Vagifem, Vagirux, Gina, Imvaggis) inserted using an applicator or finger
Creams/gels (Ovestin, Blissel) applied with an applicator
Rings (Estring) inserted for 90-day continuous release [9] [10]

Since vaginal oestrogen has minimal whole-body absorption, women with an intact uterus can use it without progestogen [13]. Studies show estriol cream reduces symptom severity scores by 48% [12].

Body-Identical vs Synthetic Hormones

"Bioidentical" describes hormones with identical chemical structures to those your body produces naturally [11]. Both NHS and private prescriptions can include these options.

The safest approach often involves "body-identical" hormones—those matching your natural hormone structure, typically derived from plant sources like Mexican yams [4] [12]. These include oestradiol for oestrogen and micronised progesterone (Utrogestan in the UK) [4].

Older preparations sometimes contain synthetic hormones or animal-derived mixtures (like Premarin from pregnant mares' urine) [12]. Some practitioners believe bioidentical hormones cause fewer side effects due to their natural structure similarity [12], though the North American Menopause Society warns about potential risks with unregulated compounded versions [11].

Oestrogen-only vs combined HRT

Choosing the right hormones for your HRT treatment comes down to one key factor: whether you still have your womb. This decision affects both your safety and how effective your treatment will be for managing menopause symptoms.

When is oestrogen-only HRT used?

Had a hysterectomy? Then oestrogen-only HRT is your go-to option. Women who've had their womb surgically removed don't need progestogen—there's simply no benefit to adding it [13] [14]. Oestrogen alone tackles your symptoms without exposing you to unnecessary hormones.

This simpler approach works brilliantly for addressing hot flushes, night sweats, and vaginal dryness without any womb cancer risk. One hormone instead of two means fewer potential side effects and often better tolerance.

Why combine oestrogen with progestogen?

Still have your womb? You'll need combined HRT for your safety. Oestrogen on its own can cause the womb lining to thicken abnormally, slightly raising endometrial cancer risk [5]. Progestogen acts as your protective shield, preventing this dangerous build-up [5].

Your menopause stage determines which combined approach works best:

Sequential combined therapy suits women who've had a period within the last 12 months [1]
Continuous combined therapy works for those period-free for at least a year [1]

This combination approach gives you symptom relief while keeping you safe—exactly what you need during this transition.

Micronised progesterone and its benefits

Utrogestan represents the gold standard in progesterone therapy. Unlike older synthetic versions, this medication contains progesterone identical to what your body naturally makes [15].

Derived from plants like yam or soy, micronised progesterone delivers real advantages [16]:

Fewer side effects than synthetic alternatives [16]
No increased blood clot or heart disease risk [16]
Lower breast cancer risk for the first five years [4]

This "body identical" match means your body recognises and tolerates it better, reducing unwanted effects like mood swings, bloating, or skin problems [4].

Testosterone in HRT for women

Think testosterone is just for men? Think again. Women's ovaries actually produce more testosterone than oestrogen before menopause [4]. When these levels drop, some symptoms persist despite standard HRT.

The 2024 NICE guidelines now recommend testosterone for women with low sexual desire when regular HRT isn't enough [17]. Applied as a gel or cream, it absorbs directly through your skin [18].

Testosterone can help with more than just libido:

Boosted energy and physical stamina [17]
Better mood and less anxiety [17]
Clearer thinking and reduced brain fog [17]
Stronger muscles and bones [17]
Improved sleep quality [17]

Research involving 1,200 women found testosterone's biggest wins came in mood and anxiety improvement, not just sexual symptoms [19].

HRT Benefits That Go Beyond Symptom Relief

"HRT initiated before the age of 60 or within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality." — British Menopause Society (BMS), Leading UK authority on menopause and hormone therapy

Older adult starting hormone replacement therapy, highlighting benefits, considerations, and treatment options after 65

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HRT offers powerful health benefits that extend far beyond tackling hot flushes and night sweats. These science-backed advantages support multiple body systems and can influence your long-term health outcomes during the menopause transition.

Stronger Bones and Fracture Prevention

Your bones need oestrogen to stay strong and healthy. When oestrogen levels drop during menopause, women can lose up to one-fifth of their bone density in just 5-7 years—dramatically increasing fracture risk. HRT helps maintain bone strength and reduces both spine and hip fracture risks [20].

Women experiencing early or premature menopause (before age 45) benefit most from HRT bone protection. Doctors typically recommend continuing hormone therapy until at least age 51 to guard against osteoporosis and other health conditions [2]. Even women already diagnosed with osteoporosis see bone strengthening effects, reducing their fracture risk significantly [2].

The research supporting HRT for bone health is impressive—studies show it can increase bone density by approximately 7% over two years and cut spinal fractures by one-third [21].

Heart Health Protection and Lower Disease Risk

Want to protect your heart during menopause? HRT delivers significant cardiovascular benefits when started at the right time. The key is timing—oestrogen helps healthy blood vessels but may not benefit established heart disease [8].

Women who start HRT within 10 years of menopause and before age 60 see remarkable heart health improvements:

32% reduction in coronary heart disease [8]
Up to 52% decreased cardiovascular disease risk after 10 years of treatment [8]
39% lower all-cause mortality [8]

HRT also reduces new diabetes cases by 20-30%, offering extra metabolic protection [8]. The British Heart Foundation notes that HRT can improve cholesterol levels, though some formulations may have varying effects [22].

Better Mood, Sleep and Mental Clarity

Struggling with brain fog or mood changes? HRT can help with cognitive function, though research continues to explore its full potential for preventing dementia.

Oestradiol helps regulate key brain chemicals linked to depression—serotonin, dopamine, and norepinephrine [6]. This explains why HRT often improves mood swings during menopause. One study found women taking oestrogen plus progesterone were significantly less likely to experience depression compared to those on placebo (17.3% vs 32.3%) [6].

Sleep quality improves too, as HRT reduces the night sweats that frequently disrupt rest. Better sleep naturally enhances both cognitive function and emotional wellbeing.

Enhanced Muscle Strength and Youthful Skin

HRT helps preserve muscle strength during menopause transition. The NHS confirms that hormone therapy can improve muscle strength and help maintain strong muscles when combined with regular exercise [3].

Your skin benefits significantly from oestrogen therapy:

Increased hydration and reduced dryness [23]
Enhanced collagen content—up to 48% increase in some studies [23]
Improved thickness and elasticity [23]
Fewer wrinkles and better overall appearance [24]

Research shows postmenopausal women on HRT have significantly thicker skin compared to those without treatment [23]. Studies also reveal improved water retention and better barrier function in the skin's outer layer [23].

These wide-ranging benefits show why healthcare professionals view HRT as more than symptom management—it's protection for multiple body systems during your menopausal transition.

Risks and side effects of HRT

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Like all medications, HRT comes with certain risks alongside its benefits. Understanding these potential issues helps you make informed decisions about menopause treatment that's right for your situation.

Breast cancer: what the evidence says

Research shows a small increase in breast cancer risk with HRT use. Women taking combined HRT for 5 years face approximately 5 additional cases per 1,000 women [3]. The risk depends on which type you choose—combined therapy (oestrogen plus progestogen) carries higher risks than oestrogen-only HRT [25]. For women who've had a hysterectomy using oestrogen-only therapy, studies show little to no increased breast cancer risk [3].

Blood clots and stroke risk

Your delivery method makes a real difference here. Oral HRT tablets do slightly increase blood clot and stroke risk [3]. Patches, gels and sprays work differently—they deliver hormones through the skin, bypassing the liver and not increasing clot risk [26]. This is why women with higher clot risk usually get recommended transdermal options instead of tablets [3].

Gallbladder and liver concerns

HRT users do face increased gallbladder disease risk, with studies showing higher gallstone incidence across all hormone types [27]. However, transdermal therapy presents much lower gallbladder risks compared to oral forms (1.3 versus 2.0 per 100 women over five years) [28]. For every 140 women choosing patches over tablets during five years, one gallbladder removal could potentially be avoided [29].

Dementia and cognitive risks

The research on dementia remains mixed. Some studies suggest oestrogen may reduce dementia risk, while others indicate potential increases [30]. A large Danish study found that hormone therapy might increase dementia risk in later life [31]. Timing seems crucial—starting HRT after age 65 appears more likely to affect cognitive risk than earlier treatment [32].

Common side effects and how to manage them

Most side effects settle within three months of starting HRT [7]. Common issues from oestrogen include headaches, breast tenderness, and unexpected vaginal bleeding [7]. Progestogen may cause mood changes, nausea, and mild rash [7]. The good news? Most women experience either no side effects or only minor ones [7]. Despite weight gain concerns, evidence suggests minimal association with most HRT types [7].

If breast tenderness or unexpected bleeding continues beyond six months, speak to your healthcare provider about adjusting your dosage or changing HRT type [33]. For nausea, taking tablets with food and sticking to simple meals while your body adjusts usually helps [33].

Who should and shouldn't take HRT

Not every woman can safely take HRT. Certain medical conditions make hormone therapy unsuitable, requiring careful assessment before starting treatment.

Medical conditions that may prevent HRT use

Some women face higher risks from hormone replacement therapy. These include women with:

History of hormone-sensitive cancers like breast, endometrial or ovarian cancer
Active or recent venous thromboembolism (blood clots)
Untreated high blood pressure
Active liver disease
Undiagnosed vaginal bleeding

Women experiencing premature menopause typically benefit from HRT until at least the natural age of menopause (51) unless contraindications exist.

When to consider alternatives

Can't take HRT safely? Several effective options can help manage your symptoms:

Antidepressants for hot flushes and night sweats
Vaginal moisturisers for vaginal dryness
Lifestyle changes to support bone health and manage weight gain
Natural remedies like cognitive behavioural therapy for mood swings

Talking to your doctor about eligibility

Your GP needs the complete picture to recommend the safest treatment approach. Come prepared to discuss:

Complete medical history
Family history of cancer or clotting disorders
Current symptoms affecting your quality of life after menopause
Personal preferences regarding HRT alternatives

Regular reviews remain essential throughout treatment to reassess benefits versus risks as your health needs change.

Conclusion

The science is clear—HRT can be a game-changer for women struggling with menopause symptoms. From tackling hot flushes and night sweats to protecting bone health and supporting cardiovascular health, hormone replacement therapy offers real solutions when you need them most.

Your options have never been better. Patches, gels and sprays eliminate the blood clot risks of tablets, while body-identical hormones like micronised progesterone deliver fewer side effects than older synthetic versions. Research consistently shows that HRT benefits outweigh risks for most women—especially when started before age 60 or within 10 years of menopause.

Some women can't take HRT due to hormone-sensitive cancers or clotting disorders. If that's you, don't worry—HRT alternatives exist to help manage symptoms, though they typically provide less consistent relief. Women with premature menopause usually benefit from HRT until at least age 51 unless medical reasons prevent it.

The key to success lies in personalised treatment. Regular check-ups with your healthcare provider ensure your treatment stays right for your changing needs. Consider your symptom severity, medical history, and personal preferences when making decisions. While natural remedies for menopause can help some women, they often fall short compared to hormone therapy.

Most women report dramatically improved quality of life once they find the right HRT approach—saying goodbye to disruptive mood swings and frustrating brain fog. Don't let menopause symptoms hold you back from enjoying life after menopause.

Ready to explore your options? Book a consultation with your GP or menopause specialist. They can assess your individual situation and create a treatment plan that works for your body and lifestyle. You deserve to feel your best during this important life transition.

Key Takeaways

Understanding HRT options and their benefits can help women make informed decisions about managing menopause symptoms and protecting long-term health.

• HRT effectively treats 80% of menopausal symptoms - Hot flushes, night sweats, and vaginal dryness often improve within weeks of starting treatment.

• Transdermal options (patches, gels, sprays) are safer than tablets - They don't increase blood clot risk and are recommended for women with higher VTE risk.

• Body-identical hormones like micronised progesterone cause fewer side effects - These match natural hormone structures and reduce risks compared to synthetic alternatives.

• Starting HRT before age 60 provides cardiovascular protection - Early initiation reduces heart disease risk by 32% and overall mortality by 39%.

• Breast cancer risk is small but real - Combined HRT adds approximately 5 cases per 1,000 women over 5 years, but benefits often outweigh risks.

The key to successful HRT lies in personalised treatment plans that consider individual medical history, symptom severity, and personal preferences. Regular medical reviews ensure optimal dosing and safety throughout treatment.

FAQs

Q1. What are the main types of HRT available in the UK? The main types of HRT in the UK include tablets, patches, gels, sprays, and vaginal treatments. Tablets and patches are common options, while gels and sprays are becoming increasingly popular. Vaginal treatments are available for localised symptoms.

Q2. How long does it typically take for HRT to start working? Most women notice an improvement in menopausal symptoms within a few weeks of starting HRT. However, it may take up to three months to experience the full benefits and for any side effects to settle.

Q3. Can HRT help with bone health during menopause? Yes, HRT can significantly improve bone health during menopause. It helps maintain bone density and reduces the risk of osteoporosis and fractures, particularly beneficial for women experiencing early or premature menopause.

Q4. Are there any cardiovascular benefits to taking HRT? HRT can offer cardiovascular benefits when started within 10 years of menopause or before age 60. It may reduce the risk of coronary heart disease and lower overall cardiovascular mortality in this group of women.

Q5. What are the main risks associated with HRT? The main risks associated with HRT include a slightly increased risk of breast cancer with combined HRT, and a small increase in the risk of blood clots with oral HRT. However, the risk varies depending on the type of HRT, method of delivery, and individual health factors.

References

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