Types of HRT: Which Is Right for You? (UK Complete Guide)

by Goldman Labs Team

Key Takeaways

Understanding the different types of HRT empowers women to make informed decisions about their menopause treatment, ensuring they find the most suitable option for their individual needs and circumstances.

• Body identical HRT offers the safest profile - Micronised progesterone and 17 beta oestradiol have identical molecular structures to natural hormones, reducing side effects and health risks compared to synthetic alternatives.

• Uterus status determines hormone requirements - Women with intact wombs need combined estrogen-progesterone therapy to prevent cancer risk, while those post-hysterectomy can safely use estrogen-only treatment.

• Delivery method impacts effectiveness and safety - Transdermal options (patches, gels, sprays) carry lower blood clot risks than tablets, while offering flexible dosing and steady hormone release.

• Sequential vs continuous timing depends on menopause stage - Perimenopausal women typically use sequential HRT with monthly bleeds, switching to continuous combined therapy after 12 months without periods.

• Specialist options address specific symptoms - Testosterone helps with low libido and energy when standard HRT proves insufficient, while vaginal estrogen treats localized symptoms without systemic risks.

Most women require 2-5 years of treatment and often need to try different formulations before finding their optimal regimen. Working with healthcare professionals ensures safe, effective personalized treatment that can significantly improve quality of life during menopause. Women often feel overwhelmed by the options available when choosing between different types of HRT, but the process doesn't have to be complicated. Most women need to take HRT for 2 to 5 years, and finding the right fit from the start becomes crucial. HRT remains the most effective solution for helping with symptoms of menopause. This piece explores HRT types UK options, including body identical HRT and bioidentical HRT, along with the different types of HRT delivery methods. Readers will learn about estrogen and progesterone formulations, combined versus estrogen-only options and how to choose the best type based on individual circumstances.

Understanding HRT Hormones: Estrogen and Progesterone

HRT works by replacing hormones that decline during menopause. The two main hormones involved are estrogen and progesterone. Understanding which type of each hormone suits individual needs makes a most important difference to both effectiveness and safety.

Estrogen types: Body identical vs synthetic

The optimal estrogen used in HRT menopause treatment is 17 beta oestradiol ^[1]. This body identical hormone has the same molecular structure as the estrogen that decreases during perimenopause and beyond. Estradiol is the most common estrogen in HRT formulations ^[1].

Plant chemicals extracted from yam plants provide the source for body identical estrogen ^[1]. This natural source undergoes laboratory processing to create hormones structurally identical to those the body produces. Common brand names include Elleste Solo, Bedol, Progynova and Zumenon tablets. Patches include Evorel, Estradot, Estraderm, Femseven and Progynova. Gels include Oestrogel and Sandrena, and Lenzetto spray ^[1].

Older HRT formulations contain conjugated oestrogens, notably Premarin, which is made from pregnant mares' urine ^[1]. This type contains multiple oestrogens that bodies don't produce. Doctors rarely prescribe this form these days ^[1]. Body identical options offer better safety profiles.

Progesterone vs progestogen: What's the difference

Infographic comparing natural progesterone and synthetic progestogen (progestin) with chemical structures and lab visuals.

Progesterone and progestogen sound alike but represent distinct hormone types. Progesterone refers to the hormone that occurs in nature, while progestogen (called progestin in the US) describes synthetic versions created in laboratories ^[2].

The chemical structure makes all the difference. Synthetic progestogens have molecular structures that differ from natural progesterone and can cause different side effects ^[2]. Body identical progesterone, such as Utrogestan available in the UK, has the same chemical structure as the progesterone bodies make ^[2]. Laboratory processing uses sweet potatoes or yams, yet it remains structurally identical ^[2].

Micronised progesterone stands out as the optimal progestogen choice ^[1]. The term "micronised" means the particles are reduced to very fine powder and suspended in oil. This makes absorption through the gut easier ^[2]. Studies show women taking micronised progesterone experience fewer side effects than those using older synthetic progestogens ^[2].

Synthetic progestogens include norethisterone, medroxyprogesterone acetate (MPA), and dydrogesterone ^[2]. These older types, when given as tablets or combination patches, carry a higher risk of blood clots and heart disease ^[2]. Micronised progesterone doesn't increase the risk of blood clots or heart disease ^[2].

Breast cancer risk also is different by progestogen type. Women taking estrogen with micronised progesterone show no increased breast cancer risk for at least five years of use ^[2]. The risk remains very low even after this period and is lower than risks associated with older synthetic progestogens ^[1]. Research from France found no increased breast cancer risk for estrogen-progesterone users (relative risk 1.00). Estrogen plus synthetic progestins showed relative risks between 1.16-1.69 depending on the specific progestin ^[3].

Why Women with Natural Cycles Need Both Hormones

Women who still have their womb require both estrogen and progesterone menopause treatment ^[4]. Taking estrogen alone causes the womb lining to build up and thicken over time ^[2]. This thickening can increase endometrial cancer risk ^[5].

Progesterone prevents this dangerous build-up by regulating and thinning the womb lining ^[2]. The protective effect means there is no increased womb cancer risk when taking combined HRT ^[1]. Women who have had a hysterectomy to remove their womb can take estrogen-only HRT without needing progesterone ^[1].

The requirement for both hormones applies whatever the delivery method. Women might take estrogen as patches or gel and progesterone as capsules, or use combined preparations containing both hormones ^[4]. Some women receive their progesterone through a Mirena coil, which releases the hormone directly into the womb ^[2].

Different Types of HRT Delivery Methods

HRT delivery methods matter just as much as the hormones themselves. Each option offers distinct advantages. Women often need to try different formats before finding what works best for their lifestyle and body.

Patches (transdermal)

Estrogen patches stick onto clean, dry skin below the waist, on the buttock or upper thigh ^[1]. Patches release different amounts of estradiol into the body every 24 hours, depending on the brand ^[1]. Most patches require changing once or twice weekly ^[1].

Women should avoid placing patches near breasts, on cuts or irritated skin, under tight clothing, on skin creases, or on areas treated with moisturizer ^[1]. Absorption reaches peak levels at 12 hours and remains stable over seven days. It drops to baseline within 24 hours of removal if no replacement patch is applied ^[1]. About 10% of patches fall off and prevent proper hormone absorption ^[1].

Patches provide steady estrogen release. They don't increase blood clot risk compared to tablets ^[1]. Skin irritation or marks can occur, though applying patches to dry, non-moisturized skin helps ^[1].

Gels and sprays

Oestrogel comes in pump dispensers containing 64 doses, with one pump supplying 0.75mg of estradiol ^[1]. Sandrena arrives in sachets of 0.5mg or 1mg ^[1]. Both gels rub onto the outer arms from shoulder to elbow or inner thighs. They take 2-5 minutes to dry ^[1].

Lenzetto spray contains 1.53mg estradiol per spray, applied to the inner forearm ^[1]. Women use one to three sprays daily, though some require more ^[1]. The spray dries within two minutes but requires waiting one hour before bathing ^[1].

Gels and sprays offer dosing flexibility. Women can adjust amounts based on symptom severity in consultation with healthcare professionals ^[1]. Peak estradiol levels occur within 3-5 days of starting gel and return to pre-treatment levels six days after stopping ^[1].

Tablets (oral)

Estrogen tablets come in 1mg or 2mg strengths, taken once daily with water ^[1]. Women can start tablets at any time if periods have stopped or are infrequent, or between days 1-5 of a regular cycle ^[1].

Tablets remain one of the most common HRT types UK options ^[1]. Taking tablets once daily may be the easiest treatment method ^[1]. Blood clot risks run higher with tablets than transdermal options, though overall risk remains small ^[1].

Mirena coil (IUS)

The Mirena coil functions as the progesterone menopause component of HRT for women with a uterus ^[6]. This intrauterine system releases levonorgestrel into the womb and provides endometrial protection whilst offering contraception and bleeding control ^[6].

The Mirena lasts five years as part of HRT regimens once fitted ^[6]. Women can start estrogen right after insertion ^[6]. The localized hormone delivery often causes fewer side effects than oral progesterone ^[6]. One study found the levonorgestrel-releasing IUS reduces blood loss by more than 90% over six months for most women with heavy menstrual bleeding ^[6].

Vaginal estrogen

Vaginal estrogen treats localized symptoms such as dryness, burning, or pain during sex ^[1]. Available formats include tablets (Vagifem, Vagirux, Gina), pessaries (Imvaggis), creams (Ovestin, Ovesse), gel (Blissel), and rings (Estring) ^[1][1].

Vaginal tablets require insertion once daily for two weeks, then twice weekly ^[1]. The Estring ring stays in place for three months ^[1]. Vaginal estrogen doesn't carry the same risks as systemic HRT and doesn't increase breast cancer risk ^[1]. Women can use it without progesterone, maybe even with an intact uterus, because little medicine enters the bloodstream ^[1].

Implants

Hormone implants are small crystalline pellets containing body identical hormones inserted under the skin, in the abdomen or buttock ^[7]. Both estradiol 50mg and testosterone 100mg implants remain unlicensed in the UK but specialists use them when other options fail ^[7].

Implants last 6-8 months ^[7]. Blood tests every six months monitor hormone levels ^[7]. The physiological estradiol range is 250-600pmol, though higher limits may be agreed in exceptional cases ^[7]. Estrogen levels can become very high in about 3% of cases and cause symptoms to return sooner than six months ^[7].

Combined HRT vs Estrogen-Only HRT

Infographic comparing combined HRT for women with womb and estrogen-only HRT for women without womb, showing safety and effectiveness.

Whether combined or estrogen-only HRT menopause suits individual needs mainly depends on one factor: whether the womb remains intact. This difference shapes both safety profiles and menopause treatment effectiveness.

Who needs combined HRT

Women who still have their womb require both estrogen and progestogen, known as combined HRT ^[1]. Estrogen alone thickens the womb lining over time ^[4]. This thickening increases the risk of womb cancer ^[1]. Progestogen prevents abnormal thickening and keeps the womb lining stable and healthy ^[4].

The protective mechanism works through regular shedding. Progestogen stops the womb lining from getting too thick. When stopped (usually for a few days each month), this causes the womb lining to shed like a period ^[4]. Both hormones together reduce womb cancer risk ^[1].

This requirement applies whatever the age or perimenopause stage. Women experiencing what is menopause symptoms whilst still having periods need combined therapy just as much as those in postmenopause.

Several specific situations require combined HRT even after surgical procedures. Women who had a subtotal hysterectomy, where the womb is removed but the cervix remains, may need combined treatment as some womb lining might remain ^[8]. Those who went through endometrial ablation, a procedure destroying the womb lining, still require combined HRT ^[8]. Women who had a hysterectomy for endometriosis may also need combined therapy if residual intra-peritoneal endometriosis exists ^[6].

Who can take estrogen-only HRT

Women who have had their womb removed during a hysterectomy should take estrogen-only HRT ^[1]. Without a uterus, there is no therapeutic advantage in prescribing progestogen ^[6]. Adding progestogen creates distinct disadvantages in terms of increased breast cancer and thrombotic risk, plus adverse changes in cardiovascular risk factors ^[6].

Women experiencing premature menopause or early menopause before age 45 should take estrogen until the average age of what is menopause at 50 years ^[6]. This applies especially to those who experienced induced menopause through surgery.

Research shows women using estrogen-only HRT after hysterectomy have a reduced risk of developing or dying from breast cancer ^[6]. But women with a family history of breast cancer do not seem to benefit from the protective effects of estrogen-only HRT ^[6]. The potential benefit needs balancing against an increased risk of blood clots and strokes ^[6].

Estrogen reduces the severity and frequency of hot flushes by around 85% ^[6]. Beyond symptom relief, it improves vaginal dryness menopause concerns and reduces the risk of post-menopausal bone fracture, including hip fracture ^[6]. In stark comparison to this common belief, estrogen use is not associated with weight gain ^[6].

Body identical HRT options in the UK

Body identical HRT formulations contain hormones structurally similar to those the body produces naturally. Micronised progesterone represents the gold standard body identical option ^[1]. Available as Utrogestan in the UK, this capsule form mirrors the body's own natural progesterone menopause production ^[1].

Women can take micronised progesterone with estrogen patches, gel, spray or tablets ^[7]. Micronised progesterone carries several advantages when you compare it to synthetic progestogens. It doesn't affect heart disease or blood clotting risk ^[4]. Studies show no increased breast cancer risk for at least five years when you take estrogen with micronised progesterone ^[8].

Bijuve offers another body identical option. This tablet contains both 1mg estradiol and 100mg body identical progesterone in a single softgel capsule taken daily ^[1]. This represents the only combined tablet in the UK containing both body identical hormones together ^[1].

The Mirena coil, while not classified as body identical, provides a safe and effective progestogen option with the least side effects or risk compared to other types ^[1]. Many women seeking NHS menopause services or consulting a menopause specialist UK opt for this alongside estrogen therapy. Understanding HRT prescription cost UK helps women make informed choices about these different formulations.

Sequential vs Continuous Combined HRT

Woman holding birth control pills and a glass of water, illustrating Hormone Replacement Therapy (HRT) guide.

The timing of hormone intake determines which HRT types UK regimen suits individual needs. Sequential and continuous combined options both contain estrogen and progesterone menopause hormones, but differ in how these hormones are scheduled throughout the month.

Sequential HRT for perimenopause

Sequential combined HRT, also called cyclical HRT, involves taking estrogen every day whilst adding progesterone for only 10 to 14 days of each 28-day cycle ^[7]. Doctors recommend this pattern for women still experiencing periods or whose last period occurred less than 12 months ago ^[8].

Two scheduling patterns exist within sequential therapy. Monthly HRT suits women having regular periods and requires progesterone for the last 14 days of the menstrual cycle ^[9]. Three-monthly HRT works better for women with irregular periods, adding progesterone for about 14 days every three months ^[9]. Withdrawal bleeding occurs at the end of each progesterone course in both cases ^[7].

Sequential HRT mimics natural hormone cycles and leads to monthly withdrawal bleeds like contraceptive pill effects ^[6]. Some women experience no bleeding whilst taking sequential HRT, which causes no concern provided progesterone is taken as prescribed ^[10]. Others continue getting withdrawal bleeds even when natural periods have stopped. This makes it harder to determine when to switch regimens ^[6].

Continuous combined HRT for post-menopause

Continuous combined HRT involves taking both estrogen and progestogen every day without breaks ^[8]. Women in postmenopause, defined as not having had a period for one year or more, receive this regimen ^[8].

Starting continuous combined HRT too early causes irregular bleeding problems ^[8]. Up to 80% of women experience breakthrough bleeding within the first month of continuous therapy ^[6]. This decreases over time, but about half of women still have irregular bleeding after six months ^[6]. All vaginal bleeding should stop after six months or less ^[10].

Continuous combined HRT protects the womb more than sequential options ^[11]. Sequential HRT carries a higher endometrial cancer risk compared to continuous combined therapy, whilst continuous combined HRT shows greater breast cancer risk ^[12].

When to switch between types

Women take sequential combined HRT for 2 to 5 years before switching to continuous therapy ^[7]. Medical guidance recommends switching after five years of use or by age 54, whichever comes first ^[13]. But timing depends on individual circumstances.

A 50-year-old having periods every few months might use sequential therapy for one year before trialing a switch. A 45-year-old with regular periods might continue sequential therapy for 4-5 years ^[12]. If unscheduled bleeding occurs after switching to continuous therapy, reverting to sequential for another year resolves the issue ^[12].

Periods sometimes stop whilst taking sequential HRT and allow earlier transition to continuous regimens ^[6]. Conversely, if bleeding returns after switching, the change occurred too soon and reverting to sequential becomes necessary ^[6]. This trial and error approach helps identify optimal menopause treatment timing for each woman.

Specialist HRT Options: Testosterone and Tibolone

Some women need specialist HRT menopause options beyond standard estrogen and progesterone therapy. Testosterone and tibolone address specific symptoms that conventional treatments may not fully resolve.

Testosterone for low libido and energy

Testosterone is an important female hormone. Women produce more testosterone than estrogen ^[1]. The ovaries and adrenal glands each contribute about half of endogenous testosterone and precursors ^[1]. Testosterone levels decline throughout a woman's lifespan, with loss especially profound after induced menopause when production decreases by more than 50% ^[1].

NICE guidelines state testosterone supplementation can be thought about for menopausal women with low sexual desire if HRT alone doesn't work ^[1]. Testosterone maintains normal metabolic function and muscle strength. It also supports bone health, urogenital function, mood and cognitive performance ^[1]. Many women notice improvements in mood, concentration and motivation. Energy levels often improve as well ^[14].

Studies show transdermal testosterone does not increase breast cancer risk or cardiovascular disease. It doesn't cause venous thromboembolism ^[1]. Blood pressure, renal function and liver function remain unaffected. Blood cell indices also stay normal ^[1].

Tibolone (Livial): Who it suits

Tibolone is a synthetic steroid hormone whose metabolites have oestrogenic, progestogenic and androgenic properties ^[15]. Postmenopausal women who haven't experienced a natural period for at least one year can take tibolone as 2.5mg tablets once daily [154, 158].

Evidence suggests tibolone is less effective than combined menopause treatment options for controlling vasomotor symptoms ^[15]. But it improves sexual function in women with low libido ^[15]. Women with breast cancer history shouldn't use tibolone. Women over age 60 should use it cautiously due to increased stroke risk ^[15].

UK availability and prescribing

No testosterone products hold licenses for female use in the UK ^[1]. Male-licensed products including Tostran and Testogel can be prescribed off-label in female doses ^[1]. AndroFeme, a 1% testosterone cream designed for female use, received MHRA approval in August 2025 ^[16]. Specialists initiate testosterone therapy, with GPs continuing prescriptions after 3-6 months stabilization ^[17].

Choosing the Right HRT Type for You

Doctor in a white coat consulting a patient about hormone replacement therapy in a modern office setting.

Selecting the right HRT menopause option depends on several individual factors ^[4]. Multiple elements shape which treatment works best.

Factors that influence your HRT choice

Combined or estrogen-only therapy depends on whether you've had a hysterectomy ^[4]. Your perimenopause or postmenopause stage influences sequential versus continuous regimens. Your priorities regarding delivery method matter substantially ^[4]. Medical history affects whether transdermal or oral HRT patches vs pills suits you best, including clotting risks. Doctors prescribe low doses at first and increase them later if needed ^[18].

Body identical vs bioidentical: Understanding the difference

Body identical HRT contains regulated hormones that match those your body produces. NICE guidelines recommend them, and NHS menopause services prescribe them ^[19]. Bioidentical hormones refer to compounded products that pharmacies custom-make. They are unregulated and unlicensed ^[19]. No evidence shows compounded bioidentical hormones work better than body identical types ^[19].

What to discuss with your GP

You should discuss symptoms, medical history and HRT side effects to identify suitable options ^[20]. A 3-month review assesses effectiveness ^[21]. Complex cases may need consultations with a menopause specialist UK.

Switching between HRT types

You should take menopause treatment for a few months before trying alternatives ^[18]. Side effects often improve, but persistent issues warrant switching ^[18].

Managing HRT shortages in the UK

Pharmacists can supply specified alternatives under serious shortage protocols without adjusted prescriptions ^[10]. Private prescriptions offer another option when HRT prescription cost UK allows ^[10].

Conclusion

You don't need to find the right HRT on the first try. Body identical options like micronised progesterone and transdermal estrogen delivery offer the safest profiles with fewer side effects, as I wrote in this piece. Women still having periods typically start with sequential combined therapy, whilst those in postmenopause can use continuous combined regimens.

The choice between patches, gels, tablets, or other delivery methods depends on individual circumstances, medical history and personal preference. A conversation with a GP or menopause specialist about symptoms and concerns helps identify the most suitable starting point. Most women need to try different formulations before finding what works best, and that's normal.

FAQs

Q1. Do I need to take both estrogen and progesterone for HRT? If you still have your womb (uterus), you need to take both estrogen and progesterone. Taking estrogen alone can cause the womb lining to thicken, which increases the risk of endometrial cancer. Progesterone protects against this by regulating the womb lining. However, if you've had a hysterectomy to remove your womb, you can safely take estrogen-only HRT without needing progesterone.

Q2. What's the difference between body identical and bioidentical HRT? Body identical HRT contains regulated hormones that are structurally identical to those your body naturally produces, such as micronised progesterone (Utrogestan) and 17 beta oestradiol. These are recommended by NICE guidelines and available through the NHS. Bioidentical hormones, on the other hand, refer to custom-compounded products made by pharmacies that are unregulated and unlicensed, with no evidence showing they work better than body identical options.

Q3. Which HRT delivery method is safest - patches, gels, or tablets? Patches and gels (transdermal methods) are generally considered safer than tablets because they don't increase the risk of blood clots. Tablets carry a slightly higher risk of blood clots and heart disease, though the overall risk remains small. Transdermal options deliver hormones through the skin directly into the bloodstream, bypassing the liver and reducing certain health risks.

Q4. When should I switch from sequential to continuous combined HRT? You should typically switch from sequential (cyclical) to continuous combined HRT after your periods have stopped for at least 12 months, or after taking sequential HRT for 2-5 years. Medical guidance generally recommends switching after five years of use or by age 54, whichever comes first. If you experience irregular bleeding after switching, you may need to revert to sequential therapy for another year.

Q5. Can testosterone help with low energy and libido during menopause? Yes, testosterone can be prescribed for menopausal women experiencing low sexual desire if standard HRT alone hasn't been effective. Beyond improving libido, testosterone can help with mood, concentration, motivation, and energy levels. It also supports muscle and bone strength. While no testosterone products are currently licensed for female use in the UK, male-licensed products can be prescribed off-label in appropriate doses for women.

References

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