Hormone replacement therapy (HRT) (Menopausal hormone therapy)
Medicine that replaces the hormones your body makes less of around the menopause, mainly to ease symptoms.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- HRT mainly relieves menopausal symptoms and helps protect bone; for many healthy women under 60 the benefits usually outweigh the risks.
- It is a personal balance: oral HRT raises the risk of blood clots, while patches, gels and sprays through the skin do not, so the type matters.
- Combined (oestrogen plus progestogen) HRT is linked to a small extra risk of breast cancer that rises with longer use and falls after stopping; oestrogen-only HRT has little or no effect.
- It is for symptoms and bones, not for preventing heart disease or dementia, and should be reviewed regularly with your clinician.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Relieves hot flushes, night sweats and related sleep disturbance for most women
HRT is generally not suitable if you have, or have had, certain hormone-sensitive breast cancers, untreated womb-lining problems or unexplained vaginal...
Symptoms such as flushes and sleep often start to improve. Early side effects like breast tenderness or bloating may appear and usually settle.
A clear plan for how to use HRT, when to review, and which bleeding to report.
Symptoms such as flushes and sleep often start to improve. Early side effects like breast tenderness or bloating...
A review to check how you are getting on, sort out any bleeding or side effects, and adjust the type, dose or...
Once the right regimen is found, symptoms are usually well controlled. Cyclical combined HRT may give a monthly...
A review of symptoms, blood pressure, any bleeding and whether the benefit-risk balance still suits you, and a...
What is hormone replacement therapy (HRT)?
Hormone replacement therapy (HRT) replaces oestrogen, and usually progestogen, that the body makes less of around the menopause. Its main job is to relieve menopausal symptoms such as hot flushes, night sweats, sleep problems, mood changes and vaginal dryness. It also helps protect the bones.
Most women who still have a womb take oestrogen plus a progestogen, because oestrogen alone can thicken the womb lining. Women without a womb usually take oestrogen alone. Oestrogen comes as tablets or, increasingly, as patches, gels or sprays through the skin, which carry a lower risk of blood clots than tablets. Vaginal oestrogen treats local symptoms with very little absorbed into the body.
HRT is a balance of benefits and risks that is different for each woman. For most healthy women under 60, or within 10 years of the menopause, who have troublesome symptoms and are not at high risk, the benefits usually outweigh the risks. The picture changes with age, type of HRT and personal risk factors, which is why the decision should be individual and reviewed over time.
HRT is a treatment for symptoms and bone protection, not a way to prevent heart disease or dementia, and it is not the only option.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Tablets versus through-the-skin oestrogen
| Feature | Oral (tablets) | Through the skin (patch/gel/spray) |
|---|---|---|
| Blood clot (VTE) risk | Increased | Not increased |
| Stroke risk | Small increase | Lower than tablets |
| Good if higher clot risk or BMI over 30 | Less preferred | Often preferred |
NICE suggests considering through-the-skin oestrogen for women at higher risk of blood clots, including those with a BMI over 30.
Preparing for your treatment
- Have a discussion of your symptoms, your personal and family history (especially breast cancer, blood clots, heart disease and stroke) and your preferences.
- Expect your blood pressure and usually your weight to be checked; routine blood tests are not needed to diagnose menopause in most women over 45.
- Ask whether you still need contraception, as HRT is not a contraceptive.
- If you are at higher risk of blood clots or have a higher BMI, ask about through-the-skin (transdermal) oestrogen.
- Make sure you are up to date with breast screening as offered.
- Discuss non-hormonal options too, so your choice is informed.
- Agree how and when your treatment will be reviewed, usually after about three months and then yearly.
What happens
HRT is usually started and managed in general practice or a menopause clinic, not in hospital. After talking through your symptoms, history and preferences, your clinician recommends a type, dose and route (tablet, patch, gel, spray or vaginal), and whether you need a progestogen.
You start at a suitable dose and use it daily or weekly as directed. Many symptoms begin to improve over a few weeks, though it can take a little longer to find the right type and dose. Some women have side effects such as breast tenderness, bloating or irregular bleeding at first, which often settle.
You are normally reviewed after about three months to check how you are getting on and to adjust treatment, then at least once a year. At reviews your clinician checks your symptoms, blood pressure, any side effects or bleeding, and whether the balance of benefits and risks still suits you.
There is no fixed time you must stop; the decision to continue is reviewed regularly based on your symptoms and risks.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- HRT is generally not suitable if you have, or have had, certain hormone-sensitive breast cancers, untreated womb-lining problems or unexplained vaginal bleeding until investigated.
- It is usually avoided with active or recent blood clots, certain liver disease, or untreated high blood pressure until controlled.
- Systemic HRT is not a contraceptive and is not the right choice if your only goal is preventing heart disease or dementia.
- If you still have a womb, oestrogen-only HRT is not appropriate because it can thicken the womb lining.
Delay or rearrange if…
- You have unexplained vaginal bleeding that has not yet been investigated.
- Your blood pressure is high and not yet controlled.
- You have a recent blood clot, heart attack or stroke that needs assessment first.
- A possible breast problem is being investigated.
Alternatives to discuss
- Non-hormonal medicines for hot flushes in women who cannot or prefer not to take HRT.
- Cognitive behavioural therapy and lifestyle measures for flushes, sleep and mood.
- Vaginal oestrogen or non-hormonal moisturisers for local symptoms only.
- Watchful waiting if symptoms are mild and tolerable.
- Bone-specific treatments if the main concern is osteoporosis rather than symptoms.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Relieves hot flushes, night sweats and related sleep disturbance for most women
- Can improve mood, concentration and quality of life linked to menopausal symptoms
- Treats vaginal dryness, soreness and some urinary symptoms, especially vaginal oestrogen
- Helps protect bones and reduces the risk of osteoporosis-related fractures while used
- Lets you choose a type and route that fits your symptoms and personal risk
Risks & complications
- Breast tenderness, bloating, nausea or headaches, especially in the first weeks
- Irregular or unexpected vaginal bleeding, which is common in the first 6 months after starting systemic HRT and for up to 3 months after changing the dose or type
- Mood changes related to the progestogen in some women
- Skin irritation from patches, or the bother of daily gels or sprays
- A small increase in the risk of breast cancer with combined (oestrogen plus progestogen) HRT, rising with longer use
- A small increase in the risk of blood clots with oral (tablet) HRT
- A small increase in the risk of stroke with oral HRT, particularly over 60
- Persistent or troublesome bleeding that needs investigation
- A blood clot in the leg or lung (more linked to tablets than to skin-based oestrogen)
- Gallbladder problems, more associated with oral HRT
- Serious bleeding problems that turn out to have another cause and need further tests
The main risks people worry about are breast cancer and blood clots, and the size of these depends on the type of HRT, your age and your personal risk. Combined HRT carries a small extra breast-cancer risk that rises with longer use and falls after stopping; oestrogen-only HRT has little or no effect. Oral HRT raises clot and stroke risk, while skin-based oestrogen does not raise clot risk. Tell your clinician about any history of breast cancer, blood clots, heart disease, stroke or liver problems, and report any unexpected or persistent bleeding.
Published figures to discuss
The benefits and risks of HRT vary with your age, time since menopause, the type and route of HRT, and your personal and family history. Absolute risks for most healthy women under 60 are small, but they are not zero, and the type of HRT changes them. The figures below follow NHS and NICE summaries and are expressed cautiously; individual risk should be assessed by your clinician rather than read off a table.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Extra breast cancer with combined HRT | Around 5 extra cases per 1,000 women using combined HRT for 5 years (NHS estimate) | Rises with longer use and is higher in current than past users; the risk falls after stopping. Oestrogen-only HRT has little or no effect. | NHS - Benefits and risks of HRTnhs.ukPublished figure |
| Blood clots (VTE) by route | Increased with oral HRT; not increased with through-the-skin oestrogen | NICE suggests considering transdermal oestrogen for women at higher clot risk, including BMI over 30. | NICE NG23 - Menopause: identification and management (recommendations)nice.org.ukSource-linked context |
| Stroke | Small increase with oral HRT, still low under 60 | Risk rises with age; route and personal risk factors matter. | NHS - Benefits and risks of HRTnhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Here, recovery means how your symptoms respond and what monitoring continues, rather than physical healing. Many women notice improvement within a few weeks, though finding the right type and dose can take a little longer.
- Gradual improvement in flushes, sleep and mood over the first weeks
- Early breast tenderness, bloating or headaches that usually settle
- Some irregular bleeding or spotting when starting or changing HRT
- Needing one or two adjustments to find the type and dose that suits you
Aftercare
- Use your HRT as directed, daily or weekly, and do not stop a progestogen on your own if you still have a womb.
- Report any unexpected, heavy or persistent vaginal bleeding, as it needs checking.
- Keep up with breast screening and be breast aware.
- Mention HRT to clinicians before any surgery or if you become unwell, especially with leg or chest symptoms.
- Attend your reviews so the balance of benefits and risks can be reassessed.
- Remember HRT is not contraception if you might still become pregnant.
- Tell your clinician about new symptoms or changes in your health that might affect your treatment.
- Clear instructions on how and when to use your HRT
- A note of whether you still need contraception
- A date for your 3-month and yearly reviews
- Awareness of breast screening and being breast aware
- Knowing which bleeding to report
- Knowing the symptoms of a blood clot
- A point of contact for side effects or questions
⚠ Get urgent help if…
- Pain, swelling, redness or warmth in one leg, or sudden breathlessness or chest pain, possible blood clot, seek urgent help
- Sudden severe headache, weakness, numbness, slurred speech or vision loss, possible stroke, call emergency services
- A new breast lump, skin change or nipple change, get it checked promptly
- Vaginal bleeding that starts or continues more than 6 months after starting systemic HRT, or beyond 3 months after a change of dose or type, or any bleeding that becomes heavy or concerning, or bleeding after sex, get it checked promptly
- Yellowing of the skin or eyes, or severe upper tummy pain
- Very high blood pressure readings or severe, persistent headaches
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
HRT works well when your troublesome menopausal symptoms ease and your quality of life improves, with side effects kept to a minimum and the type and dose suited to you. Vaginal oestrogen reliably helps local symptoms.
HRT does not stop the menopause or reverse ageing, and it is not taken to prevent heart disease or dementia. A good result is steady symptom control on the lowest dose that works for you, with the benefit-risk balance reviewed over time.
There is no fixed limit on how long HRT can be used; the decision to continue is reviewed regularly based on your symptoms and your personal risks. Some women use it for a few years around the menopause, others for longer. The small extra breast-cancer risk with combined HRT rises with duration of use and declines after stopping, while bone protection lasts mainly while you are taking it. Vaginal oestrogen can often be continued long term because very little is absorbed.
Related tests, treatments or support
Vaginal oestrogen can be used alongside systemic HRT if local symptoms persist. A hormonal coil can provide the progestogen part of HRT and contraception at the same time. HRT may be considered with bone treatments in women at high fracture risk, and non-hormonal medicines or talking therapies can be combined for symptoms like low mood or persistent flushes. Your clinician coordinates these.
Follow-up & long-term care
After starting HRT you are usually reviewed at about three months to check symptoms, blood pressure, bleeding and side effects and to adjust treatment, then at least once a year. Reviews reassess whether the benefit-risk balance still suits you. Some vaginal bleeding is common in the first 6 months after starting systemic HRT, and for up to 3 months after changing the dose or type; bleeding that first starts after those periods, continues beyond them, becomes heavy or concerning, or occurs after sex is assessed promptly. You should be referred on if symptoms are not controlled or new concerns arise.
- At least yearly review of symptoms, blood pressure and the benefit-risk balance
- Keeping up with breast screening and being breast aware
- Continuing the progestogen if you have a womb, to protect the womb lining
- Reporting any new, persistent or post-coital bleeding promptly
- Reviewing the type and route if your risk factors change, for example weight or a new diagnosis
Repeat, follow-on and what comes next
- Finding the right type, dose and route often takes one or two adjustments.
- Regimens may change over time, for example switching from cyclical to continuous combined HRT, or from tablets to skin-based oestrogen.
- The decision to continue, change or stop is reviewed at least yearly as symptoms and risks change.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear plan for how to use HRT, when to review, and which bleeding to report.
- A 3-month review then at least yearly reassessment of the benefit-risk balance.
- Easy access to advice for side effects and a route to investigate abnormal bleeding.
- Support to be breast aware and to keep up with breast screening.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether care is NHS or via a private menopause specialist
- Length and number of consultations and reviews
- The type and route of HRT chosen (tablet, patch, gel, spray, vaginal)
- Whether a hormonal coil is fitted for the progestogen part
- Any tests done, though routine blood tests are not usually needed over 45
- Frequency of follow-up and any letters or reports
- The clinician's consultation and review fees, if private
- What follow-up and adjustments are included
- Whether any coil fitting or procedure is included
- Cost of the HRT itself and how prescriptions are issued
- What happens if the type or dose needs changing
- Whether investigations for bleeding are included or referred
- How urgent concerns and side effects are handled between reviews
On the NHS? HRT is routinely available on the NHS when appropriate; some women self-pay to see a menopause specialist for speed or particular preferences, but it can usually be managed in general practice.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Presenting HRT as without risks, or as a way to prevent heart disease or dementia.
- Not discussing the difference between oral and through-the-skin oestrogen for clot risk.
- Failing to explain that combined HRT carries a small, duration-related breast-cancer risk.
- Overlooking that systemic HRT is not contraception.
- Starting HRT without a plan to investigate unexpected bleeding.
Marketing red flags
- Claims that HRT or 'bioidentical' compounded hormones are risk-free or anti-ageing.
- Promising HRT will prevent cancer, heart disease or dementia.
- Selling unregulated compounded 'bioidentical' hormones outside standard, regulated products.
- Heavy upselling of tests, supplements or expensive packages around the menopause.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Given my history, do the benefits of HRT outweigh the risks for me?
- Should I use tablets or oestrogen through the skin, given my clot risk and BMI?
- Do I still need contraception, and would a hormonal coil suit me?
- What type of bleeding should I report, and what would happen next?
- How will we review whether to continue, and is there a recommended duration for me?
- What non-hormonal options could help my symptoms?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does HRT cause breast cancer?
Are patches and gels safer than tablets?
How long can I stay on HRT?
Is it normal to bleed on HRT, and when should I get it checked?
Is HRT contraception?
Will HRT protect my heart or memory?
Can I get HRT on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG23 - Menopause: identification and management (recommendations) NHS - Benefits and risks of HRT NHS - HRT overview
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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