Menopause and HRT advice
A consultation to assess menopause symptoms and discuss treatments, including hormone replacement therapy (HRT) and non-hormonal options, so you can make an informed choice.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- For women over 45, menopause is usually diagnosed from symptoms, and a blood test is not normally needed.
- HRT is effective for hot flushes and night sweats; the benefits and risks depend on your age, health and the type used, and should be weighed individually.
- If you still have a womb you need a progestogen alongside oestrogen to protect the womb lining; oestrogen-only HRT is for women who have had a hysterectomy.
- There are good non-hormonal options too, and a normal plan is reviewed at around 3 months and then yearly.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your GP will give you advice for your situation.
HRT is effective at reducing hot flushes and night sweats.
Systemic HRT may not be suitable if you have current or past hormone-sensitive breast cancer, active liver disease, or a recent blood clot, heart attack...
You agree a plan together and, if appropriate, receive a prescription with instructions on how to start.
A clear written plan, including how to start and what side effects to expect.
You agree a plan together and, if appropriate, receive a prescription with instructions on how to start.
Start-up side effects such as breast tenderness or spotting are common and often settle. Hot flushes usually begin...
A review checks whether the treatment is helping, whether side effects have settled, and whether the dose or type...
An annual review reconsiders benefits and risks, blood pressure and weight, and whether to continue, change or...
What is menopause and HRT advice?
The menopause is when periods stop because the ovaries make less oestrogen, usually between the ages of about 45 and 55. The years of changing hormones and symptoms leading up to it are called the perimenopause. Symptoms can include hot flushes, night sweats, disturbed sleep, mood changes, brain fog, joint aches, and vaginal dryness or discomfort.
A menopause consultation is a conversation with a GP or specialist to understand your symptoms, your medical history and what matters to you, and to discuss the options. For most women over 45, the diagnosis is made from symptoms alone and a blood test is not needed.
Hormone replacement therapy (HRT) replaces the oestrogen your body is no longer making, usually as a patch, gel, spray or tablet. If you still have a womb, you also need a progestogen to protect the lining of the womb. HRT is effective for hot flushes and night sweats and can help some other symptoms. It has both benefits and risks, which depend on your age, your health and the type you use.
This guide explains what to expect and how the benefits and risks are weighed, following NICE guidance. It is not a recommendation for or against HRT — that decision is personal and should be made with your clinician.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
HRT routes compared
| Feature | Through the skin | Tablets by mouth |
|---|---|---|
| Form | Patch, gel or spray | Daily tablet |
| Blood clot risk | Not increased | Slightly increased |
| Often preferred if | Higher clot risk or higher BMI | Personal preference, simplicity |
| Stroke risk | Not thought to be increased | Small increase, dose-related |
This is a general summary based on NICE guidance; your clinician will tailor advice to your own health.
Preparing for your appointment
- Keep a short diary of your symptoms, how often they happen and how much they affect your daily life.
- Note the date of your last period and your usual cycle, and bring a list of all your medicines.
- Write down your personal and family medical history, especially breast cancer, blood clots, stroke or heart disease.
- Think about what bothers you most and what you hope treatment will help with.
- Have a recent blood pressure reading and weight/height if you can, as these help guide HRT choices.
- Bring any questions about benefits, risks, and how long you might stay on treatment.
- If you are under 45, expect that blood tests may be arranged to help confirm the diagnosis.
What happens
The clinician asks about your symptoms, periods, general health, medicines and family history, and what you want from treatment. For most women over 45 the menopause is diagnosed from this conversation without a blood test; under 45, blood tests may be used to help.
They will explain the options — HRT and non-hormonal approaches — and talk through the benefits and risks for someone with your age and health, often using a chart that shows real numbers. If HRT is suitable and you choose it, you will discuss the type, the route (through the skin or by mouth), whether you need a progestogen, and how to start and adjust the dose.
You usually leave with a shared plan, a prescription if appropriate, and a date to review how you are getting on. Vaginal symptoms can be treated with local oestrogen at the same time if needed.
Is this appointment 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…
- Systemic HRT may not be suitable if you have current or past hormone-sensitive breast cancer, active liver disease, or a recent blood clot, heart attack or stroke — non-hormonal options should be discussed.
- Undiagnosed abnormal vaginal bleeding should be investigated before starting HRT.
- If your main problem is heavy or irregular bleeding rather than menopause symptoms, a different assessment may be needed first.
- Some symptoms blamed on the menopause may have another cause that needs its own assessment.
Delay or rearrange if…
- You have new, unexplained vaginal bleeding that has not been investigated.
- You have a recent blood clot, heart attack or stroke.
- You have a breast lump or breast change that has not been checked.
- Your blood pressure is very high and not yet controlled.
Alternatives to discuss
- Menopause-specific cognitive behavioural therapy (CBT) for flushes, mood and sleep.
- Non-hormonal prescription medicines for hot flushes in selected women.
- Vaginal moisturisers and lubricants, or vaginal oestrogen, for local symptoms.
- Lifestyle measures such as regular physical activity, sleep and reducing triggers.
- Choosing no treatment and reviewing if symptoms change.
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
- HRT is effective at reducing hot flushes and night sweats.
- It can help some mood symptoms that start around the menopause.
- Vaginal oestrogen relieves dryness, discomfort and some urinary symptoms.
- Starting HRT around the time of menopause helps maintain bone strength.
- A consultation gives you clear, personalised information so you can make your own decision.
- Non-hormonal options can help if HRT is not suitable or not wanted.
Risks & complications
- Side effects when starting HRT, such as breast tenderness, bloating, headaches or nausea, which often settle within a few months
- Irregular bleeding or spotting, which is common in the first 6 months after starting systemic HRT and for up to 3 months after a change in dose or type
- Skin irritation from patches, or needing to adjust the dose or type to suit you
- Symptoms returning if HRT is stopped
- A small increase in the risk of blood clots with tablet (oral) HRT — not with HRT through the skin
- A small, dose-related increase in stroke risk with oral HRT
- An increase in breast cancer risk with combined HRT, which rises with longer use and falls after stopping
- Serious blood clots
- Rare serious reactions or complications, which your clinician will discuss in the context of your own health
The risks of HRT are not the same for everyone. The increase in breast cancer risk applies mainly to combined HRT and is small, rises with longer use, and largely falls after stopping; oestrogen-only HRT carries little or no increase. Blood clot risk applies to tablets, not to HRT through the skin. NICE advises weighing these against the benefits for your age and health, and reviewing regularly. Ask your clinician to show you the actual numbers for someone like you.
Published figures to discuss
HRT risks vary a great deal with your age, your personal and family history, the type of HRT and how long you use it. NICE provides a discussion aid with real incidence numbers because relative-risk figures alone can be misleading. The points below are qualitative because a single percentage cannot capture this individual variation; ask your clinician to show you the absolute numbers for someone your age.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Bleeding after menopause | Red flag | Postmenopausal bleeding needs assessment and should not be assumed to be HRT or menopause. | Women's Health Concern (British Menopause Society) — HRT factsheetwomens-health-concern.orgSource-linked context |
| VTE or stroke risk with systemic HRT | Route- and patient-dependent | Transdermal oestrogen usually has lower clot risk than oral oestrogen; personal risk factors matter. | Women's Health Concern (British Menopause Society) — HRT factsheetwomens-health-concern.orgSource-linked context |
| Breast cancer risk discussion incomplete | Regimen- and duration-dependent | Combined HRT and oestrogen-only HRT have different risk profiles; hysterectomy status matters. | Women's Health Concern (British Menopause Society) — HRT factsheetwomens-health-concern.orgSource-linked context |
| Symptoms caused by another condition | Recognised | Thyroid disease, anaemia, depression, sleep apnoea and medicines can mimic or worsen menopausal symptoms. | Guide sourcesClinical 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
There is no physical recovery from a consultation. 'Afterwards' means starting or adjusting a plan and seeing how your symptoms respond over the following weeks and months.
- Breast tenderness, bloating or mild nausea in the first weeks of HRT
- Irregular bleeding or spotting early on, which usually settles
- Gradual easing of hot flushes and night sweats over weeks
- Needing one or two dose or type adjustments to find what suits you
Aftercare
- Take or apply HRT as directed and give it a few weeks to work before judging it.
- Note any new, heavy or persistent bleeding and report it, as it needs checking.
- Attend the 3-month review and then annual reviews.
- Keep using vaginal oestrogen regularly if prescribed, and review it periodically.
- Continue to attend breast screening and cervical screening when invited.
- Tell other clinicians you are on HRT, for example before any surgery.
- Discuss any plan to stop HRT with your clinician rather than stopping suddenly.
- Symptom diary to track improvement
- List of current medicines
- Family history of breast cancer, clots, stroke or heart disease
- Recent blood pressure and weight/height
- Questions about benefits and risks for your age
- Date for the 3-month review
- Up to date with breast and cervical screening
⚠ Get urgent help if…
- Vaginal bleeding that first starts, or carries on, more than 6 months after starting systemic HRT (or more than 3 months after a dose or type change), or bleeding that becomes heavy or worrying, or bleeding after sex — get any of these checked promptly
- A new breast lump, skin change or nipple change — get this checked promptly
- Pain, swelling, redness or warmth in a calf or leg (possible blood clot)
- Sudden breathlessness or chest pain (seek emergency help)
- Sudden severe headache, weakness, numbness, or difficulty speaking or seeing (possible stroke — call 999)
- Yellowing of the skin or eyes, or severe tummy pain
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 GP gives you.
Results & realistic expectations
A good outcome is symptoms that are well enough controlled for you to feel like yourself again, on a treatment whose benefits and risks you understand and accept. With HRT, hot flushes and night sweats often improve within weeks, while other symptoms can take longer.
HRT does not stop the ageing process or treat every symptom, and it is not a guaranteed fix. The plan is reviewed over time and can be adjusted, continued or stopped as your needs and preferences change.
There is no fixed time limit for HRT for most women. NICE advises that the decision to continue is reviewed at least once a year, weighing your symptoms against the benefits and risks at your age. Symptoms can return when HRT is stopped, and you can discuss restarting if needed. Vaginal oestrogen for local symptoms can often be continued long term.
Related tests, treatments or support
Vaginal oestrogen for dryness or urinary symptoms can be used alongside systemic HRT or on its own. A hormonal coil can provide the progestogen part of HRT while also giving contraception. Menopause-specific CBT and lifestyle measures can be combined with or used instead of HRT. Your clinician can help you put these together.
Follow-up & long-term care
Expect a review at around 3 months to check the treatment is working and tolerable, then at least yearly. Reviews reconsider benefits and risks, blood pressure and weight, and whether to continue, change route or dose, or stop. You can return sooner if you have side effects or concerns. Get any bleeding checked promptly if it first starts, or carries on, more than 6 months after starting systemic HRT (or more than 3 months after a dose or type change), or if it becomes heavy or happens after sex.
- Attend the 3-month and annual reviews.
- Report any new or unusual bleeding promptly.
- Keep up with breast and cervical screening invitations.
- Review vaginal oestrogen use periodically.
- Revisit the benefit-risk balance as you get older or if your health changes.
Repeat, follow-on and what comes next
- Many women adjust the dose, type or route of HRT once or twice before finding what suits them.
- Breakthrough bleeding may prompt a change of regimen or further investigation.
- Treatment plans are reviewed and may change as you age or your health changes.
- Stopping HRT can bring symptoms back, and restarting can be discussed.
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 written plan, including how to start and what side effects to expect.
- A 3-month review and at least annual reviews of benefits and risks.
- Clear advice to report new or unusual bleeding and other warning signs.
- Communication with your NHS GP so your records stay joined up.
- Support to make your own decision, including the option not to take HRT.
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 you use the NHS or a private clinic.
- The length and number of appointments and whether they are with a GP or a specialist.
- Any blood tests or other investigations arranged.
- The type and brand of HRT or other medicines prescribed.
- Follow-up reviews and any letters or reports.
- Whether vaginal oestrogen or additional treatments are added.
- The consultation fee and how long the appointment is.
- What any follow-up reviews will cost.
- Whether blood tests or other investigations are extra.
- How prescriptions are issued and whether the medicine cost is separate.
- What happens if the treatment needs changing or is not tolerated.
- Whether letters to your NHS GP are included.
On the NHS? Menopause care and HRT are available on the NHS; people use private clinics mainly for quicker access, longer appointments or a second opinion, and HRT itself is a prescription medicine.
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
- Being quoted scary relative risks without the actual numbers for your age.
- Not being told that breast cancer risk relates mainly to combined HRT and largely falls after stopping.
- Not being offered HRT through the skin when clot risk is a concern.
- Not being told about effective non-hormonal options.
- Not having a plan for reviewing treatment or investigating abnormal bleeding.
Marketing red flags
- Clinics promoting 'bioidentical' compounded hormones as safer or superior to regulated HRT — these are not recommended.
- Heavy use of routine blood tests, hormone 'panels' or saliva tests to justify treatment in women over 45.
- Promising HRT will reverse ageing, guarantee weight loss or prevent all disease.
- One-size-fits-all prescribing without weighing your personal risks.
Choosing a specialist safely
- Check the GP 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 GP 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 GP will welcome every one of these.
- Based on my age and health, what are the benefits and risks of HRT for me, in numbers?
- Would HRT through the skin or by mouth suit me better, and why?
- Do I need a progestogen, and would a hormonal coil be an option?
- What non-hormonal options could help my main symptoms?
- How long might I take HRT, and how would we review it?
- What bleeding or symptoms should prompt me to come back?
- 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 GP who carries out my appointment, 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 appointment 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
Do I need a blood test to diagnose the menopause?
Does HRT cause breast cancer?
Is HRT through the skin safer than tablets?
Can I get HRT on the NHS?
How long can I stay on HRT?
Will I gain weight on HRT?
Do I still need contraception?
Is bleeding on HRT normal, and when should I worry?
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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 NICE CKS — Menopause NHS — Menopause NHS — Hormone replacement therapy (HRT) Women's Health Concern (British Menopause Society) — HRT factsheet
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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