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Hormone replacement therapy (HRT)


Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
Next review due May 2022

Hormone replacement therapy (HRT) is a treatment used to ease the symptoms of the menopause. It tops up, or replaces, low levels of the hormone oestrogen. Sometimes you’ll need to take progesterone too.

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Benefits of taking hormone replacement therapy (HRT)

Your doctor may prescribe HRT if your symptoms of the menopause interfere with your daily life and don’t get better with self-help measures. You can learn more about these self-help measures in our separate topic on the menopause. We also have a blog on common questions about the menopause that you may find helpful.

Menopausal symptoms are caused by your body no longer producing enough oestrogen. Your ovaries make the hormones oestrogen and progesterone during your menstrual cycle. But when you get close to the menopause, your body naturally produces less of these hormones.

Low oestrogen levels can lead to a number of physical and emotional symptoms, including hot flushes, night sweats and mood swings. The benefit of HRT is that it can help to ease many of these symptoms and improve your quality of life. It can have a positive effect on hormonal ageing. HRT also reduces your risk of osteoporosis and may help other health problems associated with the menopause, such as cardiovascular disease and stroke (see below).

Contraception and the menopause

In the years leading up to the menopause, you may notice your periods are no longer regular. This stage of life is called the perimenopause. Once you reach the menopause itself, your ovaries stop releasing eggs and your periods stop completely. But you can still get pregnant during the perimenopause, up to a year after your last period if you’re over 50 and two years if you’re under 50. HRT isn’t a form of contraception. Speak to your GP for advice about contraception while you’re going through the menopause.

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Types of hormone replacement therapy (HRT)

There are different types of HRT. Your GP will talk to you about which one is best for you based on your medical history.

Oestrogen-only HRT

This form of HRT contains just the hormone oestrogen. It helps to relieve symptoms of the menopause and strengthens your bones. Low levels of oestrogen at the menopause can weaken your bones and make you more likely to break one if you fall over.

Your GP may offer you oestrogen-only HRT if you’ve had a hysterectomy (an operation to remove your uterus). Brand names of oestrogen-only HRT include Bedol, Climaval, Elleste-Solo, Evorel, FemSeven, Progynova, Sandrena and Oestrogel.

Combined HRT

Combined HRT contains oestrogen as well as the hormone progesterone (in the form of progestogen). If you haven’t had a hysterectomy, you’ll need to take progesterone as well as oestrogen, to protect you from developing womb cancer. Brand names of combined HRT include Climagest, Climesse, Clinorette, Elleste-Duet, Evorel Sequi, Kliofem and Novofem. You can take combined HRT in two ways.

  • Cyclical HRT. You take oestrogen every day and add progesterone for 10 to 14 days in a month to mimic your menstrual cycle. You’ll usually have a monthly bleed at the end of each course of progesterone.
  • Continuous combined HRT. With this type, you take both oestrogen and progesterone every day. You won’t have any monthly bleeding (although you might have some light bleeding for the first three to six months).

Most women start taking cyclical HRT and then change to continuous combined HRT a year or two later.

Tibolone

Tibolone is a synthetic (artificial) version of HRT, which mimics the effects of oestrogen and progesterone. It also has weak androgenic (male hormone) properties. Like combined HRT, you take tibolone every day. Your doctor will only prescribe tibolone if you haven’t had a period for 12 months. The brand name of tibolone is Livial.

Talk to your GP about which type of HRT is best for you.

How do I take hormone replacement therapy (HRT)?

You can take HRT in a number of ways. Your GP will talk to you about your options to help you work out which is best for you.

HRT patches

Patches may be best for you if you’re prone to certain medical conditions, such as liver disease or blood clots in your legs. You stick a self-adhesive patch on your skin below your waist. This provides a constant flow of hormones. You remove the patch once or twice a week, depending on the product. You then replace it with a fresh patch on a different area of your skin each time. You shouldn’t put the patches on or near your breasts or under the waistband of your clothes. Patches may irritate your skin. If a patch falls off in the bath, apply a new one once your skin has cooled down.

HRT gels

You put gels on a clean dry area of skin, such as on your lower back or on your thighs, every day. You shouldn’t apply gels to your breasts or near your eyes or vaginal area. Gels are less likely to irritate your skin than patches. Once you have applied it, allow it to dry for five minutes and wash your hands. For at least an hour afterwards, don’t use other skin products over the gel or wash that area of skin. And don’t let that area of skin come into contact with anybody else’s skin, especially men and boys.

HRT tablets

Tablets are the most popular form of HRT. You take these every day to control your symptoms.

Vaginal oestrogens

HRT also comes in the form of vaginal tablets, rings or creams. Your doctor may recommend these for you if you mainly have vaginal dryness or bladder symptoms. You should use the smallest amount of cream possible to ease your symptoms. Some vaginal creams may damage condoms and diaphragms so if you need to use these, it’s best to use vaginal tablets or the vaginal ring.

Can all women take hormone replacement therapy (HRT)?

Most women can use HRT, but your GP may not prescribe it if you have, or have ever had:


If you're having menopausal symptoms but aren’t sure if you can take HRT, speak to your GP. Your GP will go through your medical history to see whether HRT is right for you, and discuss what your options are.

Side-effects of hormone replacement therapy (HRT)

HRT can cause several side-effects. HRT side-effects include:

  • tender, and larger, breasts – this may last for four to six months
  • cramp in your legs
  • feeling sick
  • feeling bloated
  • mood swings
  • depression
  • headaches
  • fluid retention – this is when fluid builds up in your ankles or face, which can cause swelling
  • more frequent migraines, if this is something you’re normally prone to

If you’re taking cyclical HRT, you may notice some vaginal bleeding for the first two to three months. If you’re taking continuous combined HRT, you may notice a tiny amount of blood, called vaginal spotting, for up to three to six months. This is normal for many women when they start taking HRT, but it’s important to mention it to your GP.

Your GP may recommend that you take HRT for three months at first to see how you get on. Then you’ll have a check-up with your GP every six months to a year. You can make an appointment sooner than this if you have any problems. Most side-effects get better within a few months. If they don’t improve, your GP may suggest you try a different type of oestrogen or progesterone.

Always read the patient information leaflet that comes with your medicine.

Risks of hormone replacement therapy (HRT)

HRT is the most effective treatment for the menopause, but it has been associated with increased risk of certain conditions. These are summarised below. Any risks associated with taking HRT are very small, but they can outweigh the benefits in some women. Your GP will discuss any risks that apply to you, so that you can make an informed choice about whether or not to take HRT.

Breast cancer

Taking combined HRT may increase your risk of developing breast cancer. This excess risk disappears within five years of stopping HRT. Oestrogen-only HRT is associated with little or no change in your risk.

If you’re taking HRT, it’s important to be ‘breast aware’ and get any changes, lumps or bumps checked by your GP straightaway.

Ovarian cancer

Using combined HRT or oestrogen-only HRT over a long time is associated with a small increase in risk of ovarian cancer. This disappears within a few years of stopping HRT.

Endometrial cancer

Oestrogen-only HRT is associated with an increased risk of endometrial cancer (cancer of the lining of the womb). Because of this, you’ll be offered combined HRT. Your doctor will only offer you oestrogen-only HRT if you don’t have a womb (you’ve had a hysterectomy).

Blood clots

Taking HRT can increase your risk of developing blood clots in your legs (deep vein thrombosis). Very occasionally, some or all of a blood clot can break away and move to your lungs. You’re more likely to have a blood clot if you’re using HRT tablets rather than HRT patches or gel. See your GP if you:

  • have swelling or pain in one of your calves
  • notice the skin on your calf feels hotter than usual
  • notice the skin on your calf looks red or purple
  • have severe chest pain
  • suddenly find it difficult to breathe
  • have a cough – you may cough up bloody mucus

Heart disease and stroke

Taking oestrogen-only tablets can increase your risk of stroke. But oestrogen-only HRT doesn’t affect your risk of heart disease – it may even reduce your risk.

Combined HRT may slightly increase your risk of heart disease.

If you’re worried about the risks of HRT, or notice any unusual symptoms while you’re taking it, speak to your GP.

Stopping hormone replacement therapy (HRT)

Menopausal symptoms last from two to five years in most women so you might not need to take HRT for longer than this. But some women need to take HRT for longer, it varies between women. If you’ve been using HRT for one or two years, your GP may suggest you stop it for a short while to see if you still need it.

You may find that some of your symptoms, such as hot flushes and sweats, come back for a few months when you stop taking HRT. These usually go away again after a few months. To prevent your symptoms coming back, your GP may ask you to reduce your HRT dose gradually over three to six months. If your hot flushes and night sweats return and are severe, your GP may suggest that you go back on HRT. Your GP will prescribe the lowest dose possible to control your symptoms.

Your GP may ask you to stop taking HRT straightaway if you have any severe side-effects, such as a blood clot in your leg.

Your GP will speak to you about the pros and cons of stopping HRT.

Frequently asked questions

  • Many women try herbal remedies to ease their menopausal symptoms. But there isn’t enough research to show whether or not these work.

    Some research has found that phytoestrogens and the herbs black cohosh and St John’s wort can help to ease menopausal symptoms. Phytoestrogens are naturally occurring products, similar to oestrogen. They’re found in plants and foods such as soy beans, nuts, cereals and seeds.

    There are many different herbal products available and these can vary in safety and quality. The actual daily doses are also unclear. This is why herbal remedies aren’t recommended by most doctors.

    If you choose to take herbal remedies, it’s important to remember that natural doesn’t always mean harmless. Herbal remedies aren’t regulated in the same way that medicines are. They may cause side-effects or affect other medicines you may be taking. Always talk to your pharmacist or GP before trying anything new.

  • It’s common to put weight on as you approach the menopause, but there’s no evidence that HRT itself causes this. If you do gain weight, it’s more likely to be due to the menopause itself.

    Many women notice they put on weight at the menopause, particularly around their waistline. Doctors aren’t sure whether this is caused by ageing or hormonal changes. Being overweight at the menopause may make your hot flushes more regular and more severe. It can also make you more prone to heart disease, stroke, type 2 diabetes and breast cancer.

    If you’re going through the menopause, it’s important to exercise regularly and lose any excess weight slowly and steadily. Try to eat a healthy, balanced diet.


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Related information

    • HRT and alternatives. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, accessed 23 April 2019
    • Menopause. BMJ Best Practice. bestpractice.bmj.com, last reviewed March 2019
    • Menopause. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2018
    • Hamoda H, Panay N, Arya R, et al. The British Menopause Society & Women’s Health Concern 2016 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health 2016; 22(4):165–83. doi: 10.1177/2053369116680501
    • Hormone replacement therapy including benefits and risks. PatientPlus. www.patient.info/patientplus, last reviewed 29 January 2018
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    • Estradiol with norethisterone. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed 2 April 2019
    • Tibolone. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed 2 April 2019
    • Hormone replacement therapy (HRT). Reproductive endocrinology. Oxford handbook of endocrinology and diabetes. Oxford Medicine Online. oxfordmedicine.com, published March 2014
    • Menopause: diagnosis and management. National Institute for Health and Care Excellence (NICE), November 2015. www.nice.org.uk
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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2019
    Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
    Next review due May 2022



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