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Hormone replacement therapy (HRT)

Expert reviewer, Dr Sam Wild, General Practitioner
Next review due September 2024

Hormone replacement therapy (HRT) is a treatment 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 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. You may then get menopausal symptoms because your body has reduced production 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. HRT doesn't delay the menopause, but it can improve the symptoms. It can have a positive effect on hormonal ageing too.

HRT also reduces your risk of osteoporosis and may help other health problems associated with the menopause, such as cardiovascular disease and stroke.

Your doctor may prescribe HRT alongside self-help measures if your symptoms of the menopause interfere with your daily life.

Contraception and the menopause

In the years leading up to the menopause, you may notice that you don’t get regular periods anymore. This 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 and even for a time after your periods stop. You can get pregnant up to a year after your last period if you’re over 50, and two years if you’re under 50.

HRT, with the exception of the Mirena coil (an intrauterine contraceptive device), 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.

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.

Your GP may offer you oestrogen-only HRT if you’ve had a hysterectomy (an operation to remove your womb). Brand names of oestrogen-only HRT include:

  • Estradot
  • Lenzetto
  • Elleste-Solo
  • Evorel
  • FemSeven
  • Progynova
  • Sandrena
  • Oestrogel

Combined HRT

If you haven’t had a hysterectomy, your doctor will advise you to take the hormone progesterone as well as oestrogen to protect you from developing womb cancer.

You can take oestrogen and progesterone separately or combined in one therapy. If your doctor advises that you take them separately, one option is utrogestan tablets that you can take with oestrogen patches or gel. Another option is an intrauterine device (IUS or coil), such as the Mirena coil. You can use this form of progesterone alongside oestrogen patches, gel, spray or tablets.

You can also take combined HRT, which contains oestrogen as well as progesterone (in the form of progestogen). Brand names of combined HRT include:

  • Femoston
  • Kliovance
  • Clinorette
  • Elleste-Duet
  • Evorel Sequi
  • Kliofem
  • Novofem
  • Trisequens

You can take combined HRT in different ways.

  • Monthly 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 bleed (like a period) every month.
  • 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 four to six months).
  • Three-monthly cyclical HRT. You take oestrogen every day and add progestogen for 14 days every 13 weeks. You’ll usually bleed every three months.

The best way for you to take HRT will depend on whether you are postmenopausal or perimenopausal, and what type of HRT you’d prefer. Your doctor will discuss with you what the best method is for you.

Tibolone

Tibolone mimics the effects of oestrogen and progesterone. It also has weak androgenic (male hormone) properties. 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 or any other questions about the menopause.

Testosterone

Your doctor may prescribe you testosterone if you have a low sex drive and HRT alone hasn’t worked for you.

The National Institute for Health and Care Excellence (NICE) has approved testosterone for this use specifically, but it isn’t currently licensed for this purpose. This is known as ‘off-label’ or ‘unlicensed’ use and NICE recommends a medicine in this way when there is enough evidence to support it. A GP or doctor with specialist menopause training may prescribe testosterone in some situations. Ask your doctor for more information and if it’s a treatment option for you.

How do I take hormone replacement therapy (HRT)?

There are different types of HRT medication that you can take 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

You stick a self-adhesive patch on your skin below your waist, which will provide 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.

Don’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, put a new one on once your skin has cooled down.

HRT gels

You put HRT gel on a clean, dry area of skin such as on your shoulder or outer arm or thighs, every day. Once you have applied it, allow it to dry for five minutes and wash your hands with soap and water. Wait at least an hour before you use any 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 because the oestrogen is absorbed through the skin. This means that if other people touch your skin with the gel on it, they could get a dose of oestrogen themselves.

Don’t apply gels to your breasts or near your eyes or vaginal area. Gels are less likely to irritate your skin than patches.

HRT spray

Oestrogen-only HRT is available as a spray, that you spray onto the skin on your forearm or inner thigh. The spray delivers a set dose. Make sure your skin is dry first. To begin with, you’ll usually use a spray once every day, but this may go up to two or three times a day. Your doctor will let you know what’s best for you.

HRT tablets

You can take tablets that contain both oestrogen and progesterone. Or you can take progesterone tablets in combination with oestrogen gels or patches.

Vaginal oestrogens

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

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 have menopausal symptoms but aren’t sure if you can take HRT, speak to your GP. They’ll check your medical history to see if HRT is right for you and discuss what your options are. There may be other treatment options that are better suited to you. Your GP may refer you to a specialist for further treatment.

Side-effects of hormone replacement therapy (HRT)

HRT side-effects include:

  • tender breasts, larger breasts
  • 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
  • trouble sleeping
  • acne
  • lower back pain or tummy pain

If you take continuous combined HRT, you may notice a tiny amount of blood, called vaginal spotting, for up to four to six months. While this is normal when you start taking HRT, 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 year to see how HRT is working for you, and if it’s worth continuing. You can make an appointment sooner than this if you have any problems. Most side-effects get better but if they don’t improve, your GP may suggest you try a different type of HRT. Your GP may refer you to a menopause specialist for more support.

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 linked with a higher risk of certain conditions (see below). The benefits of HRT outweigh the risks for many women if you’re under 60. Any risks associated with taking HRT are very small, but they can outweigh the benefits for some people. Your GP will discuss any risks that apply to you, so that you have all the information to decide whether or not to take HRT.

Breast cancer

If you take combined HRT, it may slightly increase your risk of developing breast cancer. This risk can remain for more than 10 years after you stop HRT. There is less risk if you take oestrogen-only HRT.

It’s important to be aware of how your breasts normally look and feel, and to get any changes, lumps or bumps checked by your GP straightaway.

Ovarian cancer

If you take combined HRT or oestrogen-only HRT over a long time, it’s linked to a small increase in the risk of ovarian cancer. This disappears within a few years of stopping HRT.

Endometrial cancer

Oestrogen-only HRT is linked to an increased risk of endometrial cancer (cancer of the lining of the womb). Because of this, your doctor will offer you progesterone too as combined HRT. They’ll only offer you oestrogen-only HRT if you don’t have a womb (you’ve had a hysterectomy).

Blood clots

If you take HRT tablets, it 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. 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

Stroke and heart disease

Oestrogen-only HRT tablets (but not patches or gels) can slightly increase your risk of stroke. But the risk of stroke in women under 60 is very low. Oestrogen-only HRT doesn’t affect your risk of heart disease – it may even reduce it.

Combined HRT (oestrogen and progestogen) may slightly increase your risk of heart disease or not affect it at all. This depends on your age and whether or not you have other conditions that may increase your risk – for example, high blood pressure, high cholesterol or are a smoker. If you start HRT before 60, it reduces your risk of cardiovascular disease.

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

Stopping hormone replacement therapy (HRT)

You may wish to stop taking HRT once your menopause symptoms settle, but there’s no limit (for most women) on how long you can take it for.

You may find that some of your symptoms come back after you stop taking HRT, particularly if you stop suddenly rather than gradually. So, your GP may advise you to reduce your HRT dose gradually over three to six months, rather than stop it completely. If hot flushes and night sweats return and are severe, your GP may suggest that you go back on HRT.

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 and how best to do it.

Frequently asked questions

  • You get menopause symptoms such as hot flushes and night sweats when your body reduces production of oestrogen. HRT tops up or replaces low levels of the hormone oestrogen. This can help to ease many of the symptoms of the menopause and improve your quality of life.

    For more information, see our section: Benefits of taking hormone replacement therapy (HRT).

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

  • HRT has been linked to a higher risk of some health conditions such as breast cancer and blood clots, but these risks are very small. They can outweigh the benefits for some people depending on how their personal circumstances. Your GP can help you to decide if HRT is right for you.

    For more information, see our section: Risks of hormone replacement therapy (HRT).



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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, September 2021
    Expert reviewer, Dr Sam Wild, General Practitioner
    Next review due September 2024

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