Medically Reviewed
HRT for Women:
Menopause Symptoms, Types & Treatment
A complete guide to Hormone Replacement Therapy — what it is, how it works, the different types available, and how to get started with a licensed UK clinician online today.
Licensed UK clinicians
Same-day prescriptions
Delivered to your door within 24 hours
Overview
What Is HRT and How Does It Work?
Hormone Replacement Therapy (HRT) is the most effective treatment available for menopausal symptoms. It works by replacing the hormones — primarily oestrogen, and often progesterone — that your body produces in decreasing amounts as you approach and pass through menopause.
Oestrogen is the hormone responsible for regulating your menstrual cycle and plays a central role in the health of your heart, bones, brain, skin, and urogenital system. As oestrogen levels decline in the years around menopause, many women experience a wide range of physical and psychological symptoms that can significantly impact quality of life.
HRT directly addresses this hormonal decline. For women who still have a uterus, a progestogen (synthetic or natural progesterone) is added alongside oestrogen to protect the lining of the womb. Women who have had a hysterectomy can typically take oestrogen-only HRT.
Current NHS and NICE guidance reflects a major shift in the understanding of HRT over the past decade. For most healthy women under 60, or within 10 years of the onset of menopause, the benefits of HRT are now recognised to significantly outweigh the risks. HRT is no longer considered a short-term measure — many women use it safely for a decade or more.
HRT requires a clinician-led assessment and a prescription. A licensed clinician can review your symptoms and medical history and prescribe the most appropriate form and dose of HRT through a convenient online consultation.
Understanding Menopause
Perimenopause, Menopause & Postmenopause
Menopause is not a single moment but a biological transition that unfolds over several years. Understanding the different stages helps clarify when HRT might be appropriate and what to expect.
Perimenopause
The years leading up to menopause, often beginning in the mid-40s. Oestrogen levels begin to fluctuate and decline. Periods become irregular, and symptoms can begin even while periods continue. This stage can last 4–10 years.
Menopause
Defined as 12 consecutive months without a period. The average age in the UK is 51, though it can occur earlier. Symptoms are often at their most intense around the time of the final period and the year or two that follow.
Postmenopause
The stage that follows menopause and lasts for the rest of a woman's life. While acute symptoms may ease, the long-term effects of low oestrogen — including on bone density and cardiovascular health — continue. HRT remains beneficial for many women in this phase.
Premature Menopause (POI)
Menopause occurring before the age of 40 (premature ovarian insufficiency) affects around 1 in 100 women. HRT is strongly recommended in this group to protect bone and cardiovascular health, and is typically continued until at least the average age of natural menopause.
Symptoms
What Are the Symptoms of Menopause?
Menopause symptoms vary widely between women in both type and severity. Some women experience only mild disruption; others find their symptoms significantly affect their daily functioning, relationships, and mental health. Symptoms can begin during perimenopause and persist for many years.
Physical Symptoms
- Hot flushes — sudden waves of heat, often with sweating and flushing
- Night sweats — hot flushes occurring during sleep, disrupting rest
- Irregular or changing periods (perimenopause)
- Vaginal dryness, itching, or discomfort during sex
- Urinary changes — increased urgency, frequency, or recurrent UTIs
- Joint and muscle aches
- Headaches or migraines
- Palpitations
- Changes in skin, hair, and nail texture
- Weight changes, particularly around the abdomen
Psychological Symptoms
- Low mood, sadness, or depression
- Anxiety and panic attacks
- Irritability and mood swings
- Brain fog — difficulty concentrating or finding words
- Memory lapses
- Loss of confidence or motivation
- Reduced libido
- Sleep disturbance and insomnia
- Fatigue and exhaustion
Symptoms Are Often Underestimated
Research suggests that many women experience menopause symptoms for 7–10 years or more, and that psychological symptoms — particularly anxiety and brain fog — are frequently misdiagnosed or attributed to other causes. If you recognise these symptoms, a menopause-specialist clinician can help.
Types of HRT
What Types of HRT Are Available?
HRT is not one-size-fits-all. There are several different types, delivery methods, and formulations. The right choice depends on your symptoms, medical history, whether you still have a uterus, and personal preference.
By Hormone Content
Type
Hormones
Suitable For
Combined HRT
Oestrogen + progestogen
Women who have not had a hysterectomy
Oestrogen-only HRT
Oestrogen alone
Women who have had a hysterectomy
Testosterone
Low-dose testosterone
Women with persistent low libido or fatigue despite other HRT
Local (vaginal) oestrogen
Low-dose topical oestrogen
Women primarily experiencing vaginal/urinary symptoms; can be used alongside systemic HRT or alone
By Delivery Method
Method
Examples
Notes
Gel
Oestrogel, Sandrena
Applied to skin daily; absorbed transdermally; preferred by many as dose is adjustable
Patch
Evorel, Estradot
Changed every 1–3 days; consistent hormone delivery; good for those who prefer not to apply gel daily
Spray
Lenzetto
Applied to the forearm; convenient and discreet
Tablets
Elleste, Premarin
Oral route; slightly higher risk of blood clots than transdermal; not preferred as first-line
Implant
Subcutaneous pellet
Inserted under the skin; releases hormones over 6 months; specialist procedure
Vaginal (local)
Vagifem, Gina, Ovestin, Estriol cream
Treats local symptoms only; minimal systemic absorption; no added progestogen needed
Mirena IUS
Levonorgestrel coil
Can provide the progestogen component of combined HRT while also providing contraception
Transdermal HRT Is Generally Preferred
Oestrogen applied through the skin (gels, patches, sprays) does not pass through the liver in the same way oral tablets do. This means transdermal HRT does not increase the risk of blood clots (VTE) and is the preferred first-line approach for most women, particularly those with any cardiovascular risk factors.
HRT Regimens
Cyclical vs Continuous HRT
For women taking combined HRT (oestrogen + progestogen), there are two main regimens. The right one for you depends largely on whether you are still having periods.
Regimen
How It Works
Best For
Sequential (cyclical)
Oestrogen taken daily; progestogen added for 10–14 days each month. A monthly bleed usually occurs.
Perimenopausal women still having periods, or within 12 months of last period
Continuous combined
Both oestrogen and progestogen taken every day, with no breaks. No monthly bleed.
Postmenopausal women (12+ months since last period)
Oestrogen-only
Oestrogen taken daily with no progestogen.
Women who have had a hysterectomy
Local oestrogen only
Low-dose vaginal oestrogen; no systemic effect.
Women with isolated vaginal or urinary symptoms
Benefits of HRT
What Are the Benefits of HRT?
HRT is highly effective at treating menopausal symptoms and has a range of additional health benefits that are increasingly recognised in current UK clinical guidance.
Reduces Hot Flushes
HRT is the most effective treatment for vasomotor symptoms including hot flushes and night sweats, reducing frequency and severity in most women.
Improves Mood & Cognition
Many women report significant improvements in low mood, anxiety, brain fog, and memory — symptoms often misdiagnosed as depression.
Better Sleep
By reducing night sweats and their direct impact on mood and cognition, HRT often leads to meaningful improvements in sleep quality.
Protects Bone Density
Oestrogen is essential for maintaining bone density. HRT significantly reduces the risk of osteoporosis and fragility fractures.
Cardiovascular Protection
When started within 10 years of menopause, HRT may reduce the risk of heart disease — the leading cause of death in women.
Vaginal & Urinary Health
HRT reverses vaginal atrophy, reducing dryness, discomfort, and recurrent UTIs associated with the genitourinary syndrome of menopause.
Risks & Considerations
What Are the Risks of HRT?
Understanding the risks of HRT in context is important. Much of the earlier concern about HRT safety was based on older studies using oral oestrogen and older progestogens. Modern transdermal HRT with body-identical hormones has a more favourable risk profile.
Common Side Effects (Usually Settle)
- Breast tenderness or swelling
- Nausea (more common with oral HRT)
- Headaches or migraines
- Irregular spotting or bleeding (especially in early months)
- Bloating or mild fluid retention
- Mood changes in the first few weeks
Risks to Discuss With Your Clinician
- Breast cancer: small increased risk with combined HRT after 5+ years; less or no risk with oestrogen-only HRT
- Blood clots (VTE): risk with oral HRT only; not seen with transdermal routes
- Stroke: slight increase with oral oestrogen; not seen with transdermal routes
- Endometrial cancer: risk is eliminated when adequate progestogen is used
HRT Is Not Suitable for Everyone
HRT may not be recommended if you have a personal history of oestrogen-sensitive breast cancer, unexplained vaginal bleeding, untreated endometrial cancer, active blood clots, or severe liver disease. Your clinician will review your full medical history to assess suitability.
Key Risk Factors Your Clinician Will Review
Personal or family history of breast cancer
History of blood clots (DVT / PE)
Uncontrolled high blood pressure
Liver disease
History of stroke or TIA
Unexplained vaginal bleeding
Cardiovascular disease
Migraine with aura
Body-Identical HRT
What Is Body-Identical HRT?
Body-identical HRT (also called bioidentical or micronised HRT) uses hormones that are chemically identical in structure to those produced by the human body. This is distinct from "compounded bioidentical" HRT, which is not regulated and not recommended.
The most widely used body-identical oestrogen is estradiol, available in gel, patch, and spray form. The body-identical progestogen is micronised progesterone, available as Utrogestan capsules (which can also be used vaginally). These are licensed, regulated medicines prescribed by clinicians across the NHS and privately.
The most widely used body-identical oestrogen is estradiol, available in gel, patch, and spray form. The body-identical progestogen is micronised progesterone, available as Utrogestan capsules (which can also be used vaginally). These are licensed, regulated medicines prescribed by clinicians across the NHS and privately.
Utrogestan (Micronised Progesterone)
Utrogestan is increasingly preferred over synthetic progestogens such as norethisterone or medroxyprogesterone acetate because it has a more favourable side effect profile, is better tolerated, and is associated with a lower breast cancer risk. It is taken orally or vaginally and is available on prescription.
Common HRT Medications
HRT Medications Available Through The GP Service
Our clinicians can prescribe a full range of licensed HRT products. The most appropriate choice will depend on your symptoms, preferences, and medical history.
Medication
Type
Route
Oestrogel
Oestrogen (estradiol)
Gel — applied to skin daily
Sandrena
Oestrogen (estradiol)
Gel — applied to skin daily
Lenzetto
Oestrogen (estradiol)
Spray — applied to forearm daily
Evorel / Estradot
Oestrogen (estradiol)
Patch — changed twice weekly
Utrogestan
Progesterone (micronised)
Oral capsule or vaginal pessary
Qlaira / Elleste / Femoston
Combined (oestrogen + progestogen)
Oral tablet
Evorel Conti / Evorel Sequi
Combined patch
Patch — changed twice weekly
Vagifem / Gina
Local oestrogen (estradiol)
Vaginal tablet
Ovestin cream
Local oestrogen (estriol)
Vaginal cream
Mirena IUS
Progestogen (levonorgestrel)
Intrauterine system — lasts 5 years
When to Seek Help
When Should You See a Clinician About Menopause?
Seek Urgent Medical Attention If:
You experience unexpected or heavy vaginal bleeding after menopause · You have chest pain, sudden breathlessness, or leg swelling (possible blood clot) · You experience sudden severe headache, vision changes, or one-sided weakness (possible stroke).
See a Clinician Soon If:
Your menopause symptoms are significantly affecting your daily life, sleep, work, or relationships · You are experiencing low mood or anxiety that isn't responding to other measures · Your symptoms started before the age of 45 · You are experiencing vaginal dryness or pain during sex · You want to understand your HRT options and whether they are right for you · You are already on HRT and feel your dose needs reviewing.
You Don't Have to Suffer in Silence
Many women are still told to "just get on with it" or are unaware that effective treatment is available. Current NICE guidelines are clear: HRT is a safe and effective first-line treatment for most women experiencing menopausal symptoms. You deserve support.
Getting Treatment
How Can The GP Service Help?
Our licensed UK clinicians are experienced in menopause care and can assess your symptoms, discuss all available HRT options, review your medical history, and prescribe the most appropriate treatment — all through a convenient online consultation.
1
Book Your Appointment
Book to see a consultant online the same day, at a time that suits you.
Open 365 days a year, 8am - 5pm
Same-day appointments available
2
See a Consultant
Speak to one of our licensed medical professionals from anywhere - using a phone, computer, or tablet.
Request prescriptions
Request Fit Notes
Request Referral Letters
3
Get Treatment
Within minutes of your consultation receive treatment, prescriptions, fit notes, and referral letters.
Collect prescriptions within an hour
Pick up from ANY pharmacy
Shared with your medical records & NHS GP
Start feeling like yourself again.
See a licensed clinician online today. If HRT is right for you, your prescription will be sent to your chosen pharmacy the same day.
Check My Eligibility
No waiting room
Delivered to your door within 24 hours
Open 365 days a year
Licensed UK clinicians
Secure & confidential
Frequently Asked Questions
If you have questions about The GP Service, check below. Still need help? Contact our friendly patient care team.
Is HRT safe?
For the majority of healthy women under 60, or within 10 years of their last period, current evidence shows that the benefits of HRT significantly outweigh the risks. The reassessment of HRT safety over the past 15 years — driven largely by re-analysis of the Women's Health Initiative study and newer research — has led to a much more positive view of HRT, particularly transdermal formulations using body-identical hormones. Your clinician will review your individual medical history to assess suitability.
How long does it take for HRT to work?
Many women notice an improvement in vasomotor symptoms such as hot flushes and night sweats within two to four weeks of starting HRT. Mood, sleep, and cognitive symptoms often take a little longer, typically 6–12 weeks. Full benefit is usually experienced after three months. If symptoms persist, a dose adjustment or change of formulation may be needed — this is normal and your clinician can help.
Does HRT cause breast cancer?
The relationship between HRT and breast cancer risk is nuanced and depends on the type of HRT used. Oestrogen-only HRT is associated with little or no increase in breast cancer risk. Combined HRT (oestrogen plus synthetic progestogen) is associated with a small increased risk after around five years of use — roughly comparable to the risk associated with drinking one to two glasses of wine per day. Combined HRT using micronised progesterone (Utrogestan) appears to carry a lower risk than those using synthetic progestogens. Your clinician will discuss this in the context of your personal and family history.
Can I start HRT during perimenopause?
Yes. You do not need to wait until your periods have stopped to start HRT. Many women begin HRT during perimenopause, when symptoms can be significant even though periods are still occurring. In this case, a sequential (cyclical) regimen is typically used to allow a monthly withdrawal bleed. HRT during perimenopause also provides contraceptive benefit if a progestogen-releasing IUS (Mirena) is used.
How long can I take HRT for?
There is no fixed upper time limit on HRT. Current guidance recommends that women are not routinely advised to stop HRT after a set period, as the decision should be based on ongoing individual benefit-risk assessment. Many women choose to continue HRT for a decade or more. Women with premature ovarian insufficiency are typically advised to continue HRT until at least the average age of natural menopause (around 51). Your clinician will review your treatment annually.
Does HRT cause weight gain?
HRT itself does not cause weight gain. Many women gain weight around the time of menopause due to hormonal changes, reduced physical activity, and the natural effects of ageing — but this is not caused by HRT. Some women find that HRT actually helps manage their weight by improving energy levels, sleep, and mood, making it easier to maintain a healthy lifestyle. Transdermal HRT, in particular, has no documented association with weight gain.
Can I still get pregnant on HRT?
If you are perimenopausal and still having periods, you may still be fertile. HRT does not provide reliable contraception. You should continue to use contraception until you have had 12 consecutive months without a period if you are over 50, or 24 months if you are under 50. A Mirena IUS can provide both the progestogen component of HRT and effective contraception simultaneously — your clinician can advise you.
What happens when I stop HRT?
When you stop HRT, menopausal symptoms may return, particularly if stopped abruptly. It is generally recommended to taper the dose gradually over several weeks to minimise the return of symptoms. Long-term benefits such as bone protection are also lost over time after stopping. If you wish to stop HRT, your clinician can guide you through the process and discuss the implications.
Medical Disclaimer: The information on this page is provided for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay seeking it because of something you have read on this page. If you think you may have a medical emergency, call 999 or your local emergency services immediately.