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Hormone Replacement Therapy (HRT)

Find out what hormone replacement therapy (HRT) is, what the different types of HRT are and how to take it

A woman holds a hormonal patch

What is hormone replacement therapy (HRT)?

Hormone replacement therapy (HRT) is a medicine used to treat perimenopause and menopause symptoms. It replaces the hormones oestrogen and progesterone which fall to low levels as you reach the menopause. HRT is also called menopausal hormone therapy (MHT).

The menopause is when your periods stop. It happens when your ovaries stop producing a hormone called oestrogen and no longer release eggs. It usually happens between the ages of 45 and 55, but for some women, it happens earlier.

You may be able to manage your menopause symptoms without treatment, but for some women, HRT helps manage symptoms. HRT is the most prescribed menopause treatment.

HRT will usually be a combination of oestrogen and progestogen. If you’ve had a hysterectomy to remove your womb, you can take oestrogen on its own.

Find out more about the menopause

What are the types of hormone replacement therapy (HRT)?

There are different types of HRT including different hormones. The type of HRT that’s best for you will depend on factors such as:

  • what you prefer
  • your stage of menopause
  • your age
  • your symptoms
  • other health conditions and
  • if you’ve had a hysterectomy.

Combined HRT

If you’re prescribed combined HRT, you’ll take both the hormones oestrogen and progestogen. You will take this if you still have a womb (uterus). Taking combined HRT helps to protect you against an increased risk of womb cancer. The risk of womb cancer from HRT is small. Find out more about HRT risks. You can get HRT as a single treatment that combines oestrogen and progestogen, or you may get your oestrogen and progestogen in two separate forms.

Combined HRT comes in the following forms:

  • tablets
  • skin patches
  • oestrogen gel, patches or spray and oral or vaginal progestogen
  • oestrogen gel, patches, or spray and an intrauterine system (IUS) such as the Mirena coil

Oestrogen-only HRT

If you’ve had your womb removed through a hysterectomy, you will be recommended oestrogen-only HRT.

Oestrogen-only HRT comes in the following forms:

  • tablets
  • skin patches
  • oestrogen gel which you apply to the skin
  • sprays

Vaginal oestrogen

Vaginal oestrogen is a local HRT that you will only apply to the vagina. It’s used to treat vaginal dryness and irritation that can happen during the menopause. It won’t treat other symptoms of the menopause such as hot flushes or mood swings.

Usually, if you take oestrogen, you must use progestogen alongside it to protect your womb. With vaginal oestrogen, little of the medicine gets into the rest of your body, so you don’t need to take progestogen.

Vaginal oestrogen does not have the same risks as other types of HRT, because the dose is low and little of the medicine gets into your body.

It comes in the following forms:

  • tablet
  • pessary
  • cream
  • gel
  • a ring that you insert into your vagina

Testosterone

Like oestrogen and progestogen, menopause can cause the sex hormone testosterone to fall over time. This can make you feel tired, affect your mood and your sex drive (libido) can become low. Testosterone can help to improve your sex drive if HRT hasn’t helped. It’s not currently licensed to treat menopause symptoms but a specialist doctor may be able to prescribe it to you. It's usually only recommended if you’re post-menopause and HRT alone hasn’t helped.

Testosterone comes as a gel.

Tibolone

Tibolone (brand name Livial) is a prescription steroid medicine. It’s like combined HRT but it also has a steroid effect. It may not be as effective as HRT and would only be suitable if your last period was more than a year ago. It comes in tablet form.

You may need to try different types of HRT before you find the best one for you.

The NHS has more information about how to take the different forms of HRT. You can also learn more about the advantages and disadvantages of the different forms.

How will I take HRT?

When you start taking HRT, you’ll usually start with a low dose. This may be increased later. You will usually have a review of your treatment after 3 months when you first start taking HRT or when you change your type of HRT. If your treatment is working well, you will usually have 1 review a year.

If there are problems with your treatment, please ask your GP for an earlier review. Problems can include your treatment not working or getting side effects.

If this happens, your GP may change your HRT dose or the type of HRT you’re taking. They may also refer you to a specialist doctor.

The way you take HRT will depend on different things like if you’ve had a hysterectomy, which stage of menopause you’re at and what you may prefer.

Taking oestrogen-only HRT

If you’ve had a hysterectomy and take oestrogen-only HRT, you’ll take it every day.

Taking combined HRT

If you need to take combined HRT, your routine for taking it will depend on various things including your stage of menopause.

Sequential combined HRT

If you have menopause symptoms but still have periods (perimenopause), sequential (cyclical) combined will usually be recommended.

The NHS has more information about sequential combined HRT and how to take it.

Continuous combined HRT

Continuous combined HRT is usually recommended if you’re post-menopause. This is when you’ve not had a period for 1 year.

The NHS has more information about continuous combined HRT and how to take it.

How long will I take HRT for?

There are no set time limits for how long you can take HRT. You’ll usually need treatment for a few years until you stop getting symptoms. This is usually for 2 to 5 years, although it can be longer for some people. How long you take HRT will also depend on your symptoms, age and risk factors.

Stopping HRT

Your GP will advise you about stopping HRT.

You can either stop immediately or gradually reduce your dose. It’s usually recommended to reduce your dose over 3 to 6 months. You may have some menopause symptoms again after stopping HRT. If your symptoms come back and don’t go away after 3 months, your GP may recommend other treatments or restarting a low dose of HRT.

Does HRT work as a contraception?

HRT does not provide contraception. You need to continue using contraception for 1 year after your last period if this happens after the age of 50 years. If your last period happens before you’re 50 years of age, you need to continue using contraception for 2 years.

If you take hormonal contraception such as the combined pill, you may not know when you reach perimenopause or menopause because the contraception can affect your periods.

The NHS has more information about contraception and HRT.

Getting support


Our menopause campaigns

Penny and Carolyn

Let's #ChatMenopause

We want to make sure all women are able to get the help and support they need. This starts with normalising conversations about the menopause. This campaign features films of inspiring women sharing their experiences.

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Menopause Workplace Pledge

We are calling on employers to sign the Menopause Workplace Pledge and take positive action to make sure everyone going through the menopause is supported.


Some of our menopause videos

Let's #ChatMenopause webinar

The Countess of Wessex talks about the impact of menopause on women in the workplace

Menopause and how to survive it with Kaye Adams and Dr Shahzadi Harper

Read about our menopause research

As a women’s health charity, part of what we do is fund research to save and change the lives of women, girls and babies.

We are currently funding research to

  • develop an online toolkit to help organisations become more ‘menopause friendly’. This will give organisations information, training and resources to raise awareness of the menopause at work and improve workplace culture
  • investigate if ovarian tissue transplants can delay early menopause in women who have had their ovaries partially or totally removed

We have also helped to develop a CBT-based treatment. This is to help women manage their perimenopause and menopause symptoms. It can help people develop strategies to reduce stress, deal with hot flushes and improve sleep.

And we are delivering vital menopause training to small and medium-sized businesses in Bedfordshire. Our Menopause Xplored programme uses virtual reality to help people understand the impact that menopause can have. It also helps companies develop appropriate menopause support for their staff.