The types, the benefits, the risks exactly as the NHS and NICE describe them, what it costs, and a free list of questions to take to your GP.
Last reviewed 18 October 2026 · Checked against NHS guidance · 18 min read
The short answer
Hormone replacement therapy (HRT) replaces the oestrogen, and usually progestogen, that your body makes less of around menopause. It helps most symptoms, including hot flushes, night sweats, sleep problems, anxiety, low mood and vaginal dryness, and it helps prevent osteoporosis. The NHS says the benefits usually outweigh the risks. Combined HRT slightly raises breast cancer risk (around 5 extra cases in every 1,000 women who take it for 5 years), and HRT tablets slightly raise the risk of blood clots, while patches, gels and sprays do not. Your GP can help you weigh this up for your age, symptoms and health.
HRT is one part of the bigger picture in our guide to menopause symptoms and what helps each one. This article goes deep on the treatment itself. Every point comes from NHS pages and the NICE menopause guideline (NG23, updated November 2024). It is information to help you talk to your GP, not a recommendation to start or stop anything.
9 things to know before you start HRT
- It replaces falling hormonesOestrogen, plus a progestogen if you have a womb.
- There are two main typesCombined HRT, or oestrogen-only after a hysterectomy.
- You can take it several waysTablets, patches, gel, spray, coil or vaginally.
- It often works quicklySymptoms should improve within days or weeks.
- The risks are smallThey depend on type, form and how long.
- Side effects often settleYour first review is at about 3 months.
- It is not for everyoneSome health conditions need a different plan.
- There are alternativesCBT, other medicines, lifestyle changes.
- It can cost £19.80 a yearWith the HRT prepayment certificate in England.
What HRT is and what it can help
Menopause is when periods stop because hormone levels have fallen, usually between 45 and 55. HRT tops up oestrogen and, if you have a womb, adds a progestogen. The NHS says it can help:
- hot flushes and night sweats
- sleep problems
- mood swings, anxiety and low mood
- vaginal dryness
You do not have to wait until symptoms are severe or your periods have stopped: the NHS says starting HRT is your choice, and it can be used in perimenopause too. If you are not sure whether your symptoms are menopause at all, our guide to early perimenopause signs is a good place to start.
Types of HRT and the ways to take it
Finding the right HRT can take time. Three questions decide most of it: do you still have a womb, are you still having periods, and which way of taking it fits your life?
Combined HRT or oestrogen-only HRT
Combined HRT
Oestrogen plus a progestogen. You need both, because the NHS says progestogen helps protect against womb cancer.
The progestogen can come as tablets, as part of a combined patch, or from a hormonal coil (IUS).
Oestrogen-only HRT
If your womb has been removed, oestrogen-only HRT is usually recommended, taken every day.
The NHS says oestrogen-only HRT carries little or no increase in breast cancer risk.
Sequential or continuous: which routine?
- Sequential (cyclical) combined HRT is usually recommended if you still have periods. You take oestrogen daily and add progestogen for the last 10 to 14 days of each cycle, then have a bleed. If no bleed comes, speak to your doctor.
- Continuous combined HRT is usually recommended after menopause (no period for a year): both hormones every day, without a break. Your doctor may suggest switching to it from sequential HRT.
The ways to take HRT
| Form | Good to know (NHS) | Downsides the NHS mentions |
|---|---|---|
| Tablets | One a day may be the easiest option. | Blood clot risk is higher than with patches, gel or spray, though still small. |
| Patches | Good if tablets are hard to swallow or remember. No added clot risk. | May not stick on moisturised skin; can irritate. |
| Oestrogen gel | Smoothed on once a day. No added clot risk. | Can take 5 minutes or more to dry. |
| Spray | On the inner arm or thigh once a day. No added clot risk. | Wait 1 hour before a bath or shower. |
| Hormonal coil (IUS) | Supplies the progestogen for up to 5 years; also contraception. | Can cause tummy pain and bleeding. |
| Vaginal oestrogen | For dryness, burning or painful sex. No progestogen needed, even with a womb. | Does not help flushes, mood or sleep. |
Bioidentical hormones, testosterone and tibolone
- Bioidentical or "natural" hormones sold by some private clinics are often made up specially and are not regulated like the licensed HRT your GP prescribes. NICE advises that the safety, quality and purity of ingredients in unregulated preparations may be unknown, so ask your GP about licensed options instead.
- Testosterone is not licensed for menopause symptoms, but a specialist can prescribe it, usually for low libido after menopause or when HRT alone has not helped.
- Tibolone is a daily tablet similar to combined HRT, only for those whose last period was over a year ago.
This article tells you what the options are. The course helps you work out which questions matter for you.
Understanding HRT and Other Treatment Options (£17.99, Focused, 2 hr) explains HRT and the non-hormonal options using NHS guidance, and gives you a clear set of questions for your GP.
The benefits of HRT
The NHS describes three main benefits:
- Relief from most symptoms. HRT is effective for most perimenopause and menopause symptoms, including hot flushes, night sweats, sleep problems, anxiety, low mood and vaginal dryness. Symptoms should improve within a few days or weeks. Our guide to hot flushes and night sweats covers the practical steps that sit alongside treatment.
- Protecting your bones. Oestrogen is needed for healthy bones, so osteoporosis (thinning bones that break more easily) is common after menopause. HRT helps prevent it, which the NHS says is especially important if your periods stop before 45. NICE asks doctors to discuss bone health at review appointments.
- Muscle strength. Muscle strength often declines around menopause. HRT can help muscles stay strong, alongside regular exercise.
The risks of HRT, in proportion
Much of the worry about HRT comes from older studies. The NHS says that view is out of date because it ignored the benefits, that the risk of serious side effects is very low, and that for women under 60 with menopause symptoms who are not at high risk of breast cancer or blood clots, the benefits are likely to outweigh the risks. The risks depend on the type of HRT, how long you take it and your own health.
Breast cancer
The NHS says there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years. Oestrogen-only HRT carries little or no increased risk.
Each dot is one woman taking combined HRT for 5 years. The highlighted dots are the extra cases the NHS describes.
- The risk rises the longer you take HRT and with age, and it falls again after you stop.
- The NHS advises not taking HRT for longer than you need to control symptoms, and going to all your breast screening (mammogram) appointments while on HRT.
- If you have had breast cancer, you will usually be advised not to take HRT.
Blood clots: why tablets and patches differ
The NHS says HRT tablets can increase the risk of blood clots, although the risk is still very low. Patches, sprays and gels do not, because oestrogen absorbed through the skin is considered safer. NICE advises considering transdermal (through the skin) HRT rather than tablets for people at increased risk of clots, including those with a BMI over 30. If you are at risk of clots, you will usually be offered patches, spray or gel.
Stroke, heart disease, dementia and diabetes
| Condition | In short | What the NHS and NICE say |
|---|---|---|
| Stroke | Tablets only | HRT tablets (not patches, gels or sprays) slightly increase the risk of stroke. The risk is still very low, particularly under 60. |
| Heart disease | Little or no effect | NHS: little or no effect on coronary heart disease risk. NICE: HRT should not be offered just to prevent heart disease. |
| Dementia | Not known | It is not known whether HRT affects dementia risk. Research is ongoing, and any effect is likely to be small. |
| Type 2 diabetes | No increase | HRT does not increase the risk. Some recent studies suggest it may slightly reduce it. |
| Vaginal oestrogen | No increase | Does not increase the risk of breast cancer, blood clots or other conditions. Very little enters the rest of the body. |
NICE has a discussion aid on HRT and the likelihood of some medical conditions that GPs can use to talk these figures through with you. It is worth asking whether your GP can go through it with you.
Side effects and the 3-month review
Many people get no side effects, or only mild ones that ease with time, so the NHS suggests sticking with HRT for at least 3 months if you can.
Common side effects
Headaches, breast pain or tenderness, unexpected bleeding or spotting, feeling sick, low mood, leg cramps, mild rash or itching, diarrhoea and hair loss. These often go after a few weeks.
Common side effects
Changes to periods (including spotting), headaches, breast tenderness, feeling sick, diarrhoea, tiredness or dizziness, low mood, mild rash or itchy skin, and acne. These usually fade after a few weeks.
Bleeding on HRT
Irregular bleeding or spotting is common in the first few months and usually settles within 6 months. On sequential HRT, a bleed at the end of each progestogen course is normal. Mention any irregular bleeding at your 3-month review. See your GP if bleeding carries on for more than 6 months after starting, gets heavier, or starts again after a time with no periods.
Weight
The NHS says there is little evidence that most types of HRT cause weight gain. Some weight gain can happen around menopause and with age, with or without HRT.
Your reviews
NICE recommends a review at 3 months, then once a year. To help with side effects, your GP might suggest changing the dose, the type or how you take it (for example, tablets to patches), and can refer you to a menopause specialist if needed. Symptom notes make that first review far more useful; our guide to preparing for a menopause GP appointment shows how.
When to get help straight away
The NHS lists these as rare but serious. Call 999 or go to A&E if you have chest pain and breathlessness, difficulty speaking or moving your arm or leg, or your lips, mouth, throat or tongue suddenly swell. Call a doctor or 111 if you have pain, redness or swelling in one leg, usually the calf. See your GP about any breast lump or change, or changes in vaginal bleeding after taking oestrogen for more than a few months.
You can report suspected side effects to the MHRA's Yellow Card scheme.
Who may not be able to take HRT
Most people with menopause symptoms can take HRT. The NHS says it may not be suitable if you:
- have a history of breast, ovarian or womb cancer
- have a history of blood clots (patches or gels may be used instead of tablets)
- have untreated high blood pressure (this needs to be controlled first)
- have liver disease
- are pregnant
The NHS oestrogen medicine page also asks you to tell your doctor if you have unexplained vaginal bleeding, thrombophilia, have ever had angina or a heart attack, or have diabetes, high blood pressure, migraines or severe headaches, or are breastfeeding. These do not always rule HRT out, but they help your GP choose the safest option. If HRT is not right for you, there are alternatives.
Starting, how long to take it, and stopping
How long
HRT is usually taken for 2 to 5 years, sometimes longer, with no fixed limit. The NHS says it is best taken while the benefits outweigh the risks, and it is reviewed every year. After 60 in particular, the risks may begin to outweigh the benefits; if you continue or start then, your GP may suggest a low dose and patches or gel rather than tablets. Vaginal oestrogen can be used for as long as needed.
Early or premature menopause
If your menopause comes before 45 (early) or before 40 (premature), the NHS says taking HRT or the combined pill is particularly important to protect against conditions such as osteoporosis, and you are usually advised to take HRT until at least 51.
Contraception
It is still possible to get pregnant while taking HRT. The NHS says to use contraception until 2 years after your last period if you are under 50, or for 1 year after the age of 50. You cannot take HRT at the same time as the combined pill, but you can usually take it with the progestogen-only pill. You no longer need contraception after 55.
Stopping
Talk to your GP before stopping. You can stop suddenly, but the NHS usually recommends reducing the dose gradually over 3 to 6 months, as symptoms are less likely to come back that way. If symptoms return and do not go away after 3 months, speak to your GP.
My HRT questions list
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Alternatives to HRT
If you cannot take HRT or prefer not to, the NHS lists other options.
Talking therapy and medicines
- Cognitive behavioural therapy (CBT) may be offered for hot flushes and night sweats, and the NHS says it can help with low mood, anxiety and sleep problems. NICE recommends considering it for hot flushes, sleep problems and depressive symptoms linked to menopause.
- Clonidine, a prescription tablet, can reduce hot flushes and night sweats. It does not affect hormone levels, so it does not increase breast cancer risk. It may take 2 to 4 weeks to work.
- Antidepressants (SSRIs or SNRIs) may be offered for low mood, depression or anxiety linked to menopause, though NICE says they have not been shown to help low mood if depression has not been diagnosed. A doctor may also suggest one for hot flushes if CBT has not helped. Our guide to menopause mood changes and anxiety goes further.
Lifestyle changes
- Regular exercise can ease hot flushes and help you sleep; a varied diet supports bone health.
- Loose clothing and a cooler bedroom help with flushes and night sweats.
- Cutting back on caffeine, alcohol and spicy food may help, and stopping smoking may reduce hot flushes.
- For vaginal dryness, lubricants or moisturisers can help, alone or with vaginal oestrogen.
Herbal and "natural" remedies
Products such as black cohosh, red clover, evening primrose oil and St John's wort are not tested and regulated like medicines, so their safety and effectiveness are unknown. Some, especially St John's wort, can cause serious side effects with other medicines. Ask your GP or pharmacist before trying one, and tell your GP about any you take.
What HRT costs: the HRT prepayment certificate
If you pay for NHS prescriptions in England, each item costs £9.90. The HRT prescription prepayment certificate (HRT PPC) costs a one-off £19.80, the price of 2 items, and covers an unlimited number of eligible HRT medicines for 12 months.
- When it saves money: if you pay for HRT 3 or more times in 12 months.
- What it covers: medicines on the NHSBSA list, including many tablets, patches, gels, sprays, vaginal oestrogens and progesterone capsules, but only HRT also licensed for menopause in the UK. Check the list or ask your pharmacist first.
- The hormonal coil: the levonorgestrel coil on the list is a free contraceptive, so no charge applies even when it is prescribed for menopause.
- Other items: non-HRT prescriptions are not covered. If you collect several, a standard 3-month (£32.05) or 12-month (£114.50) PPC may save more.
- Buying and refunds: buy online from the NHS Business Services Authority or at some pharmacies, with a start date up to 1 month either side. Ask for an FP57 form if you pay while waiting; you can claim within 3 months. The certificate itself is non-refundable.
Before your appointment
The NHS suggests seeing a GP if you are over 45 with menopause symptoms and thinking about HRT, or if you are under 45 and think you have menopause symptoms, as this may be early menopause. Note any recent changes to your periods, and tell your GP about every medicine and herbal remedy you take. You can also talk to a nurse or pharmacist about HRT and other options.
Go into your appointment prepared
This guide explains the options; our courses help you apply them to your own symptoms. Not sure which fits? See our guide to picking a course by goal or browse all menopause courses.
Understanding HRT and Other Treatment Options
HRT and the non-hormonal options explained in plain English, based on NHS guidance, with clear questions for your GP.
Menopause Symptom Tracking and GP Appointment Prep
8 weeks of tracking turned into a GP conversation, with a script, questions and a readiness check.
Complete Menopause Guide
Every stage in one place, with a symptom tracker, a GP appointment summary and who to ask for help.
Our courses are education to help you understand your options and prepare for appointments. They do not diagnose or treat any condition.
Related guides
- Menopause symptoms: the full UK list: what helps each one.
- Your menopause GP appointment: what to bring and what to say.
- Hot flushes and night sweats: triggers and practical cooling steps.
- Menopause, mood and anxiety: what is normal and where to get support.
Questions people ask about HRT
What are the main benefits and risks of HRT?
HRT relieves most menopause symptoms and helps prevent osteoporosis. The main risks are a small rise in breast cancer risk with combined HRT, and in blood clot and stroke risk with HRT tablets. The NHS says that for women under 60 not at high risk of breast cancer or blood clots, the benefits are likely to outweigh the risks.
What are the different types of HRT?
Combined HRT (oestrogen plus a progestogen) if you still have a womb, or oestrogen-only HRT after a hysterectomy. Combined HRT is sequential if you still have periods, or continuous after menopause. It comes as tablets, patches, gel or spray, with a hormonal coil as one source of progestogen. Vaginal oestrogen treats vaginal symptoms.
Are HRT patches safer than tablets?
For blood clots, yes. The NHS says HRT tablets can slightly increase the risk of blood clots and stroke, while patches, gels and sprays do not, because oestrogen absorbed through the skin is considered safer.
How much does HRT increase breast cancer risk?
The NHS says there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years. The risk rises the longer you take it and falls after you stop. Oestrogen-only HRT carries little or no increased risk.
How long can you stay on HRT?
There is no fixed limit. HRT is usually taken for 2 to 5 years, sometimes longer, and reviewed every year. If your menopause was early, you are usually advised to take it until at least 51.
How much does HRT cost in England?
Each NHS prescription item costs £9.90. The HRT prescription prepayment certificate costs £19.80 and covers eligible HRT medicines for 12 months, so it saves money if you pay for HRT 3 or more times a year.
What are the alternatives to HRT?
The NHS lists CBT and clonidine for hot flushes and night sweats, antidepressants for diagnosed depression or anxiety, and lifestyle changes such as exercise, staying cool and cutting back on caffeine, alcohol and spicy food. Ask your GP which suit you.
Sources
- NHS: About hormone replacement therapy (HRT)
- NHS: Types of HRT
- NHS: Benefits and risks of HRT
- NHS: Side effects of HRT
- NHS: When to take HRT
- NHS: Oestrogen tablets, patches, gel and spray (who can take it; side effects)
- NHS: Alternatives to HRT (lifestyle changes, other medicines, herbal remedies)
- NHS: Treatment for menopause and perimenopause (last reviewed 19 May 2026)
- NICE: Menopause: identification and management (NG23), updated November 2024
- NHS: Save money with a prescription prepayment certificate
- NHSBSA: HRT prescription prepayment certificate and medicines covered (list correct as of 1 July 2026)
This article is general information based on UK NHS and NICE guidance. It is not medical advice and does not replace a consultation. Do not start, change or stop HRT without speaking to your GP, nurse or pharmacist.
