HRT explained: menopause treatment options
Reviewed by the My London Pharmacy clinical team, Michelle Chuku, Pharmacist Independent Prescriber
·29 July 2026
·10 min read
Quick answer
Hormone replacement therapy (HRT) replaces the oestrogen your body makes less of around menopause, easing symptoms such as hot flushes, night sweats and mood changes. It comes as patches, gels, sprays and tablets, and a clinician chooses the type and dose that suits your health, preferences and whether you still have a womb.
What HRT is and who it is for
Hormone replacement therapy, usually shortened to HRT, tops up the hormones your ovaries produce in smaller amounts as you move through the menopause transition. For most people that means oestrogen, often alongside a progestogen. The aim is to ease symptoms that affect day-to-day life rather than to change the natural course of menopause itself.
HRT is generally considered for people whose menopausal or perimenopausal symptoms are troublesome, and for some who reach menopause early. The National Institute for Health and Care Excellence (NICE) supports discussing HRT with anyone bothered by symptoms, so that the potential benefits and risks can be weighed against your individual circumstances. It is not a one-size-fits-all treatment, and a qualified clinician can advise based on your medical history, family history and what matters most to you.
Types of HRT: which hormones are involved
There are two broad building blocks. Oestrogen is the hormone that relieves most menopausal symptoms. Progestogen is added to protect the lining of the womb from the effects of oestrogen. Whether you need progestogen depends largely on whether you still have a womb. The oestrogen in HRT is usually a form called oestradiol, which closely resembles the hormone the ovaries once made, while the progestogen component may be a synthetic progestogen or micronised (sometimes called body-identical) progesterone.
If you have had a hysterectomy, oestrogen-only HRT is usually appropriate. If you still have your womb, combined HRT (oestrogen plus a progestogen) is used. Combined HRT is given in two patterns. Cyclical, or sequential, HRT is often chosen when periods have not yet fully stopped and can produce a monthly bleed. Continuous combined HRT, such as Evorel Conti, Kliovance Tablets or Femoston in its continuous form, is typically used once someone is postmenopausal and is designed to be bleed-free over time. Some people are prescribed micronised progesterone such as Utrogestan 100mg capsules alongside a separate oestrogen. A less commonly used option, Livial (tibolone) Tablets, is a single tablet with combined hormone-like activity that may suit some postmenopausal people.
How HRT is taken: patches, gels, sprays and tablets
Oestrogen can be delivered through the skin as a patch, gel or spray, or taken by mouth as a tablet. Skin (transdermal) routes such as an Oestrogel Pump or an oestrogen patch are often preferred because the hormone is absorbed directly into the bloodstream, avoiding first pass through the liver. This route is generally favoured for people with certain risk factors, though a clinician will confirm what is suitable for you.
Tablets remain a straightforward option for many people and can be convenient to take. The choice between routes usually comes down to your health background, how your skin reacts, and personal preference. There is rarely a single correct answer, and it is common to adjust the route or dose in the first few months to find the best fit.
- Patches: applied to the skin and changed once or twice a week.
- Gels and sprays: measured doses applied daily to the skin.
- Tablets: taken by mouth, once daily.
Vaginal (local) HRT for urogenital symptoms
Some menopausal symptoms are focused on the vagina and urinary tract, including dryness, discomfort, itching and recurrent urinary symptoms. These can be treated with low-dose local oestrogen that acts mainly where it is applied, such as Vagifem Vaginal Tablets. Because the dose is low and the effect is largely local, this treatment can often be used on its own and, for many people, does not require an added progestogen.
Local vaginal treatment can be used alongside systemic HRT if both types of symptoms are present. If dryness or discomfort is your main concern, it is worth raising specifically, as it responds well to targeted treatment and does not always need full-body hormone therapy.
Weighing up the benefits and risks
For people with troublesome symptoms, HRT can meaningfully improve hot flushes, night sweats, sleep, mood and vaginal symptoms, and it supports bone strength. As with any medicine, there are potential risks to consider, and these vary with your age, the type of HRT, the route and how long it is used. This is why HRT is a personal decision made with a clinician rather than a blanket recommendation.
NHS and NICE guidance frames HRT as a balance: for many people under 60 or within ten years of menopause, the benefits for symptom relief often outweigh the risks, but individual factors matter. A clinician will review your personal and family medical history, take your blood pressure and discuss any concerns before recommending a treatment. Reviews are usually arranged so the plan can be adjusted over time.
Is HRT safe, and does it cause cancer?
One of the most common questions is simply whether HRT is safe. For most healthy people under 60, or within about ten years of their last period, current NHS and NICE guidance indicates that the benefits of HRT for troublesome symptoms generally outweigh the risks. Safety is never absolute for any medicine, though, and it depends on your age, your personal and family medical history, the type of HRT and how it is taken. This is why HRT follows an individual assessment rather than being offered as a blanket treatment.
The question of cancer understandably worries many people, so it helps to see it in proportion. Combined HRT (oestrogen with a progestogen) is associated with a small increase in the risk of breast cancer, and this tends to be greater the longer it is used; oestrogen-only HRT carries little or no added breast cancer risk for most people. Any increase is generally small, is often comparable in scale to other everyday lifestyle factors, and much of it reduces after treatment stops. The route can matter too, with skin-based oestrogen thought to carry a lower risk of blood clots than tablets. None of this means HRT is unsafe; it means the balance is personal. A clinician can talk you through what the current evidence means for your own circumstances so you can make an informed choice.
Starting HRT, how long it takes, and when to stop
When you start HRT it can take a few weeks to notice an improvement, and often a few months to settle on the right type and dose. Symptoms such as hot flushes and night sweats may ease first, while effects on sleep, mood and energy can build more gradually. Some people experience early, usually temporary, effects such as breast tenderness, mild nausea or spotting as the body adjusts. These often ease with time, but they are worth mentioning at a review because sometimes a small change to the dose or route helps.
An initial review is commonly arranged around three months after starting, and then usually once a year if things are stable. At each review a clinician checks how you are getting on, revisits the benefit-and-risk balance, and confirms the plan still suits you. There is no fixed time limit that applies to everyone; how long to continue is decided individually. When and how to come off HRT is an individual decision too, and some people find it easier to reduce the dose gradually rather than stopping abruptly, which may lessen the chance of symptoms returning suddenly. A clinician can guide the timing based on how you feel, your symptoms and your overall health.
What HRT costs on the NHS
HRT is a prescription treatment, and people often ask whether it is free. In England, standard NHS prescription charges normally apply for each item you collect, so someone using more than one HRT product could pay more than one charge. To help with this, an HRT-specific prescription prepayment certificate is available: for an annual fee it covers most HRT items for twelve months, which can reduce the cost for people who need regular prescriptions. In Scotland, Wales and Northern Ireland, NHS prescriptions are free.
Some people in England are also exempt from prescription charges altogether, for example those aged 60 or over, people on certain low-income or benefit schemes, and those holding particular medical exemption certificates. If cost is a concern, it is worth asking a pharmacist or clinician which option works out best for you, as the right prepayment or exemption arrangement can make ongoing treatment more affordable.
HRT, libido and sexual wellbeing
Many people notice changes in sex drive around the menopause, and it is a reasonable thing to raise. HRT does not act as a direct libido booster, but by easing symptoms that get in the way, such as vaginal dryness and discomfort, disturbed sleep, low mood and fatigue, it can help some people feel more like themselves, and sex drive may improve as a result. Local vaginal treatment can be particularly helpful where dryness or discomfort is the main barrier to comfort.
For some people whose libido remains low despite HRT, a clinician or specialist may consider testosterone, which the body also produces in smaller amounts after menopause. Where used, it is prescribed and monitored carefully and is not suitable for everyone. If sexual wellbeing is affecting your quality of life, it is worth mentioning at a consultation, as there are several avenues a clinician can explore with you.
Non-hormonal options and lifestyle support
HRT is not the only way to manage menopausal symptoms, and it is not suitable for everyone. Some people cannot take it for medical reasons, while others simply prefer to avoid hormones. In these situations a clinician can discuss non-hormonal approaches, which may include certain prescription medicines used to reduce hot flushes, a licensed non-hormonal treatment for vasomotor symptoms, and psychological approaches such as cognitive behavioural therapy (CBT), which NHS guidance recognises as helpful for flushes, low mood and sleep problems.
Lifestyle measures also play a genuine role, whether alongside HRT or on their own. Regular physical activity, a balanced diet, limiting alcohol and caffeine, not smoking and paying attention to sleep can all support how you feel through the menopause transition. Weight-bearing exercise and adequate calcium and vitamin D help protect bone health, which naturally becomes more important after menopause. None of these replace a treatment where one is needed, but they complement it and are worth discussing as part of a rounded plan.
When to speak to a clinician
HRT is a prescription treatment, so it should always follow a proper assessment. Speak to a clinician before starting if you have a history of certain cancers, blood clots, liver problems, or unexplained vaginal bleeding, as these influence what is safe and suitable for you. Your clinician will also take your blood pressure and ask about your personal and family medical history, current medicines and lifestyle, so the right option can be matched to you.
Once on HRT, seek advice if you develop new or unexpected vaginal bleeding, calf pain or swelling, chest pain or breathlessness, or a sudden severe headache, as these need prompt attention. If your symptoms are affecting your quality of life, a consultation is a sensible first step. A clinician can talk through whether HRT or a non-hormonal approach may suit you, arrange any checks needed, and put a clear, reviewable plan in place. Everything is handled discreetly and at your own pace, and you can return to adjust the plan at any time.
Frequently asked questions
Do I need a progestogen with my HRT?
If you still have your womb, a progestogen is usually included to protect the womb lining. If you have had a hysterectomy, oestrogen-only HRT is generally appropriate. A clinician will confirm what is right for you.
What hormones are in HRT?
HRT usually contains oestrogen, typically a form called oestradiol, and for people with a womb a progestogen (either a synthetic progestogen or micronised progesterone). Testosterone is sometimes added by a specialist. A clinician selects the combination that suits you.
Is HRT safe, and does it cause cancer?
For most healthy people under 60 or within about ten years of menopause, NHS and NICE guidance indicates the benefits often outweigh the risks. Combined HRT carries a small increase in breast cancer risk that rises with longer use, while oestrogen-only HRT carries little or none. A clinician can weigh this against your circumstances.
How long does HRT take to work?
Many people notice symptoms such as hot flushes starting to ease within a few weeks, but it can take a few months to settle on the right type and dose. A review is commonly arranged around three months after starting.
When should I come off HRT?
There is no single time limit that applies to everyone; how long to continue is reviewed individually, usually at an annual review. Some people reduce the dose gradually rather than stopping suddenly, and a clinician can guide the timing.
Is HRT free on the NHS?
In England, standard prescription charges usually apply per item, though an HRT prescription prepayment certificate can cap the cost of HRT items over a year, and some people are exempt from charges. Prescriptions are free in Scotland, Wales and Northern Ireland.
Does HRT increase sex drive?
HRT is not a direct libido booster, but by easing symptoms such as vaginal dryness, poor sleep and low mood it can help some people feel more themselves, and sex drive may improve. A clinician or specialist may consider testosterone in some cases.
Is a patch or gel better than tablets?
Skin routes such as gels, sprays and patches deliver oestrogen directly into the bloodstream and are often preferred for certain risk factors. Tablets remain suitable for many people. A clinician helps you choose based on your health and preferences.
Can HRT help vaginal dryness?
Yes. Low-dose local vaginal oestrogen targets dryness and discomfort directly and can be used on its own or alongside systemic HRT. It is worth raising this symptom specifically with a clinician.