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Considering HRT? Your essential guide to the benefits, risks & more
Written byMedico Digital
Reviewed byDr Shazia Malik
Hormone replacement therapy: what's the deal? Get clear on how HRT works, who it can help and the key facts you need to know to make confident decisions about your health
Summary
1What is HRT?
HRT is a treatment used to help alleviate menopause symptoms and reduce the risk of certain health problems…
2Why take HRT?
You may want to try HRT if your menopause symptoms are making life difficult – whether that’s during perimenopause or postmenopause…
3Does HRT delay menopause?
No, HRT doesn’t delay menopause, but it can make menopause symptoms more manageable.
While some people breeze through menopause with barely a symptom, unfortunately, lots of us aren’t so lucky.1
HRT works by replacing the hormones progesterone and oestrogen that your body produces less of as you approach menopause.2,3 But how exactly does it work?
What is HRT?
HRT is a treatment used to help alleviate menopause symptoms and, in some cases, may also offer additional benefits.2,3 It comes in various forms, including tablets, patches and gels.3,4
HRT contains hormones (that may be synthetic or body-identical, depending on the formulation) that replace the natural levels of oestrogen – and usually progesterone – that decline as you approach menopause.3
Low levels of these hormones, especially oestrogen, are responsible for many common menopause symptoms, including:3,4
- night sweats and hot flushes (vasomotor symptoms)
- mood changes
- vaginal dryness
- low libido (sex drive)
So, by topping up oestrogen and progesterone, HRT may help ease your menopause symptoms.2-4 Let’s dive into the specifics of how it works.
Why take HRT?
You may want to try HRT if your menopause symptoms are making life difficult – whether that’s during perimenopause or postmenopause.5 Here’s why some women can benefit from HRT – and how it can help.
Your symptoms are interfering with daily life
HRT offers effective relief from many menopause symptoms, including vasomotor symptoms and genital/urinary discomfort.3,5,6
There’s no need to wait until your periods have stopped or your symptoms become unbearable to start HRT.5 If menopause symptoms are impacting your quality of life, it may be worth discussing treatment with your doctor.5
You’re going through early menopause
HRT can be especially helpful for women experiencing early menopause (before the age of 45) or premature menopause (before the age of 40).5,6
As early menopause leads to lower oestrogen levels for a longer period, these women are at higher risk for long-term health issues like osteoporosis, mood changes and heart disease.6 HRT can help reduce some of these risks.5,6
You’re under 60 years old
HRT tends to be most beneficial in women under 60.5-7 For those older than 60, the risks of HRT may start to outweigh the benefits.5
As menopause symptoms usually ease off as you get older, continuing HRT may offer less benefit.5 At the same time, taking HRT for longer is associated with a greater risk of breast cancer.5,6
Studies suggest that HRT may be particularly effective at reducing the risk of cardiovascular disease and improving sexual function in younger menopausal women.7,8
If you’re over 60 and still experiencing menopause symptoms, it’s a good idea to talk to your doctor about whether continuing HRT is right for you.5
You’re worried about your bone health
After going through menopause, women face a higher risk of various long-term health issues, including osteoporosis (thinning of the bones).5,9
There’s some evidence that HRT (especially if started early) can help protect against osteoporosis and reduce the risk of fractures.9
How to take HRT and available options
Since low oestrogen is behind many menopause symptoms, most HRT contains synthetic or bioidentical oestrogen.10,11
Taking oestrogen alone can cause the lining of your womb to thicken, so progesterone is usually added to HRT to prevent this, unless you’ve had a hysterectomy (a surgical procedure to remove the womb).10,11 This combination is known as combined HRT.11
Combined HRT contains both artificial oestrogen and progesterone, and is available as a tablet or a patch, so you don't need to take anything else.11
But if you prefer, you can also take the hormones separately. Oestrogen comes in a variety of forms, including:10,11
- a tablet or capsule
- patches
- gels
- sprays
- vaginal creams, gels, tablets, pessaries or rings
These oestrogen formulations can be used on their own (if you’ve had a hysterectomy or are using a vaginal-only formulation) or in combination with progesterone.11
Progesterone options include:10,11
- a tablet
- a Mirena coil (otherwise known as an intrauterine system, or IUS)
You can take HRT in two main ways: either continuously (oestrogen and progesterone every day) or sequentially (oestrogen every day and progesterone on just a few days).11 Which regime is right for you will depend on your individual circumstances and whether you’re still having periods.11
It’s not just oestrogen and progesterone levels that fall during menopause – testosterone levels drop too.10,11 Testosterone is important for libido and bone health, and in some cases, it may be prescribed as a gel for post-menopausal women.10
HRT isn’t a form of contraception (unless you’re using the Mirena coil).3 To prevent pregnancy, you’ll need to use another method until two years after your last period (or just one year if you’re over 50).3
When it comes to HRT, there’s no one-size-fits-all approach – the right dose and combination of hormones will be tailored to your specific symptoms and needs.10,11 It’s also important to understand the risks of HRT before deciding whether it’s the right choice for you.3
Risks and considerations of HRT
Some women worry about the health risks of HRT, but the chances of it negatively impacting your health are very small.2 A healthcare professional will always assess your medical history to ensure it’s safe for you before prescribing it.2
While HRT may be linked to a slightly increased risk of breast cancer when used for longer periods of time, the evidence is mixed.2,5,10,12 The UK National Institute of Health and Care Excellence (NICE) advises that combined HRT use is linked to an increased risk of breast cancer, but this risk drops once you stop HRT.2
There’s also a small risk of developing a blood clot in your leg or lungs if you take HRT as a tablet, but this isn’t a concern if you use it as a patch, gel or spray.2
According to NICE, HRT doesn’t increase your risk of coronary heart disease (including heart attacks), but taking HRT tablets may slightly raise your risk of experiencing a stroke.2 However, it’s important to remember that the risk of stroke in women under 60 is very low to begin with.2
HRT side effects
While HRT can help with menopause symptoms, some women do experience side effects.3
HRT containing oestrogen can lead to:2,10
- bloating
- breast tenderness or swelling
- swelling in other parts of the body (due to weight gain and fluid retention)
- feeling sick/nausea
- leg cramps
- headaches
- indigestion
- vaginal bleeding
On the other hand, progesterone-containing HRT may cause:2,10
- breast tenderness
- swelling in other parts of the body
- headaches or migraines
- mood swings
- depression
- acne
- Abdominal (tummy) discomfort
- back discomfort
- vaginal bleeding
Side effects are usually mild and tend to get better by themselves within three months.3 But if you’re worried, it’s a good idea to discuss them with a healthcare professional.3
Common questions about HRT
No, HRT doesn’t delay menopause, but it can make menopause symptoms more manageable.6,10
Some women choose to take menopause supplements alongside HRT. But unlike HRT, natural menopause remedies aren’t as well tested or regulated.13
Before adding any supplements to your routine, it’s best to check with your GP.13
There’s no strict time limit – you can continue to take HRT for as long as the benefits outweigh the risks.5 For things like hot flushes, women tend to use HRT for 2–5 years, but some continue for longer.5
After starting HRT, your symptoms should begin to improve within a few days to weeks.3
Your GP will usually arrange a follow-up appointment after about three months to see how it’s going – if it’s not working by then, they may tweak your treatment.3
The final say
While some women get on well with HRT, it’s just one option for managing menopause symptoms.5
HRT isn’t the right choice for everyone – it’s a personal decision that should be made with the guidance of a healthcare professional.5 They can also help you understand the different types of HRT and how to use them.
Interested in trying a more natural way to support your health through menopause? Take a look at our top perimenopause supplements to help you feel your best during the time leading up to menopause and beyond.
Disclaimer - The advice in this article is for information only and should not replace medical care. Please check with your GP or healthcare professional before trying any supplements, treatments or remedies. Food supplements must not be used as a substitute for a varied and balanced diet and a healthy lifestyle.
While we strive for accuracy and balance, please be aware that this article may discuss products available for purchase through Holland & Barrett. Consult a healthcare professional before making any health-related decisions.
1. NICE. Menopause: Prevalence [Internet]. [cited 2025 Apr 1]. Available from: https://cks.nice.org.uk/topics/menopause/background-information/prevalence/
2. NICE. Menopause: Management [Internet]. [cited 2025 Apr 1]. Available from: https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/
3. NHS. About hormone replacement therapy (HRT) [Internet]. [cited 2025 Apr 1]. Available from: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/
4. Santoro N, et al. The menopause transition: Signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106(1):1–15. https://doi.org/10.1210/clinem/dgaa764
5. NHS. When to take hormone replacement therapy (HRT) [Internet]. [cited 2025 Apr 1]. Available from: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/
6. Mehta J, et al. Risks, benefits, and treatment modalities of menopausal hormone therapy: Current concepts. Front Endocrinol (Lausanne). 2021;12:564781. https://doi.org/10.3389/fendo.2021.564781
7. Hodis HN, et al. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med. 2016;374(13):1221–31. https://doi.org/10.1056/NEJMoa1505241
8. Taylor HS, et al. Effects of oral vs transdermal estrogen therapy on sexual function in early postmenopause: Ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS). JAMA Intern Med. 2017;177(10):1471–9. https://doi.org/10.1001/jamainternmed.2017.3877
9. Rozenberg S, et al. Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis? Osteoporos Int. 2020;31(12):2271–86. https://doi.org/10.1007/s00198-020-05497-8
10. Harper-Harrison G, et al. Hormone replacement therapy. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK493191/
11. NHS. Types of hormone replacement therapy (HRT) [Internet]. [cited 2025 Apr 1]. Available from: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/
12. Cagnacci A, Venier M. The controversial history of hormone replacement therapy. Medicina (Kaunas). 2019;55(9):602. https://doi.org/10.3390/medicina55090602
13. NHS. Herbal remedies and complementary medicines for menopause symptoms [Internet]. [cited 2025 Apr 1]. Available from: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/herbal-remedies-and-complementary-medicines-for-menopause-symptoms/
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