Hormone Replacement Therapy (HRT): Benefits, Risks and Types

The complete, doctor-reviewed guide to HRT — what it treats, who it suits, the benefits and risks, the types available, and how to get it in the UK.

Hormone replacement therapy (HRT) replaces the hormones — mainly oestrogen, and where needed progesterone — that your body stops producing at menopause. It relieves hot flushes, night sweats, low mood, poor sleep, brain fog and vaginal dryness, and it protects your bones against osteoporosis. This guide is the hub for our HRT resources: use it to understand the essentials, then follow the links to detailed guides on each topic.

What HRT is and who it's for

During the menopause transition the ovaries gradually stop producing oestrogen, which affects body temperature, mood, sleep, bone density, and vaginal and bladder tissue. HRT restores oestrogen to physiological levels, easing the wide range of symptoms this causes. If you still have your uterus, oestrogen is combined with a progestogen to protect the womb lining; after a hysterectomy, oestrogen is taken alone.

HRT suits most women with troublesome menopausal or perimenopausal symptoms. It's particularly recommended for women with premature ovarian insufficiency (menopause before 40, affecting around 1 in 100 women). For a plain-English introduction, see What is HRT?; if your symptoms are severe, see severe menopause symptoms; and if you're still having periods, see perimenopause and HRT.

The benefits of HRT

• Reduces hot flushes and night sweats by around 75% — more than any alternative
• Restores vaginal and urinary tract tissue, easing dryness, painful sex and recurrent UTIs
• Supports mood, concentration and sleep quality
• Slows bone loss and reduces fracture risk
• May support heart health when started under 60 or within 10 years of menopause

Types and routes of HRT

The right regimen depends on where you are in the menopause transition and whether you have a uterus:

Oestrogen can be delivered as a patch, gel, spray or tablet. Transdermal routes (patches such as Evorel, gels such as Oestrogel, or spray) bypass the liver and do not carry the small clot risk associated with tablets. Body-identical HRT — transdermal estradiol plus micronised progesterone (Utrogestan) — is regulated, widely prescribed and endorsed by the British Menopause Society. For detail, see our guides to body-identical HRT, the Evorel patches range, vaginal oestrogen, and testosterone for menopause.

Benefits vs risks: the evidence

Much historical fear traces to the misreported 2002 WHI study; modern, individualised guidance takes a very different view. The main considerations:

• Breast cancer: combined HRT — about 5 extra cases per 1,000 women over 5 years of use; the increase declines after stopping
• Blood clots (VTE): oral HRT carries a small increase; transdermal HRT shows no significant increase versus non-users
• Stroke: oral oestrogen carries a small increase, mainly in older women; transdermal at standard doses does not show a significant increase

Once started, most women notice improvement within 4 weeks and full benefit by 3 months. Early side effects such as breast tenderness, bloating and irregular bleeding usually settle — see HRT side effects. If you're considering coming off HRT, our stopping HRT guide explains how to taper safely, and if your product is unavailable, see HRT shortages.

Non-hormonal options and CBT

HRT isn't right, or wanted, for everyone. The November 2024 update to NICE NG23 formally recommends cognitive behavioural therapy (CBT) for hot flushes, night sweats, and menopause-related sleep and mood problems — alongside HRT or instead of it. Non-hormonal prescription medicines (such as certain SSRIs/SNRIs, gabapentin, or the newer NK3 antagonist fezolinetant) can reduce flushes, and lifestyle measures help at the margins. Our alternatives to HRT guide covers what works and what doesn't.

Cost and how to get HRT

In England, NHS prescriptions cost £9.90 per item, but the dedicated HRT prepayment certificate (£19.80) covers unlimited eligible HRT items for 12 months — frozen for 2026/27. Prescriptions are free in Scotland, Wales and Northern Ireland. Private online services let you skip the GP wait. Full breakdown in our HRT cost guide, and our get HRT online guide explains how online prescribing works.

If you think HRT could help you, Access Doctor's pharmacist independent prescribers can assess you through a confidential online consultation and, where appropriate, prescribe the right regimen with discreet next-day delivery.