Women’s Health · HRT · Menopause
HRT Key Facts: What You Should Know About Hormone Replacement Therapy
By Dr Abdishakur Ali (G.P)
Medically authored & reviewed by
Dr Abdishakur M Ali
General Practitioner · Telehealth Expert · Clinical Director
Last reviewed: March 2026
GPhC Registered Pharmacy
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Medical disclaimer: This article is for informational purposes only. HRT is a prescription medicine. Always discuss benefits and risks with a qualified prescriber. Our prescribers are GPhC-registered pharmacist independent prescribers.
Hormone replacement therapy (HRT) is one of the most effective treatments available for menopausal symptoms — from hot flushes and night sweats to mood changes, sleep disruption, and vaginal dryness. After years of uncertainty following the Women’s Health Initiative study in the early 2000s, the evidence base has been substantially reassessed. Current NICE guidelines (NG23) confirm that HRT is safe and appropriate for most healthy women under 60 within 10 years of menopause, with benefits that significantly outweigh risks when prescribed appropriately.
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Start HRT Consultation →✓ GPhC-registered pharmacy #9011198 ✓ Pharmacist independent prescribers ✓ Discreet next-day deliveryWhat Is Menopause and Why Does It Cause Symptoms?
Menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months — marking the permanent end of ovarian function. In the UK, the average age of natural menopause is 51 years. The perimenopause — the transition period leading up to menopause — can begin several years earlier and is when many women first experience symptoms.
Menopausal symptoms are caused by declining oestrogen and progesterone production. Oestrogen plays a central role in regulating body temperature, mood, bone density, cardiovascular health, sleep, and vaginal tissue health. Its decline disrupts all of these systems, producing the range of symptoms associated with menopause:
- Hot flushes — affecting up to 80% of women; can be frequent and severe
- Night sweats — disrupt sleep and cause fatigue
- Vaginal dryness and dyspareunia (painful sex)
- Urinary symptoms — urgency, frequency, recurrent UTIs
- Mood changes — anxiety, low mood, irritability
- Sleep disturbance
- Cognitive difficulties — poor concentration, memory issues (“brain fog”)
- Reduced libido
- Thinning hair and skin changes
- Bone density loss (increased osteoporosis risk)
Types of HRT: Choosing the Right Formulation
| HRT Type | Who It’s For | Examples |
|---|---|---|
| Combined HRT (oestrogen + progestogen) | Women with a uterus — progestogen protects the womb lining from oestrogen-induced overgrowth | Evorel Conti patches, Kliofem tablets, Kliovance tablets |
| Oestrogen-only HRT | Women who have had a hysterectomy — no uterus to protect | Elleste Solo patches, Premarin tablets, Oestrogel gel |
| Cyclical combined HRT | Women in perimenopause or who still have periods | Elleste Duet tablets, Evorel Sequi patches |
| Local vaginal oestrogen | Vaginal dryness and urogenital symptoms only | Vagifem tablets, Estring ring, Ovestin cream |
| Tibolone | Postmenopausal women (at least 1 year since last period) | Livial tablets |
HRT Delivery Methods: Patches, Tablets, Gels, and More
HRT can be administered in several ways, each with advantages depending on lifestyle, preference, and medical history:
- Patches (transdermal) — worn on the skin; changed twice weekly; generally safer cardiovascular profile than oral HRT; Evorel patches available in four strengths (25, 50, 75, 100mcg)
- Tablets (oral) — most familiar format; slight increase in blood clot risk compared to patches; Kliofem, Kliovance, Livial, Premarin, Premique
- Gels — applied to the skin once daily; similar safety profile to patches; Oestrogel
- Vaginal preparations — rings, creams, pessaries — for local urogenital symptoms only; minimal systemic absorption
- Implants — pellets inserted under the skin every 4–8 months; used in specialist settings
Benefits of HRT Beyond Symptom Relief
- Osteoporosis prevention — HRT is approved for prevention and treatment of postmenopausal osteoporosis; reduces fracture risk significantly
- Cardiovascular protection — evidence suggests HRT started within 10 years of menopause reduces cardiovascular risk in previously healthy women
- Type 2 diabetes risk reduction — oestrogen improves insulin sensitivity
- Cognitive protection — earlier menopause and surgical menopause are associated with higher dementia risk; HRT may be protective when started at menopause
- Improved quality of life — relief of vasomotor and urogenital symptoms produces meaningful improvements in work performance, relationships, and mental health
HRT Risks: What You Need to Know
HRT risks are formulation-specific and must be weighed against benefits individually:
- Breast cancer — combined HRT (oestrogen + progestogen) is associated with a small increased risk after 5+ years of use; oestrogen-only HRT has a lower risk profile; the risk is less than from drinking 2 units of alcohol daily
- Blood clots (VTE) — oral HRT slightly increases venous thromboembolism risk; transdermal HRT (patches, gels) does NOT increase VTE risk and is preferred for women with higher clot risk
- Stroke — oral oestrogen may slightly increase stroke risk; transdermal HRT does not increase stroke risk
Who should NOT take HRT: Women with a personal history of hormone-sensitive breast cancer, unexplained vaginal bleeding, active blood clots or pulmonary embolism, untreated endometrial cancer, or active liver disease. Always discuss your full medical history with your prescriber.
Access Doctor’s Range of HRT Products
Access Doctor provides a comprehensive range of licensed HRT treatments including:
- Evorel patches (25mcg, 50mcg, 75mcg, 100mcg)
- Elleste Solo MX patches
- Kliofem film-coated tablets
- Kliovance 1mg/0.5mg tablets
- Livial 2.5mg tablets
- Premarin 0.625mg tablets
- Premique Low Dose modified-release tablets
- Oestrogel transdermal gel
More HRT & Menopause Guides from Access Doctor
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Browse HRT Treatments →✓ GPhC-registered pharmacy #9011198 ✓ Pharmacist independent prescribers ✓ Discreet next-day deliveryFrequently Asked Questions
What is HRT and who is it for?
Hormone replacement therapy (HRT) replaces oestrogen and progesterone (and sometimes testosterone) that the body stops producing at menopause. It is primarily prescribed to relieve menopausal symptoms including hot flushes, night sweats, vaginal dryness, mood changes, and sleep disturbance. It is also used to prevent osteoporosis in postmenopausal women.
Is HRT safe?
Modern HRT is considered safe for most healthy women under 60 who are within 10 years of menopause. NICE guidance (NG23) states that for most women with bothersome menopausal symptoms, the benefits of HRT outweigh the risks when used appropriately. Risk-benefit must be assessed individually — particularly for breast cancer risk with combined HRT.
What are the different types of HRT?
The main types are: combined HRT (oestrogen + progestogen — for women with a uterus), oestrogen-only HRT (for women who have had a hysterectomy), cyclical HRT (for women still having periods or with perimenopausal symptoms), and continuous combined HRT (for postmenopausal women). Delivery methods include tablets, patches, gels, sprays, and vaginal preparations.
How long should I take HRT?
There is no fixed maximum duration for HRT. NICE recommends that the duration should be based on individual benefit-risk assessment, reviewed annually. Many women take HRT for several years; some benefit from longer-term use. Current guidance has moved away from arbitrary limits on HRT duration for symptom relief.
What are the side effects of HRT?
Common early side effects include nausea, breast tenderness, bloating, leg cramps, headaches, and irregular vaginal bleeding (during the adjustment period). These usually improve within the first 2–3 months. If they persist, dose or formulation adjustment can help.
Does HRT cause weight gain?
HRT does not directly cause weight gain. Menopause itself is associated with changes in fat distribution (more abdominal fat) due to oestrogen decline. HRT may actually help maintain body composition during the menopause transition. Women who gain weight during HRT typically gain it due to menopause-related hormonal changes rather than HRT itself.
References
- NICE. Menopause: diagnosis and management (NG23). Updated 2024. nice.org.uk/guidance/ng23
- NHS. Hormone replacement therapy (HRT). nhs.uk
- Stuenkel CA et al. Treatment of symptoms of the menopause. J Clin Endocrinol Metab. 2015. pubmed.ncbi.nlm.nih.gov
- GPhC. Standards for registered pharmacies. pharmacyregulation.org
Access Doctor is a GPhC-registered online pharmacy (registration number 9011198). All prescriptions are issued by GPhC-registered pharmacist independent prescribers. Medicines are MHRA-compliant UK-licensed products.