HRT Explained: Types, Benefits and Risks in Plain English
Hormone replacement therapy is the most effective treatment for many menopause symptoms — and one of the most misunderstood. Here is a clear, balanced guide to what it is and how to weigh it up.
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Key takeaways
- HRT replaces the oestrogen your body makes less of around menopause; women with a womb also need a progestogen.
- It is the most effective treatment for hot flushes and night sweats, and it helps protect against osteoporosis.
- Risks depend on the type of HRT, your age and health history; for most women under 60 the benefits are considered to outweigh the risks.
- Oestrogen through the skin (patches, gel, spray) does not increase the risk of blood clots in the way tablets can.
Few treatments have had a more confusing reputation than hormone replacement therapy. A large study in the early 2000s led many women to stop HRT overnight; later analyses have given a more nuanced picture. Today, health guidelines describe HRT as the most effective treatment for many menopause symptoms, with a decision that should be made individually with a doctor.2
What HRT is
HRT replaces hormones that fall around menopause:
- Oestrogen relieves symptoms such as hot flushes, night sweats, sleep problems and vaginal dryness.
- A progestogen is added for women who still have a womb, to protect the womb lining. Women who have had a hysterectomy usually take oestrogen alone.1
- Testosterone is sometimes added for low sexual desire, under specialist advice.
How it is taken
- Tablets.
- Through the skin: patches, gels or sprays.
- Vaginal oestrogen — creams, tablets or a ring — for vaginal and urinary symptoms. It acts locally and is very low dose.
The benefits
- Relief of hot flushes and night sweats — HRT is the most effective treatment for these.1
- Improvements in sleep, mood swings, joint aches and vaginal dryness for many women.
- Protection against osteoporosis and fractures while it is taken.
The risks, in context
Breast cancer. Combined HRT (oestrogen plus progestogen) is linked to a small increase in breast cancer risk, which rises with longer use; oestrogen-only HRT carries little or no increased risk.4 The size of the risk is similar to, or lower than, some lifestyle factors such as drinking alcohol or being overweight.3
Blood clots. HRT tablets slightly increase the risk of blood clots. Oestrogen through the skin, at standard doses, does not appear to carry this increased risk.2
Other risks depend on your age, how long after menopause you start, and your personal and family history. For most women under 60, the benefits of HRT are considered to outweigh the risks.1
HRT is not right or wrong for everyone. It is a decision to make with full information, and to review over time.
Before you start
Your doctor will ask about your symptoms, health history and family history, and may check your blood pressure. Women over 45 with typical symptoms do not usually need blood tests to start HRT.2 It can take a few weeks to a few months to feel the full benefit, and the type or dose can be adjusted if side effects such as breast tenderness or bleeding occur.
If HRT is not suitable
Non-hormonal options include certain prescription medicines, cognitive behavioural therapy and newer non-hormonal treatments in some countries. Read our guide to what helps with hot flushes.
Sources
- NHS. Hormone replacement therapy (HRT). nhs.uk.
- NICE. Menopause: identification and management (NG23), updated 2024. nice.org.uk.
- Women’s Health Concern. HRT: benefits and risks (factsheet). womens-health-concern.org.
- Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk. The Lancet. 2019;394:1159–1168.