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HRT Information hub
Hormone Replacement Therapy (HRT) is exactly what it sounds like – replacing the hormones your body produces less of as you go through perimenopause and menopause. Think of it as giving your body back what it's naturally losing.
Advantages of HRT
Hormone Replacement Therapy (HRT)
can offer several important benefits. It helps relieve common menopausal symptoms such as hot flushes, night sweats, mood changes, cognitive symptoms, musculoskeletal symptoms, vaginal dryness, and sleep disturbances. It can significantly improve quality of life for many women.
HRT also helps protect against bone loss, reducing the risk of developing osteopenia and osteoporosis, which are common after menopause due to lower Oestrogen levels. HRT used within 10 years of the menopause can protect women against cardiovascular disease.
It is important to note that not all HRT is the same. Transdermal (via the skin) offer a lower risk compared to oral oestrogens that can increase the risk of blood clots and strokes in some women.
The decision to start HRT depends on your individual health and needs, and your doctor will help you weigh the benefits and any potential risks to find the best option for you.
Risks of HRT
While there is a small increased risk of breast cancer associated with certain types of Hormone Replacement Therapy, particularly combined HRT (which contains both estrogen and progestogen). This risk is generally low and depends on factors such as the type of HRT, duration of use, and when treatment is started.
It's important to understand this risk in context: lifestyle factors such as being overweight, drinking alcohol regularly, smoking, and lack of physical activity can also significantly increase breast cancer risk, often more so than HRT. For example, drinking two units of alcohol per day or being overweight after menopause can raise the risk more than taking HRT for five years.
The increased risk from HRT reduces after stopping treatment, and for many women, the benefits such as relief from menopausal symptoms and protection against osteoporosis can outweigh the risks.
Our clinicians can help you make an informed decision based on your personal health history, your family history and risk factors.
Again it is important to note that not all HRT is the same and body identical progesterone is thought to carry a lower risk of breast cancer compared with synthetic progestogens
Your Oestrogen Options
Through Your Skin (Transdermal)
What's available:
Body identical estradiol given via:
- Patches
- Gels
- Sprays
Why we often prefer this method:
Transdermal oestrogen goes straight into your bloodstream without being processed by your liver first, which means it doesn't affect your blood clotting.
We particularly recommend skin-based oestrogen if you:
- Simply prefer it
- Haven't found good symptom control with tablets
- Have migraine
- Have risk factors like high blood pressure, diabetes, or are a smoker
- Have a family history of blood clots
- Have risk factors like high blood pressure, diabetes, high BMI, or are a smoker
Taking Oestrogen by Mouth (Oral)
What's available:
- Estradiol – This is body-identical oestrogen, meaning it has the same structure as what your ovaries naturally produce
- Synthetic oestrogens – These are less commonly used now as first-choice treatments
What you need to know: When you take oestrogen by mouth, it travels through your digestive system and is processed by your liver. This process can slightly increase the risk of blood clots and stroke, which is why we're careful about who we recommend oral oestrogen for.
We might suggest alternatives if you have:
- Risk factors for blood clots or stroke
- Liver problems
- Family history of clotting issues
Vaginal oestrogen
Vaginal Oestrogen works directly where you need it most and is incredibly safe for long-term use. It targets vaginal dryness, discomfort, and urinary symptoms more effectively than tablets, patches, or gels because it goes straight to the affected tissues.
Other options:
- Prasterone (Intrarosa) - DHEA that converts to oestrogen locally
- Ospemifene (Senshio) - Oral tablet if vaginal treatments are difficult
Comparing Your Skin Options
Patches
- The good bits: Stick well and easy to use. Steady hormone levels all the time. Easy for travel. Only need to change twice a week.
- Things to consider: Worn all the time. Some women get skin irritation. Can fall off or crinkle. Might leave a sticky mark on your skin.
Gels
- The good bits: Easy to adjust your dose if needed.
- Things to consider: Higher doses need lots of bottles. Must be applied daily. Takes time to absorb before you can get dressed.
Sprays
- The good bits: Small amount needed. Absorbs quickly into your skin.
- Things to consider: Daily application needed. Difficult to know when the device is nearly empty.
Important to remember: Everyone absorbs these differently, so we might need to adjust your dose to find what works best for you. What works perfectly for your friend might need tweaking for you – and that's completely normal.
Progesterone: Protecting Your Womb
If you still have your womb, you'll need progesterone alongside oestrogen. Think of progesterone as your womb's bodyguard, it protects the lining from becoming too thick, which could increase cancer risk.
Your Progesterone Choices
Body-identical progesterone (micronised)
- Same structure as what your ovaries produce
- Made from plant extracts
- Bonus: Can help with sleep and reduce anxiety
- Note: Contains gelatin (not suitable for vegans) and soya
Synthetic progestogens:
- Different structure but does the same protective job
- Better at controlling bleeding patterns
- Various types available including norethisterone, medroxyprogesterone acetate, levonorgestrel, and dydrogesterone
How You Can Take Progesterone
By mouth:
Capsules or tablets – the most common way
Intrauterine (Mirena coil):
This delivers levonorgestrel directly to your womb and also provides contraception. Many women prefer this option because it has fewer side effects and you don't need to remember daily medication.
Through your skin:
Some patch combinations deliver both oestrogen and synthetic progestogen together.
Vaginally:
We can prescribe micronised progesterone this way if you experience side effects from tablets. This is used off-license but can be very helpful.
Important note: If you need progesterone without oestrogen for PMS or early perimenopausal symptoms, body-identical progesterone can be used, though this isn't licensed in the UK for this purpose.
Specialised Treatments
DHEA and Pregnenolone
Hormone building blocks that may help with fatigue, mood, memory, and mental fog when levels are low.
Important:
Both require private prescriptions, aren't UK-licensed, and need careful discussion about current evidence limitations.
Making HRT Affordable
HRT Prepayment Cert
For just £19.80 per year (2025 rates), you can get most licensed oestrogen and progesterone treatments on the NHS through an HRT Prepayment Certificate. This can save you significant money if you need regular prescriptions.
How we help:
- During your consultation, we'll explain which treatments are available on the NHS
- We'll identify what might need a private prescription
- We'll write to your GP requesting NHS prescriptions for eligible treatments
- We'll guide you through setting up the prepayment certificate
Our approach:
We believe hormone treatment should be as accessible as possible. We'll always work to get you the most cost-effective treatment that meets your individual needs.
For more information please see the below link:
Save money with a prescription prepayment certificate (PPC) - NHS
