If hot flushes are breaking up your day, night sweats are interrupting your sleep, or your mood feels low in a way that does not quite match what is going on around you, you may have started hearing about Hormone Replacement Therapy (HRT). HRT eases menopause symptoms by topping up hormones, mainly oestrogen, that drop as you approach and move through menopause. Understanding what it is and what it does gives you a clearer starting point for a useful conversation with your GP about whether it fits for you.1
What HRT does in the body
HRT works by bringing oestrogen back up to a level that eases the physical and emotional shifts that come as it drops. That can mean hot flushes, night sweats, broken sleep, vaginal dryness, anxiety, and low mood. It may also help you hold on to muscle strength.2
Beyond easing day-to-day symptoms, one of the bigger longer-term benefits of HRT is what it does for your bones. Oestrogen helps keep your bones strong, and when levels drop after menopause the risk of osteoporosis, where bones become weaker and break more easily, goes up. HRT can help slow that weakening.3
Who HRT is relevant for
If you are noticing menopausal symptoms, HRT may be an option for you. It can be used during perimenopause, the run-up to your final period, and after your periods have stopped. You do not have to wait for menopause to be confirmed before bringing it up with your GP.4
If you go through premature menopause, before 40, or early menopause, before 45, HRT becomes particularly relevant for protecting your bones and guarding against other effects of low oestrogen. In that situation, a clinician will often suggest staying on it until at least the average age of menopause, which is around 51.5
For easing hot flushes and night sweats, sometimes grouped together as vasomotor symptoms, your GP will go through the benefits and risks with you before any decision is made.6
When HRT may not be suitable
HRT does not suit everyone. It may not be right for you if you have a history of certain cancers (breast, ovarian, or womb), a history of blood clots, high blood pressure that is not yet under control, or liver disease. Your GP will look at your own history and circumstances before any decision is made.7
The range of HRT options available
There are two main types of HRT. If you still have your womb, you will usually be offered combined HRT, which contains both oestrogen and progestogen. The progestogen is there to protect your womb lining from thickening abnormally. If you have had a hysterectomy, oestrogen-only HRT is usually prescribed instead.8
Combined HRT can be taken in two ways. With cyclical, or sequential, HRT you take progestogen for part of the month, which usually brings on a monthly bleed. This is often the approach during perimenopause, when your hormone levels are still shifting around. With continuous HRT you take both hormones every day with no planned bleed, and it is usually used once menopause is settled. Which one suits you is a decision to make with your clinician.9
How HRT is delivered
HRT comes in a few different forms: tablets you swallow, skin patches, gels you rub into the skin, and sprays. Each one sends hormones into your bloodstream, known as systemic HRT. There are also local oestrogen options, such as vaginal tablets, creams, and rings, which work mainly in the vaginal area to ease dryness and discomfort. Because these work locally rather than throughout your whole body, they carry a lower overall risk than systemic HRT.10
One term that often comes up is "body identical". Body identical HRT uses hormones, such as 17-beta oestradiol and micronised progesterone, that have the same molecular structure as the ones your body makes. Some of these are available on the NHS. Utrogestan, a micronised progesterone, is one example, along with certain oestrogen gels and patches. It is worth knowing that "body identical" refers to licensed, regulated medicines. That is different from compounded "bioidentical" HRT, which is not regulated in the same way and is not backed by UK clinical bodies. If you have questions about any of this, your GP or a menopause specialist is the right person to ask.11
Understanding the benefits and risks together
If you are under 60 and otherwise healthy when you start HRT, the benefits usually outweigh the risks. Understanding of HRT's risk profile has shifted significantly since earlier research. There are still some risks worth knowing about.12
Combined HRT, with oestrogen and progestogen, can slightly raise the risk of breast cancer. The increase is small, around 5 extra cases per 1,000 women taking it for 5 years, and the risk drops again after you stop. HRT taken as tablets also carries a higher risk of blood clots. The transdermal forms, the patches, gels, and sprays, do not carry that same raised clot risk. This difference matters and is worth talking through with your GP when you are weighing up which form might suit you.13
There is no fixed limit on how long you can stay on HRT. How long you take it depends on your own situation, and it is something to review regularly with your healthcare professional.14
Taking the next step
HRT is one option among several for easing menopause symptoms, and it is not the right fit for everyone. A GP appointment is the place to talk through your symptoms, your medical history, and which approach, if any, suits you. Jotting down a list of your symptoms before you go can help you make the most of the time. If your GP is not up to date with current menopause guidance, you can ask to be referred to a menopause specialist.