Hormone Replacement Therapy (HRT) 

What is hormone replacement therapy (HRT)?

Hormone replacement therapy, often abbreviated as HRT, is a treatment used to relieve symptoms caused by the natural decline of hormone levels in the body, most commonly during menopause. As oestrogen and progesterone levels fall, many women experience a range of symptoms such as hot flushes, night sweats, mood changes, sleep disturbances, and vaginal dryness. HRT works by replenishing these hormones to more balanced levels, helping to ease discomfort and improve overall quality of life.

While HRT is most often associated with menopause management, it may also be prescribed for other hormone-related conditions, including early menopause, surgical removal of the ovaries, or certain hormonal deficiencies. Treatment can be given in various forms, such as tablets, skin patches, gels, or vaginal preparations, with the type and dose tailored to the individual’s needs. Modern HRT aims to provide the lowest effective dose for the shortest time necessary, balancing symptom relief with safety considerations.

What conditions is hormone replacement therapy (HRT) used to treat?

HRT is mainly prescribed to ease symptoms caused by falling hormone levels, but it also has wider uses in protecting long-term health and supporting specific medical needs.

• Menopause symptoms — helps relieve hot flushes, night sweats, vaginal dryness, mood swings, and sleep problems linked to hormonal decline.

• Early menopause — recommended for women who enter menopause before the age of 45, either naturally or after surgical removal of the ovaries.

• Bone health — helps maintain bone density and lowers the risk of osteoporosis and fractures after menopause.

• Surgical menopause — provides hormone support when the ovaries are removed, easing symptoms and protecting overall health.

What are the two types of hormone replacement therapy (HRT)?

There are two main types of HRT: oestrogen-only therapy and combined therapy (oestrogen and progesterone). The choice depends largely on whether you still have your womb, as well as your symptoms, medical history, and personal preferences. Your doctor will advise which approach is most suitable for you.

Oestrogen-only therapy

This form of HRT uses only oestrogen and is usually prescribed for women who have had a hysterectomy (surgical removal of the womb). In this situation, progesterone is not required because there is no uterine lining to protect. Oestrogen can be started in a low dose and adjusted according to response.

Oestrogen therapy can be given in several forms:

• Tablets taken by mouth.
• Skin patches that steadily release oestrogen into the bloodstream.
• Gels or sprays applied to the skin for direct absorption.
• Vaginal creams, rings, or pessaries used mainly to relieve local symptoms such as dryness and discomfort.

Combined therapy (oestrogen and progesterone)

Combined HRT is recommended for women who still have their womb. This is because taking oestrogen alone can overstimulate the lining of the uterus (endometrium), increasing the risk of abnormal thickening and, in the long term, endometrial cancer. Adding progesterone balances this effect by keeping the uterine lining healthy and reducing cancer risk.

Combination therapy is commonly available as:

• Tablets containing both hormones.
• Patches that deliver oestrogen and progesterone together through the skin.
• Intrauterine devices (IUDs) that release progesterone directly into the uterus, often alongside oestrogen given by another method.

What are the benefits of hormone replacement therapy (HRT)? 

HRT offers relief from menopausal symptoms and provides long-term health benefits for many women. By restoring hormone levels, it improves day-to-day comfort and supports overall wellbeing.

• Relief from menopausal symptoms — reduces hot flushes, night sweats, mood changes, vaginal dryness, and sleep disturbances caused by falling hormone levels.

• Better bone health — helps maintain bone density and lowers the risk of osteoporosis and fractures, especially important after menopause.

• Improved urogenital health — relieves vaginal dryness, discomfort during sex, and urinary symptoms linked to low oestrogen.

• Enhanced quality of life — improves sleep, concentration, and emotional stability, which can boost confidence and wellbeing.

• Long-term protection — in some women, HRT may reduce the risk of heart disease and bowel cancer when started close to the time of menopause, though this depends on individual health factors.

What are the risks of hormone replacement therapy (HRT)?

Although HRT offers significant benefits, it is not suitable for everyone. The risks depend on the type of HRT, the dose, how long it is taken, and individual health factors. Your doctor will weigh these carefully before prescribing treatment.

• Breast cancer — combined HRT (oestrogen and progesterone) is linked to a small increased risk of breast cancer, which rises the longer it is used. Oestrogen-only HRT carries a lower risk.

• Blood clots — oral HRT tablets can increase the risk of deep vein thrombosis (DVT) or pulmonary embolism, though skin patches and gels are thought to carry less risk.

• Stroke — a slightly higher risk of stroke exists, particularly in women who begin HRT after the age of 60.

• Endometrial cancer — taking oestrogen without progesterone when the womb is still present can overstimulate the uterine lining, raising cancer risk. Combined HRT prevents this.

• Other side effects — some women may experience breast tenderness, bloating, headaches, or mood changes, especially when first starting treatment.

Who should not take hormone replacement therapy (HRT)?

HRT is not recommended for everyone, and certain medical conditions make it unsafe. Women with the following health issues are generally advised against taking HRT:

• Breast, ovarian, or womb cancer — past or current cancers sensitive to hormones make HRT unsuitable, as added oestrogen and progesterone could increase risk of recurrence.

• History of blood clots — previous deep vein thrombosis (DVT) or pulmonary embolism raises the chance of clotting problems with HRT, especially with oral tablets.

• Stroke or heart disease — women who have already experienced a stroke or heart attack may face higher risks with HRT.

• Uncontrolled high blood pressure — poorly managed hypertension can make HRT unsafe until blood pressure is stabilised.

• Liver disease — active liver problems interfere with hormone metabolism, so HRT is usually avoided.

In all cases, a doctor will carefully assess risks and may suggest alternative treatments for managing menopausal symptoms.

What are the side effects of hormone replacement therapy (HRT)?

Like any treatment, HRT can cause side effects. These are often mild and temporary, improving as your body adjusts, but some women may find them bothersome. The type and severity of side effects can vary depending on the form of HRT used and your individual response.

• Breast tenderness or swelling — some women notice discomfort in the breasts, particularly in the early weeks of treatment.

• Bloating or fluid retention — HRT may cause a feeling of puffiness or mild weight changes.

• Headaches — hormonal adjustments can trigger headaches in some women, though these usually settle over time.

• Nausea or indigestion — more common with oral tablets, but often improves when switching to patches or gels.

• Mood changes — a small number of women report irritability or low mood linked to hormone fluctuations.

• Irregular bleeding — spotting or breakthrough bleeding may occur, especially during the first few months of combined HRT.

Most side effects are short-lived and manageable, but if they persist, your doctor may adjust the dose or suggest a different form of HRT.

How long should I take hormone replacement therapy (HRT) for?

The length of time you stay on HRT depends on your symptoms, health, and personal preference. There is no single rule, and treatment should be reviewed regularly with your doctor.

• Short-term use — many women take HRT for a few years to manage troublesome menopausal symptoms such as hot flushes and night sweats.

• Long-term use — some women may benefit from staying on HRT longer, especially if they entered menopause early or need protection against osteoporosis.

• Regular reviews — doctors usually recommend reviewing HRT every 6–12 months to check whether you still need it, whether the dose is right, and to monitor any risks.

• Stopping HRT — symptoms may return after stopping, so some women taper off gradually rather than stopping suddenly, with guidance from their doctor.

Are there alternatives to hormone replacement therapy (HRT)?

Not all women can, or wish to, take HRT. In such cases, there are alternatives that may help ease menopausal symptoms and protect long-term health.

• Lifestyle measures — regular exercise, a balanced diet, maintaining a healthy weight, and avoiding triggers such as caffeine, alcohol, and spicy food can reduce hot flushes and improve wellbeing.

• Non-hormonal medicines — certain antidepressants, blood pressure drugs, or epilepsy medications can be prescribed in low doses to help with hot flushes and night sweats.

• Vaginal moisturisers and lubricants — available without prescription, these can relieve vaginal dryness and discomfort during sex.

• Bone health treatments — for women at risk of osteoporosis, medicines such as bisphosphonates or selective oestrogen receptor modulators (SERMs) may be recommended.

• Complementary therapies — some women find relief with herbal remedies or acupuncture, but evidence is limited and safety varies, so always check with a doctor before use.

Summary

Hormone replacement therapy (HRT) is an effective treatment for easing the symptoms of menopause and protecting long-term health in many women. By restoring hormone balance, it can improve day-to-day comfort, support bone strength, and enhance quality of life. However, HRT is not suitable for everyone, and the choice of treatment, including type, dose, and duration, should always be guided by medical advice. Alternatives are also available for women who cannot take HRT or prefer other options.

If you are experiencing menopausal symptoms and want to explore whether HRT or its alternatives are right for you, schedule a consultation with Holistic Gynaecology & Fertility for expert guidance and personalised care.