What you need to know about HRT

For many women, menopause arrives with a wave of physical and emotional changes that can disrupt daily life. Hot flushes, night sweats, mood swings, brain fog, vaginal dryness, and fatigue are just some of the common symptoms. Hormone replacement therapy (HRT) is one of the most effective treatments for managing these symptoms, and yet, it’s often misunderstood.¹

Whether you’re in the perimenopause phase or you’re exploring treatment options, this guide will help you understand the essentials of HRT, including benefits, risks, types, formats, and the role of testosterone.

What is HRT?

Hormone replacement therapy is a treatment that replaces the hormones your body stops producing after menopause, primarily oestrogen, and in many cases, progesterone. In some cases, testosterone may also be added to support libido and energy levels.¹

HRT can be used to treat:¹

• Vasomotor symptoms (e.g. hot flushes, night sweats)

• Genitourinary symptoms (e.g. vaginal dryness, pain during sex, urinary issues)

• Mood changes and sleep disturbances

• Loss of bone density and increased fracture risk

Understanding the risks

Over the years, misinformation around HRT, especially following the early results of the Women’s Health Initiative (WHI) study, has caused confusion and fear.² However, newer research has clarified that the timing, type, and delivery method of HRT significantly influence its safety.¹

Here’s what you should know:

• Breast cancer risk: The risk varies depending on whether oestrogen is taken alone or with progesterone, the type of progesterone, and how long you take it.³ Oestrogen alone has been associated with a slightly reduced risk of breast cancer in some studies, while combined therapy can carry a small increased risk over time.⁴

• Blood clots and stroke: The risk is mainly associated with oral HRT. Transdermal (patch or gel) oestrogen has not been shown to increase clot risk.¹

• Heart disease: Starting HRT before age 60 or within 10 years of menopause is not associated with increased heart risk, and may even be protective.⁵

Risk varies from woman to woman. That’s why treatment should always be personalised, weighing up your symptoms, preferences, and medical history.

The different types of HRT

HRT comes in various combinations and regimens to suit different needs:

1. Combined HRT

Contains oestrogen and progesterone. It’s recommended for women who still have a uterus to protect against endometrial cancer:¹

• Sequential (cyclical): Oestrogen daily + progesterone part of the month (usually for those in early menopause with irregular periods)

• Continuous combined: Oestrogen and progesterone daily (usually recommended if you’re postmenopausal for a year or more)

1. Oestrogen-only HRT

For women who’ve had a hysterectomy, this is often the most straightforward option. No progesterone is needed.¹

The many ways to take HRT

Choosing the right format of HRT is important for comfort, absorption, and safety. Your clinician may recommend:¹

1. Oral tablets: Simple to take but associated with a higher risk of blood clots.

2. Transdermal patches or gels: Delivered through the skin, these formats avoid first-pass metabolism through the liver and are associated with lower risks of clots and strokes. Often preferred for women with cardiovascular risk factors or a higher BMI.

3. Vaginal oestrogen: Applied directly via a cream, ring, or tablet, this treats local symptoms like dryness or discomfort during sex. It delivers very low doses and can be used alongside systemic HRT. It’s not linked to an increased risk of cancer or clots.

What about testosterone?

Although it’s often overlooked, testosterone plays an important role in women’s health, especially after menopause.

While not licensed for use in women in the UK, testosterone may be prescribed off-label by specialists for those experiencing low libido, fatigue, poor concentration, or reduced sexual satisfaction, even when systemic HRT is already in place.⁶

Battling the misconceptions

The early WHI trial results led to a dramatic drop in HRT prescriptions worldwide.⁷ Headlines focused on increased cancer and heart risks without taking into account the nuance. Since then, decades of additional analysis and studies have shown that:¹

• Timing of HRT initiation matters: Younger women and those closer to menopause have better outcomes

• Route matters: Non-oral forms have different risk profiles

• Progestogen type matters: Some progestogens are safer than others

For most women starting within 10 years of menopause and without major health concerns, HRT can be a safe and effective treatment.¹

Is HRT right for you?

That’s a question only you and your clinician can answer. If you’re experiencing disruptive symptoms, or want to protect your long-term health, it’s worth discussing your options. A thorough consultation can help you weigh the pros and cons based on your health, goals, and lifestyle.

The numan take

HRT isn’t about “anti-ageing” or reversing menopause. It’s about feeling like yourself again, with more energy, better sleep, stable moods, and less discomfort. Menopause is a natural part of life. But suffering through it doesn’t have to be.

References

1. ^{Flores VA, Pal L, Manson JE. Hormone therapy in menopause: Concepts, controversies, and approach to treatment. Endocrine reviews. 2021;42(6): 720–752.} 

2. ^{Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA: the journal of the American Medical Association. 2002;288(3): 321–333.}

3. ^{Chlebowski RT, Rohan TE, Manson JE, Aragaki AK, Kaunitz A, Stefanick ML, et al. Breast cancer after use of estrogen plus progestin and estrogen alone: Analyses of data from 2 Women’s Health Initiative randomized clinical trials. JAMA oncology.}

4. ^{Kim J, Munster PN. Estrogens and breast cancer. Annals of oncology. 2025;36(2): 134–148.}

5. ^{Hodis HN, Mack WJ. Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: It is about time and timing: It is about time and timing. Cancer journal (Sudbury, Mass.). 2022;28(3): 208–223.}

6. ^{Scott A, Newson L. Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. The British journal of general practice: the journal of the Royal College of General Practitioners. 2020;70(693): 203–204.}

7. ^{Cagnacci A, Venier M. The controversial history of hormone replacement therapy. Medicina (Kaunas, Lithuania). 2019;55(9): 602.}