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HRT

What is HRT?

HRT, or hormone replacement therapy, is treatment that women take to help relieve menopausal symptoms like night sweats, hot flashes, vaginal dryness, poor sleep, brain fog, mood swings and lower sex drive.

How long you take it for can vary; many women take it for a year or two but some can take it for much longer than this. It’s a very individual thing. Certain types of HRT will also suit you more than others. When you take a consultation with us, the clinician can talk you through the different options, and help you to decide which one is right for you.

How does HRT work?

As you enter the menopause, the levels of estrogen that your body produces start to decrease, due to a shift in the balance of your sex hormones. This can cause symptoms such as hot flashes, night sweats and changes to your mood. HRT contains synthetic estrogen, which makes up for the natural estrogen you lose, and helps to relieve menopausal symptoms.

Combined forms of HRT also contain a second hormone: a synthetic form of progesterone. Without anything to keep it in check, estrogen may increase your risk of getting endometrial cancer, because it can cause the womb lining to thicken more than it should. The progesterone in combined HRT offers protection from this, keeping estrogen in line and reducing the risk of womb cancer developing. It’s more convenient to take combined HRT as a pill or patch which contains both progesterone and estrogen, but sometimes it’s better to take these separately.

If you’ve had a total hysterectomy though, because your womb has been removed, you’ll usually be prescribed estrogen only HRT.

The menopause can also cause your bones to become more fragile and more prone to breaking. HRT can provide some protection against osteoporosis by helping the bones to stay strong. HRT isn’t a primary treatment for osteoporosis though, so if you’re looking to use it for this purpose, just let the clinician know during your consultation and they can chat to you about it.

What are the benefits of HRT?

The major benefit of HRT is that it can help to ease many symptoms of the menopause by as much as 75%.

The estrogen and progesterone in combined HRT make a good team. The estrogen helps to manage symptoms of the menopause whilst the progesterone helps to keep it in check and reduces your cancer risk.

And there’s the protection it can provide from osteoporosis too, when the bones in the body are more at risk of breaking or becoming brittle after the menopause.

Medically reviewed by
Dr Daniel Atkinson
Clinical Reviewer
on August 17, 2023.
Meet Daniel  
Daniel
This page was medically reviewed by Dr Daniel Atkinson, Clinical Reviewer on August 17, 2023. Next review due on August 16, 2025.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

HRT

What forms of HRT are there?

There are a number of different types of HRT available, and the clinician can show you some options when you take a consultation.

Tablets

Tablets are one of the most widely used types of HRT. There are tablet options for both combined HRT and estrogen only HRT, and you normally take them once every day. They do carry a slightly increased risk of blood clots and breast cancer than other forms of HRT treatment, but it is only a small increase (nine more women develop a blood clot for every 10,000 women each year). Because of this increased breast cancer risk, make sure you attend your breast cancer screening (mammogram) appointments.

Skin patches

If you find having to remember to take a tablet every day a little inconvenient, skin patches may be a more low maintenance medication for you and they’re safer for your heart than tablets. You stick HRT patches to your skin, and change them twice a week. They’re available as a combined HRT treatment or as an oestrogen only medication. Skin patches can be a good option if you’re prone to side effects such as indigestion, and they don’t increase your risk at all of developing a blood clot, unlike tablets.

Oestrogen gel

More and more women are starting to use estrogen gel for menopausal symptoms, and it’s probably because it’s really easy to use. You just need to rub it onto your skin once a day. It doesn’t increase your blood clot risk either, but if you still have your womb, you’ll need to use an additional progesterone to limit your risk of womb cancer.

Implants

They’re not particularly common, but you can also get a HRT implant, which releases estrogen slowly into the body and doesn’t need to be replaced for several months at a time. You’ll need to take a separate progesterone though if you’ve still got your womb.

Medically reviewed by
Dr Daniel Atkinson
Clinical Reviewer
on August 17, 2023.
Meet Daniel  
Daniel
This page was medically reviewed by Dr Daniel Atkinson, Clinical Reviewer on August 17, 2023. Next review due on August 16, 2025.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

HRT

So what is the best HRT for me?

It depends on a number of factors, like what stage of the menopause you’re at, how sensitive you are to certain levels of hormones, and whether you prefer to take tablets or use patches, for example.

Whether or not you’ve had a total hysterectomy is also a factor, and if you have certain health conditions, that can play a big part too.

Here are your options. A clinician can talk you through them, and recommend safe and suitable HRT treatments just for you.

Combined sequential and sequential HRT

If you’re getting menopausal symptoms and still having your period, combined sequential (or cyclical) HRT treatments are usually recommended. Combined HRT is a type of treatment with two hormones: a progesterone and an estrogen. This can be given as two separate medications, but sometimes you’ll get a single treatment that contains both an estrogen and progesterone.

With sequential HRT, you start your cycle with estrogen only tablets (or patches) and then take a combination of estrogen and progesterone tablets (or patches) part way through your cycle.

You’ll see a regular bleed once per month with sequential HRT.

Continuous combined HRT

If you haven’t had a period for one year, you’re usually considered to be postmenopausal, and continuous combined HRT is normally recommended. With continuous combined HRT, you take a combination of estrogen and progesterone every day, without a break. So it’s a little different to sequential HRT. You won’t see any bleeding with continuous HRT, but if it’s less than a year since your last natural period, starting continuous HRT might lead to some unpredictable bleeding. So it’s best to start with sequential HRT.

Estrogen only HRT

Estrogen only treatments are normally recommended for women who have had their womb removed during a hysterectomy. They can also be used by women who still have their womb, but a separate progesterone is required (either as a tablet, a vaginal capsule, or a gel for the skin). Like continuous combined HRT, you typically take estrogen every day, without a break.

Side effects of HRT may also vary from one woman to the next, so some HRT medications won’t be safe (or suitable) for some women. If you’re more sensitive to estrogen, you may be better suited to lower-dose HRT. And if you have a particular health condition, this can mean that certain HRT medications won’t be safe for you to use either.

A clinician can identify which medications are appropriate for you and which aren’t, and make recommendations based on your medical background.

What HRT alternatives are there?

Tibolone

Tibolone isn’t available in the USA at the moment, but it is used by women in the UK and other countries. Also known as Livial, it’s used to relieve menopausal symptoms and as a preventative treatment for osteoporosis. It doesn’t contain any hormones, so it’s a little different to other forms of HRT, which contain estrogen and progesterone (or just estrogen).

Tibolone can help to ease symptoms like hot flushes, reduced sex drive and low mood, but research has suggested that Tibolone may be less effective than combined HRT. It’s also only a suitable option for women who are postmenopausal (so women who had their last period over a year ago).

Tibolone can cause side effects, including breast pain, vaginal discharge, pain in the pelvis, itching and abdominal pain.

The slightly increased risks of breast cancer and stroke that HRT carry are similar with Tibolone.

Clonidine

Clonidine is another prescription treatment that’s sometimes used to help tackle symptoms like hot flashes and night sweats. It’s a tablet that you take two or three times a day, and it has no effect on hormone levels, so there’s no increased risk of breast cancer for example. Studies suggest that it only has a small impact on easing flushing and night sweats though, and it can have unpleasant side effects too.

Medically reviewed by
Dr Daniel Atkinson
Clinical Reviewer
on August 17, 2023.
Meet Daniel  
Daniel
This page was medically reviewed by Dr Daniel Atkinson, Clinical Reviewer on August 17, 2023. Next review due on August 16, 2025.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

HRT

HRT: FAQ

Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.

Can Premarin help with osteoporosis?

Answer:
Around the time of menopause, bone loss can start to accelerate. As this happens, it puts some women at an increased risk of developing osteoporosis and fracturing (or breaking) their bones in later life.

HRT treatments like Premarin raise your estrogen levels, and can help prevent bone-related complications. Speak to our clinicians to get the best advice about starting a HRT that helps both menopause and preventing osteoporosis.

What side effects does HRT cause?

Answer:
It can depend on what type of HRT you’re using, but the major side effects of taking estrogen include feeling sick, headaches, vaginal bleeding, feeling bloated, tenderness or swelling in the breasts, swelling elsewhere in the body, indigestion and cramps in the legs.

These side effects tend to disappear after a couple of weeks, but there are a few things that you can try to help manage them. Taking your estrogen with food can help to ease sickness and indigestion. Following a low-fat diet with limited dairy can reduce breast pain, whilst regular exercise and stretches can help with leg cramps.

If you find that these side effects continue, let your clinician know. They may advise you to switch to a different HRT method (so switching from a tablet to a patch, for instance) or they can talk to you about adjusting your dose.

Like estrogen, progesterone in HRT can also trigger side effects, including mood changes, acne, abdominal pain, headaches or migraines, breast pain, swelling in other parts of the body, depression, back pain and vaginal bleeding.

Similarly to the side effects from taking estrogen, these symptoms should resolve by themselves after a few weeks. But if they persist, let your clinician know, and they can recommend any adjustments or changes.

If you experience any of the following side effects, you should seek urgent medical attention immediately: yellowing of the skin or whites of the eyes (jaundice), a significant rise in your blood pressure (headache, tiredness and dizziness are symptoms), migraine-like headaches that develop for the first time, if you fall pregnant, and if you get any indications of a blood clot (painful swelling and redness of the legs, sudden pain in the chest and breathing difficulties).

For more information on side effects and when to get medical assistance, you should read the package leaflet that comes with your HRT treatment, or ask your clinician.

How long after starting HRT will you notice a difference?

Answer:
It can take a few weeks before you start to feel the effects of HRT. A clinician will normally advise you to try a treatment for three months to see if it improves your symptoms. If you don’t notice an improvement at this point, they may recommend adjusting your dose, or switching to an alternative HRT treatment.

It may take your body some time to get used to HRT, and you may experience certain side effects, including tenderness in the breasts, cramps in the legs and nausea. If you get any side effects that cause you discomfort, or that concern you, let your clinician know.

Does HRT cause weight gain?

Answer:
There’s no evidence that HRT triggers weight gain (or weight loss). The menopause can affect your weight, but this normally occurs regardless of whether or not you use HRT.

If you’re looking to lose weight, following a healthy, balanced diet and getting regular exercise can help.

Can you take HRT for the rest of your life?

Answer:
There isn’t a definitive length of time you can use HRT for. Some women use it for a few years until their menopausal symptoms have eased, whereas other women take it for longer periods because they feel that it gives them more energy (and to reduce their risk of osteoporosis).

It’s a personal decision, and it can vary a lot from one woman to the next. It’s very important that you discuss it with your clinician, and see what their recommendations are for you in light of your medical background and any side effects you may experience. They will review how you’re doing with HRT on a regular basis, but you should contact them right away if you’ve got any questions.

Your risk of breast cancer may increase slightly when you use oral HRT which contains progesterone for extended periods. For example, for every 1,000 women from the age of menopause up to 69 years who are not using continuous combined HRT treatment, 13 may develop breast cancer. For every 1,000 women in this same bracket who are using continuous combined oral HRT treatment for five years or more, an additional 10 women may develop breast cancer. So the risk of developing breast cancer is 1% higher in women using HRT.

There’s a slightly greater risk of developing a blood clot with HRT tablets than there is compared to not using HRT treatment, but it is only small (there’s an extra nine cases of venous thromboembolism for every 10,000 women using tablets each year).

There’s also a slightly greater chance you may have a stroke if you use HRT. From the age of menopause up to 69 years of age, 26 women in every 1,000 who don’t use HRT may have a stroke. In this same bracket, for women who use HRT for five years, there may be one extra case of stroke.

Can you stop hot flushes without HRT?

Answer:
If you’re not able to take HRT, or if you’d rather not use it, a medicine for high blood pressure called Clonidine can help with hot flushes, as can certain antidepressants. But these treatments can have side effects, so you should always discuss using them for this purpose with a clinician first.

Making changes to your lifestyle may also help to tackle your hot flushes, such as:

  • having a cool shower, using a fan or drinking something cold;

  • making sure that you keep your bedroom cool at night;

  • exercising regularly and losing weight if you’re overweight;

  • avoiding spicy food, alcohol, smoking and caffeine;

  • reducing your stress levels; or:

  • wearing light clothing.

Why should I buy HRT online with Treated?

Answer:
There can be a lot of things to think about when it comes to finding the right HRT treatment for you. But once you’ve taken a consultation, a clinician will pick out all the suitable and safe options, and you can choose which medication you’d like from there. 

We’re big on ongoing care too, so a clinician will keep in touch with you on a regular basis to find out how you’re getting on with your treatment. If you’d like to make any adjustments, just send them a message, and they’ll talk you through your options. You can change, pause or cancel your subscription at any point. 

When will HRT be available over the counter?

Answer:
In the USA, HRT tablets, patches and gels are all prescription only medications currently, and it’s not clear if or when they’ll become available over the counter. At the time of writing, there’s only one form of HRT that could be described as ‘over the counter’ in the UK, which is Gina – a vaginal estrogen pessary.

Because Gina is only a vaginal estrogen, it means it’s safe to use for most women regardless of their individual health needs, but it also means that it only works for vaginal-related menopause symptoms, rather than cognitive symptoms or hot flushes.

This page was medically reviewed by Dr Daniel Atkinson, Clinical Reviewer on August 17, 2023. Next review due on August 16, 2025.
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