HRT in the UK
What hormone replacement therapy is, how the different types work, what the evidence says about risk, and how to get it.
- The most effective treatment for hot flushes and night sweats
- Patches, gels and sprays do not raise clot risk at standard doses
- With a womb, you also need a progestogen
- Over 45 with symptoms? Usually no blood test needed
What HRT is
Hormone replacement therapy (HRT) replaces the oestrogen your body makes less of during perimenopause and menopause. It is the most effective treatment for hot flushes and night sweats, and it can also help with mood, sleep, joint aches and vaginal symptoms.
If you still have a womb, you also need a progestogen alongside oestrogen. This protects the lining of the womb, because oestrogen on its own can cause it to thicken.
Types of HRT
Oestrogen
- Patch
- Gel
- Spray
- Tablet
Oestrogen can be taken as a patch, gel or spray on the skin, or as a tablet. Oestrogen through the skin is often preferred because it does not raise the risk of blood clots in the way tablets can.
Progestogen
- Tablet
- Capsule
- Combined patch
- Hormonal coil
For women with a womb, progestogen can be taken as a tablet or capsule, combined with oestrogen in some patches and tablets, or given through a hormonal coil, which also provides contraception.
Vaginal oestrogen
- Cream
- Gel
- Pessary
- Ring
A low-dose cream, gel, pessary or ring for vaginal dryness and urinary symptoms. Very little is absorbed into the body, so it can be used long term and alongside other HRT.
Testosterone
- Gel or cream, off-licence
Testosterone may be considered where low sexual desire persists despite established HRT. There is no testosterone product licensed for women in the UK, so it is prescribed off-licence in line with national guidance, using a male preparation at a much lower dose, with blood tests to keep levels within the normal female range. It is the part of HRT women most often struggle to access.
Risks and benefits
For most women under 60, and within ten years of the menopause, the benefits of HRT for symptom relief outweigh the risks. The risks differ by the type of HRT, the route it is taken, and your own history, which is why a proper consultation matters more than a general figure.
Risks
Breast cancerCombined HRT carries a small increase, linked to how long you take it.
Combined HRT, meaning oestrogen with a progestogen, is associated with a small increase in breast cancer risk. The increase relates to how long you take it and reduces after stopping. Oestrogen-only HRT, used by women who have had a hysterectomy, carries little or no increase. Your doctor will put the size of that risk into context against the things that affect it more, such as alcohol intake and weight.
Endometrial thickening and womb cancerWith a womb, a progestogen alongside oestrogen is not optional.
This is the reason a progestogen matters. If you have a womb and take oestrogen on its own, the lining of the womb can thicken, and unopposed oestrogen increases the risk of endometrial cancer. Taking a progestogen alongside oestrogen protects the womb lining. It is not optional, and it is one of the things we check carefully if you are transferring from elsewhere.
Blood clots and strokeTablets slightly raise clot risk. Patches, gels and sprays do not at standard doses.
HRT tablets slightly increase the risk of blood clots. Oestrogen through the skin, as a patch, gel or spray, does not raise clot risk above your baseline at standard doses, because it avoids first-pass metabolism through the liver. This is a large part of why transdermal oestrogen is often preferred.
MigraineNot a reason to avoid HRT, but it shapes which type you are offered.
Migraine, including migraine with aura, is not a reason to avoid HRT, but it does shape which type you are offered. Oestrogen through the skin is generally preferred, since steady levels are better tolerated than the peaks and troughs of tablets. Tell your doctor about any history of migraine, and particularly about aura.
Bleeding after the menopause must be checked promptly, whether or not you are on HRT.
Benefits
- Relief from hot flushes and night sweats for most women
- Improvements in sleep, mood and joint aches for many
- Protection against osteoporosis and fractures while you take it
- Treatment of vaginal dryness and some urinary symptoms
1 in 2
Bone protection matters more than most women are told. Women can lose up to around a tenth of their bone density in the five years after their final period, and roughly one in two women over 50 in the UK will break a bone because of osteoporosis.
Who may need extra care
Some women need specialist input before starting HRT, including those with a history of breast cancer or another hormone-sensitive cancer, blood clots, liver disease, or unexplained vaginal bleeding. Having one of these does not always rule treatment out, but it does change the conversation, and sometimes it means we refer you rather than treat you.
We will always refer rather than prescribe where:
- your periods stopped before 40
- you have bleeding after the menopause
- there are signs of another underlying condition that needs investigating first
If you take weight loss medication
Many women take HRT alongside weight loss medication such as Mounjaro. Tell both prescribers what you are taking. Significant weight change affects how your body handles hormones, and some women notice a change in their bleeding pattern. Any bleeding after the menopause needs checking promptly, whatever the likely explanation.
Getting HRT in the UK
Through the NHS
Your GP can diagnose menopause and prescribe HRT. In England, an HRT prescription prepayment certificate can reduce the cost of regular HRT prescriptions. Our guide to getting HRT on the NHS versus privately explains how to make the GP route work and when it tends not to.
Privately
A private clinic can offer longer appointments, faster access, and ongoing reviews with the same team. At Arc HRT, a GMC-registered doctor reviews your symptoms, explains your options, and prescribes if treatment is right for you. See what HRT costs in the UK, NHS and private, before you decide.
Book a consultationDo you need a blood test?
Over 45 with symptoms
NICE guidance says menopause can be diagnosed without a hormone blood test.
Under 45, or considering testosterone
A blood test is useful.
