Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy, commonly known as HRT, is used to manage symptoms associated with perimenopause and menopause.
As oestrogen levels decline, women may experience symptoms such as:
- hot flushes
- night sweats
- sleep disturbance
- mood changes
- brain fog
- vaginal dryness
- joint aches
HRT replaces or supplements declining hormone levels to reduce symptoms and improve quality of life.
Treatment decisions are individualised and based on age, time since menopause, medical history, clot risk, breast cancer history, and patient preference.
These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.
What Is HRT?
HRT contains oestrogen, with or without a progestogen.
Oestrogen-only HRT
Used in women who have had a hysterectomy.
Combined HRT (oestrogen + progestogen)
Required for women who still have a uterus. Progestogen protects the womb lining from overgrowth caused by oestrogen.
HRT is not a contraceptive.
Who May Benefit From HRT?
HRT may be considered in women experiencing:
- moderate to severe menopausal symptoms
- symptoms affecting sleep or daily functioning
- early menopause
- premature ovarian insufficiency
In appropriate individuals, HRT can significantly improve quality of life.
Age and Timing Considerations
The balance of benefits and risks is influenced by age and time since menopause.
The balance of benefits and risks is influenced by overall health and how long it has been since menopause. HRT is often most straightforward to start around the perimenopause or early menopause years, but suitability is always individual. Starting HRT later after menopause can involve different risk considerations and may warrant more specialist input.
Individual assessment is always required.
HRT is not usually initiated for the first time in significantly older women without specialist review.
Types of HRT
HRT can be delivered in different forms:
Oral tablets
Taken daily. Convenient but may carry a slightly higher clot risk compared with transdermal routes.
Transdermal patches
Applied to the skin. These avoid first-pass liver metabolism and are often preferred in women with higher clot risk.
Oestrogen gels or sprays
Applied to the skin. Allow flexible dose adjustment.
Vaginal oestrogen
Used for local symptoms such as dryness or discomfort. Typically carries minimal systemic absorption and lower systemic risk.
Choice depends on symptoms, risk factors, and preference.
HRT and Blood Clot Risk
Oestrogen can increase the risk of venous thromboembolism (VTE).
Risk varies depending on:
- route of administration
- personal history of clot
- smoking status
- body mass index
- underlying clotting disorders
Transdermal oestrogen (patches or gels) is generally associated with lower clot risk than oral oestrogen.
HRT is usually avoided in women with a history of certain clotting conditions unless under specialist guidance.
You can read more in: Blood thinners and antiplatelet medicines
HRT and Breast Cancer Risk
Breast cancer risk varies depending on:
- type of HRT
- duration of use
- individual baseline risk
Combined HRT may be associated with a small increase in breast cancer risk with longer-term use. Oestrogen-only HRT may have a different risk profile.
The absolute risk increase for most women is small, but decisions are individualised.
Risk discussion should include:
- alternative options
- family history
- personal medical history
- symptom severity
HRT and Cardiovascular Health
HRT is not prescribed solely to prevent heart disease. However, timing may influence cardiovascular risk.
Starting HRT closer to menopause onset may carry a different risk profile compared with starting later in life.
Blood pressure, lipid profile, and overall cardiovascular risk should be considered.
Read more: Heart health hub
HRT and Migraine
Women with migraine require careful assessment before starting HRT.
Migraine with aura is a particular consideration when oestrogen-containing therapies are prescribed.
Transdermal oestrogen may be preferred in some cases.
HRT and Abnormal Bleeding
Any unexpected or persistent bleeding while on HRT should be assessed.
Red flags include:
- bleeding after established menopause
- heavy or prolonged bleeding
- bleeding after sexual intercourse
- new bleeding after a stable period on HRT
Unexplained bleeding may require further investigation.
Bone health and menopause
Oestrogen helps maintain bone strength. Around and after menopause, reduced oestrogen can accelerate bone loss, increasing the risk of osteoporosis and fractures over time.
Monitoring and Review
HRT requires periodic review to assess:
- symptom response
- side effects
- blood pressure
- bleeding patterns
- ongoing appropriateness
The lowest effective dose for symptom control is usually considered.
You can read more in: Monitoring and follow-up for medicines
When HRT May Not Be Suitable
HRT may not be appropriate in women with:
- certain breast cancers
- active liver disease
- unexplained vaginal bleeding
- high clot risk without specialist input
Assessment is individualised and based on full medical history.
Clinical practice in the UK is informed by guidance from professional bodies such as the British Menopause Society, and its patient information service, Women’s Health Concern. Treatment decisions are individualised and based on current evidence, symptom severity, and individual risk factors.
HRT in Remote GP Care
Initial assessment may be conducted remotely if medical history and risk factors can be clearly reviewed.
In-person examination may be required if:
- blood pressure is unknown
- there are red flag bleeding symptoms
- pelvic examination is indicated
Frequently Asked Questions
1. Is HRT safe?
For many women, HRT can be used safely following individual assessment of symptoms and medical history. The balance of benefits and risks depends on personal factors such as age, time since menopause, clot risk, and breast cancer history. A GP can help review these factors in context.
2. Does HRT cause breast cancer?
Combined HRT may be associated with a small increase in breast cancer risk with longer-term use. The absolute risk for most women is low, and decisions are individualised based on symptom severity, personal risk factors, and preferences.
3. Can I stay on HRT long term?
Some women use HRT for several years. Ongoing treatment should be reviewed periodically to ensure that benefits continue to outweigh potential risks. Duration is based on individual need rather than a fixed time limit.
4. Can I start HRT many years after menopause?
Starting HRT later after menopause may involve different risk considerations compared with starting closer to menopause onset. Individual assessment is important before initiating treatment.
When to contact a GP
You should consider contacting a GP if:
- menopausal symptoms significantly affect your life
- you develop unexpected bleeding
- you experience leg swelling, chest pain, or breathlessness
- migraines worsen or change pattern
- you are unsure whether HRT remains appropriate
If you develop sudden chest pain, severe breathlessness, collapse, or neurological symptoms, seek urgent or emergency care immediately.
Further Reading and Hub Links
Visit our Medication and Prescribing hub or browse more health topics in the AccessGP Knowledge Base.
If you are considering HRT or reviewing menopausal treatment, a GP can help guide you on the safest next step.
Last reviewed by Dr Zamiel Hussain, GMC registered GP
Updated: 14 February 2026