Women’s Health and Hormonal Medicines

Name: Women’s Health and Hormonal Medicines
Creator: Dr Zamiel Hussain

Hormonal medicines are widely used in women’s health to manage contraception, menstrual symptoms, perimenopause, menopause, and certain gynaecological conditions.

These medicines influence oestrogen, progesterone, and related hormone pathways. Because hormones affect multiple systems including cardiovascular, bone, and clotting pathways, prescribing decisions require careful assessment of age, medical history, migraine history, smoking status, and clot risk.

Treatment is individualised and regularly reviewed.

This page explains the main types of hormonal medicines used in primary care and important safety considerations.h medicines used in primary care, how they work, and what monitoring is required.

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.

Book a GP appointment

Combined Hormonal Contraception (CHC)

Combined hormonal contraception contains both oestrogen and progestogen. It is available as pills, patches, and vaginal rings.

Common examples include combined oral contraceptive pills such as ethinylestradiol-based preparations.

CHC may be used for:

contraception
cycle regulation
heavy periods
acne
menstrual pain

Important safety considerations

Combined hormonal contraception is generally not recommended in women aged 50 or over.

It is also usually avoided in women who:

have migraine with aura
smoke and are aged 35 or over
have a history of blood clots
have significant cardiovascular disease
have uncontrolled hypertension
have certain liver conditions

Because oestrogen increases clot risk, individual risk assessment is essential before prescribing.

Progestogen-Only Contraception

Progestogen-only options include:

progestogen-only pill (POP)
contraceptive implant
injectable contraception
hormonal intrauterine systems (e.g. levonorgestrel IUS)

These are often suitable for women who cannot use oestrogen-containing methods.

They may also help manage:

heavy menstrual bleeding
endometriosis-related symptoms
perimenopausal cycle irregularity

Suitability depends on age, bleeding pattern, and medical history.

How GPs decide which contraception is suitable

Contraception choice is based on clinical eligibility, safety, and personal preference, not just “what is most popular”. In UK practice, clinicians commonly use the UK Medical Eligibility Criteria (UKMEC) to assess safety.

Risk screening (UKMEC) Age, smoking status, migraine history (especially aura), blood pressure, clot history, cardiovascular disease, and certain cancers can affect suitability, particularly for oestrogen-containing methods.

Medication interactions Some medicines reduce contraceptive effectiveness or change hormone levels. This includes certain anti-epileptic medicines and some treatments for infections. Clinicians check interaction guidance before prescribing.

Symptoms and bleeding pattern Heavy bleeding, painful periods, irregular cycles, acne, and PMS-type symptoms may influence the choice of method. Persistent or unusual bleeding may need assessment before changes are made.

Practical fit and preference Daily pills, long-acting reversible contraception (implant or coil), and short-term options all suit different lifestyles. Shared decision-making is key, including discussion of side effects and reversibility.

Why this matters: The safest method for one person may be unsuitable for another. If key risk factors change, such as new migraine aura, raised blood pressure, or age-related risk, a review is advised.

💡 Read more: Contraception and Family Planning.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy is used to manage menopausal symptoms such as:

hot flushes
night sweats
sleep disturbance
low mood
vaginal dryness

HRT may contain:

oestrogen alone (for women without a uterus)
oestrogen combined with progestogen (for women with a uterus)

HRT is not a contraceptive.

Age and risk considerations

HRT is typically considered for symptomatic perimenopausal or menopausal women, usually under age 60 or within 10 years of menopause onset, though decisions are individualised.

Risks and benefits are reviewed carefully, including:

clot risk
breast cancer risk
cardiovascular risk
migraine history

Transdermal oestrogen (patches or gels) may carry lower clot risk than oral oestrogen.

Emergency Hormonal Treatments

Emergency contraception may be used after unprotected intercourse or contraceptive failure.

Suitability depends on timing and individual factors.

Ongoing contraception should be reviewed following emergency use. Following unprotected sex, it can be important to screen for sexually transmitted infections.

Medicines for Menstrual Disorders

Hormonal treatments may be used to manage:

heavy menstrual bleeding
irregular cycles
painful periods
endometriosis

Options may include:

combined hormonal contraception
progestogen-only treatments
hormonal intrauterine systems

Non-hormonal treatments may also be appropriate depending on diagnosis.

Learn more: Women’s Health hub

Polycystic Ovary Syndrome (PCOS) and Hormonal Regulation

In PCOS, hormonal medicines may be used to:

regulate cycles
manage acne
reduce androgen-related symptoms

Metabolic health assessment is also important.

Fertility and Hormonal Medicines

Certain hormonal medicines are used in fertility pathways and are typically specialist-led.

Primary care may be involved in:

medication continuation under guidance
initial investigation
blood test monitoring

Learn more: Fertility-related hormone discussions

💧

Bladder and urinary symptoms in women

Overactive bladder (urgency and frequency) Medicines such as antimuscarinics or beta-3 agonists may be used when urgency and frequency significantly affect quality of life. Suitability depends on bladder emptying and overall health.

Genitourinary syndrome of menopause (GSM) Vaginal oestrogen may help improve urinary urgency, dryness, and recurrent irritation in postmenopausal women. Local treatment typically carries minimal systemic absorption.

Stress incontinence Medication plays a limited role. Pelvic floor physiotherapy is often first-line. Further assessment may be required if symptoms are persistent.

When further assessment is needed Blood in urine, recurrent infections, pelvic pain, or new urinary symptoms after menopause should be assessed before starting medication.

Urinary symptoms in women can overlap with hormonal changes, infection, or pelvic floor dysfunction. Assessment is individualised before treatment decisions are made.

Side Effects and Safety

Hormonal medicines can cause side effects such as:

breast tenderness
nausea
mood changes
breakthrough bleeding
headaches

Serious but rare risks include blood clots.

Sudden chest pain, breathlessness, leg swelling, severe headache, or neurological symptoms require urgent medical attention.

Hormonal Medicines in Remote GP Care

Hormonal medicines can often be initiated or reviewed remotely when:

medical history is clear
blood pressure readings are available
no red flag symptoms are present

However, in-person assessment may be required if:

there is clot risk
abnormal bleeding is unexplained
pelvic examination is indicated

Frequently Asked Questions

1. Can I use combined hormonal contraception after age 50?

Combined hormonal contraception is generally not recommended for women aged 50 or over. Alternative methods are usually considered.

2. Is HRT the same as contraception?

No. HRT is used to manage menopausal symptoms and does not provide contraception.

3. Does HRT increase clot risk?

Some forms of HRT, particularly oral oestrogen, may increase clot risk. Transdermal preparations may carry lower risk. Individual assessment is important.

4. Can I get contraception prescribed online without seeing a GP?

Some contraception can be prescribed remotely after a thorough medical history and safety assessment. However, first-time prescriptions, higher-risk scenarios (such as migraine with aura or a history of blood clots), and unexplained abnormal bleeding usually require individual discussion and sometimes in-person assessment. AccessGP prioritises safety over convenience.