How does hormone replacement therapy work?

As ovarian hormone levels change during perimenopause or after ovarian function falls, the body can respond with hot flushes, night sweats, vaginal symptoms, sleep changes and concentration difficulties. HRT supplies oestradiol or another form of oestrogen to reduce the effect of that hormone change. It may be given as a patch, gel, spray or tablet, while local vaginal oestrogen may suit specific vaginal or urinary symptoms.

If you have a uterus, progesterone is usually added to counter the effect of oestrogen on the womb lining. People who have had their uterus removed may have a different plan. HRT can also support bone protection while it is being used, but the choice depends on symptoms, medical history and individual risks.

Use the prescribed form consistently and note symptom changes, bleeding, breast changes, headaches and skin reactions. Do not alter the dose or stop suddenly without discussing it with your prescriber. Reviews can check whether the type and amount remain suitable, whether bleeding needs assessment and whether local treatment or another route would better match your symptoms.

Report bleeding that starts after a settled period, becomes heavy or continues unexpectedly. Seek urgent help for chest pain, sudden breathlessness, one-sided leg swelling, facial drooping, new weakness or trouble speaking. A new breast lump or persistent unusual breast change also needs clinical assessment.

Ask which hormone combination and route fit your history, whether progesterone is needed, how bleeding will be monitored, when to review treatment, and what alternatives could help hot flushes or menopausal brain fog.