What to know about hormone replacement therapy in women over 40

HRT, also called menopausal hormone therapy, replaces some oestrogen and sometimes progestogen when ovarian hormone levels change. It can help with hot flushes, night sweats, vaginal dryness, and sleep disruption linked with those symptoms. It may also help protect bone strength while it is being used, but it is not suitable for everyone and is not a general treatment for ageing.

If you still have a uterus, progestogen is usually included with systemic oestrogen to reduce the risk of the womb lining becoming too thick. Someone who has had a hysterectomy may be offered oestrogen alone, depending on the reason for surgery and other health factors. Low-dose vaginal oestrogen is a separate local option for vaginal or urinary symptoms and has different considerations from tablets, patches, gels, or sprays that affect the whole body.

Arrange an individual assessment rather than choosing a product from someone else’s prescription. Share your menstrual pattern, symptoms, contraception needs, migraine history, blood pressure, liver problems, and any personal or family history of blood clots, stroke, heart disease, breast cancer, or womb cancer. Tell the clinician about every medicine and supplement you use.

Treatment can be given as a patch, gel, spray, tablet, or local vaginal preparation. Skin-applied oestrogen may be considered when clot risk is a concern, but the choice still needs clinical review. A clinician can select the lowest effective dose for your goals, explain expected bleeding changes, and arrange a review after starting or changing treatment. Do not stop prescribed hormones suddenly without discussing a taper or alternative plan.

Seek urgent medical help for sudden chest pain, trouble breathing, coughing blood, one-sided weakness, new difficulty speaking, or a painful swollen leg. Contact a clinician promptly for heavy or persistent bleeding, bleeding after sex, a new breast change, severe headache with neurological symptoms, or yellowing of the skin or eyes.

Some spotting can occur after starting a new regimen, but bleeding that continues beyond the timeframe your clinician explained needs assessment. Keep follow-up appointments so symptoms, blood pressure, bleeding, and the ongoing balance of benefits and risks can be reviewed.

Ask which symptoms HRT is expected to improve, whether you need oestrogen with progestogen, and which route fits your health history. Ask what bleeding is expected, how long to try the plan before reviewing it, what non-hormonal options are available, and which warning signs should prompt an urgent call. If pregnancy is possible, ask how HRT will work alongside contraception.