Hormone Replacement Therapy

Hormone replacement therapy replaces hormones that have fallen and can ease menopause symptoms after an individual medical assessment.

Hormone replacement therapy, or HRT, supplies oestrogen and sometimes a progestogen when hormone levels fall. It may be given as tablets, patches, gels, sprays or local vaginal treatment. The choice depends on symptoms, whether you have a womb, your medical history and your preferences. Treatment is reviewed regularly rather than treated as a one-time decision.

Hot flushes, sleep disruption and mood symptoms may begin to improve over the first weeks, although the response varies. Vaginal dryness often needs local treatment and patience. Your clinician may adjust the dose, route or combination if symptoms remain difficult or bleeding is unexpected.

Early effects can include breast tenderness, bloating, headache, nausea, fluid retention or mood change. Unscheduled bleeding may occur, especially after starting or changing treatment. Persistent or heavy bleeding, chest pain, sudden breathlessness, a painful swollen leg or new neurological symptoms needs urgent assessment.

There is no single fixed duration. Many people continue while symptoms affect daily life, with regular reviews of benefits, side effects and personal risk factors. People with premature ovarian insufficiency or certain causes of early hormone loss may be advised to continue until around the usual menopause age, guided by their clinician.

If you have a womb, oestrogen is usually paired with a progestogen to protect the womb lining. Oestrogen can be taken through the skin or by mouth; the route affects practical use and some risks. HRT is not contraception. Symptoms can return after stopping, so tapering and follow-up are worth planning.

HRT may help people with bothersome menopause symptoms such as hot flushes, vaginal dryness, brain fog or mood changes. It may also be considered for premature ovarian insufficiency, Turner syndrome or bone protection in selected situations. A clinician reviews bleeding, migraine, clotting history, breast or womb conditions, liver disease and medicines before prescribing.

You discuss symptoms, periods, medical history and treatment goals. The clinician chooses an oestrogen route and decides whether progestogen is needed. You receive instructions for applying, taking or using the treatment, including what to do after a missed dose. A follow-up checks symptom response, bleeding and tolerability before any adjustment.

HRT is an ongoing medicine rather than a procedure with a recovery period. Apply patches, gel or spray exactly as directed and keep review appointments. Do not stop or change a prescribed combination without advice. Keep a brief record of bleeding and symptom changes to make consultations more useful.

Risks depend on the hormones, route, duration and personal history. Some people should not start HRT without specialist advice, including those with unexplained bleeding or certain hormone-sensitive cancers. Seek urgent help for symptoms suggesting a clot, stroke or serious allergic reaction, and report new bleeding promptly.

Non-hormonal menopause treatment, local vaginal products, sleep support, cooling strategies and targeted care for a particular symptom may be options. The right plan depends on which symptom is limiting you and whether systemic hormones are suitable. A clinician can combine approaches when appropriate.

Look for a menopause-trained clinician who can explain systemic and local options, review contraindications and arrange follow-up. Bring your medication list, details of bleeding and any history of clots, cancer, migraine or liver disease. Ask how to report unexpected bleeding and when the next review is due.