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Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of menopause. It replaces the female hormones no longer produced after menopause.
The menopause, sometimes referred to as the "change of life", is when a woman's ovaries stop producing an egg every four weeks. This means that she will no longer have monthly periods or be able to have children. The menopause usually occurs when a woman is in her 50s (the average age is 52).
Read more about the menopause.
Oestrogen and progesterone (see below) are female hormones that play important roles in a woman’s body. When levels fall, it causes a range of physical and emotional symptoms, including hot flushes, mood swings and vaginal dryness.
HRT helps to restore female hormone levels, allowing the body to function normally again.
Oestrogen helps to release eggs from the ovaries. It also regulates a woman’s periods and helps her to conceive.
Oestrogen also plays a part in controlling other functions, including bone density, skin temperature and keeping the vagina moist. It is a reduction in oestrogen that causes most symptoms associated with menopause, including:
Most symptoms will pass within two-to-five years, although vaginal dryness is likely to get worse if not treated. Stress incontinence may also persist and the risk of osteoporosis will increase with age.
The main role of progesterone is to prepare the womb for [pregnancy]. It also helps to protect the lining of the womb, which is known as the endometrium.
A decrease in the level of progesterone does not affect your body in the same way as falling levels of oestrogen, but it does increase your risk of developing womb cancer (endometrial cancer).
Progesterone is therefore usually used in combination with oestrogen in HRT. However, if you have had a hysterectomy (an operation to remove your womb), you do not need progesterone and can take oestrogen-only HRT.
Read more about the different types of HRT.
There are several ways HRT can be taken, including:
If you are only experiencing vaginal dryness, a type of HRT that can be applied directly to your vagina will probably be recommended.
Tablets, patches or implants are only needed if you have other menopausal symptoms, such as hot flushes.
There are many different combinations of HRT, so deciding which type to use can be difficult. Your doctor will be able to advise.
Read more about how HRT is taken.
You can start HRT as soon as you begin to experience menopausal symptoms. However, HRT may not be suitable if you are pregnant or have:
Read more about who can use HRT.
If you are unable to have HRT, different medication may be prescribed to help control your menopausal symptoms.
Read more about alternatives to HRT.
Hormones used in HRT can have associated side effects including:
Read more about possible side effects of HRT and how to alleviate them.
Over the years, many studies have been carried out looking at the benefits and risks of HRT.
The main benefit is that it is a very effective method of controlling menopause symptoms. It can make a significant difference to a woman’s quality of life and wellbeing.
HRT can also reduce a woman’s risk of developing osteoporosis and cancer of the colon and rectum. However, long-term use is rarely recommended, and bone density will fall rapidly after HRT is stopped.
HRT slightly increases the risk of developing breast cancer, endometrial cancer, ovarian cancer and stroke. Other medicines are available to treat osteoporosis that do not carry the same level of associated risk.
Most experts agree if HRT is used on a short-term basis (no more than five years), the benefits outweigh the risks.
If HRT is taken for longer, particularly for more than 10 years, you should discuss your individual risks with your doctor and review them on an annual basis.
Read more about the risks of HRT.
You can begin hormone replacement therapy (HRT) as soon as you start experiencing menopausal symptoms.
The average age for women to experience menopause is 52. However, some women have the menopause when they are in their forties or sixties. There is no way of predicting exactly when the menopause will occur.
Some women have menopausal symptoms, such as hot flushes and vaginal dryness, before menopause actually starts. This is known as the peri-menopause.
The peri-menopause occurs because levels of the female sex hormones, oestrogen and progesterone, fall when the number of remaining eggs drops below a certain number. This means you may experience menopausal symptoms even when you are still having periods.
In most cases, HRT can be used without taking a test to confirm you are starting the menopause. A test for the menopause is usually only necessary if you are under 40 or have unusual bleeding patterns during your period.
Testing can help rule out other conditions that may cause similar symptoms, such as having an overactive thyroid gland](/condition/thyroid-over-active) (hyperthyroidism) or [cervical cancer.
HRT may not be suitable if you:
In these circumstances, a different type of medication may be prescribed to help control your menopausal symptoms.
Read more about the alternatives to HRT.
Both hormones used in hormone replacement therapy (HRT), oestrogen and progestogen, have side effects.
Side effects usually improve over time, so try the treatment plan you have been prescribed for at least three months.
If side effects continue after this time, see your doctor so your treatment plan can be reviewed.
If side effects persist, your doctor may recommend:
Side effects associated with oestrogen include:
In some cases, small lifestyle changes can help to relieve side effects. For example:
Side effects associated with progestogen include:
Hormone replacement therapy (HRT) replaces two female hormones that a woman’s body is no longer producing due to menopause. These hormones are:
While there are more than 60 different preparations of HRT, the three main types are discussed below.
Oestrogen-only HRT is usually recommended for women who have had their womb and ovaries removed during a hysterectomy. There is no need to take progestogen because there is no risk of endometrial cancer (cancer of the lining of the womb).
Cyclical HRT, also known as sequential HRT, is often recommended for women who have menopausal symptoms but still have their periods.
There are two types of cyclical HRT:
Monthly HRT is usually recommended for women having regular periods. You will continue to have monthly periods until the menopause causes them to stop.
Three-monthly HRT is usually recommended for women experiencing irregular periods. You should have a period every three months.
It is useful to maintain regular periods so you know when your periods naturally stop and when you are likely to progress to the last stage of the menopause.
In some cases a woman using cyclical HRT may continue having periods after the menopause (when she is post-menopausal).
Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually said to be post-menopausal if she has not had a period for a year.
As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.
There are several ways hormone replacement therapy (HRT) can be taken.
HRT can be taken as:
If you are only experiencing vaginal dryness, you may be advised to use a form of HRT that can be applied directly to your vagina.
Tablets, patches and implants are only usually required if you have other menopausal symptoms, such as hot flushes.
There are different combinations of HRT which may make it difficult for you to decide which one is best for you. Your doctor will be able to advise you.
The hormones used in HRT will usually be prescribed at the lowest possible dose to control your symptoms. It may take a while to establish an effective dose for your symptoms. Tell your doctor if you feel your current dose is not working.
Most women are able to stop taking HRT after their menopausal symptoms finish. This is usually two-to-five years after they start.
Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may have a relapse of menopausal symptoms after you stop HRT but these should pass within a few months.
If you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms, contact your doctor because treatment may need to be restarted, usually at a lower dose.
After you have stopped HRT, you may need additional treatment for vaginal dryness and to prevent osteoporosis (brittle bones). Creams and lubricants are available for vaginal dryness, and medicines called bisphosphonates have proved effective in treating osteoporosis.
When deciding whether to have hormone replacement therapy (HRT), it is important to understand the risks and put them into perspective.
Many medical studies on HRT have been published over the past 10 years which have received a great deal of negative publicity. As a result, many women have been reluctant to use HRT.
However, it could be argued that the data within the studies was misleading. For example, if you read an article that says using combined HRT for five years increases your risk of developing breast cancer by 60%, you may be alarmed.
While this is statistically true, the average risk of developing breast cancer without other contributory risk factors (your annual baseline risk) is very small, just 1%. So using HRT for five years would only increase the average risk from 1% to 1.6%.
Cancer Research UK summarises the breast cancer risk associated with HRT as follows:
Read more about HRT and breast cancer risk on the Cancer Research UK website.
Due to the associated risk of breast cancer, if you are taking HRT it is important you attend all your breast-screening appointments.
Cancer Research UK summarises the ovarian cancer risk associated with HRT as follows:
Read more about HRT and ovarian cancer risk on the Cancer Research UK website.
If you take progestogen as directed, there is no increased risk of developing endometrial cancer (cancer of the womb).
It is very important you take progestogen as directed because only taking oestrogen will significantly increase your risk of developing endometrial cancer.
However, British researchers currently carrying out a 10-year study, say at present evidence is inconclusive.
Barbara Hunt, a retired civil servant from Canterbury, Kent, has had a rollercoaster ride with the menopause and HRT.
“I was 51 when I had my first hot flush. My periods had been erratic for six months so I realised I was approaching the menopause. Then the flushes started with a vengeance.
“My doctor immediately suggested HRT. This was when it was being hailed as the wonder drug. I started off with patches. I still had periods, but at least the flushes went away.
“After four years I heard about its possible side effects and decided to stop taking it. The flushes returned and I got night sweats, too. Heat would suddenly engulf me, then disappear just as quickly. The night sweats were really hard. I was waking up every half-hour and got so little sleep that going back on HRT seemed my only option.
“I started taking it again. To my relief, the flushes and sweats are a thing of the past. I’m now trying to wean myself off the patches by cutting a third off them each time. Having gone on HRT, it seems to be such a tough job to get off it. I sometimes wonder whether, if I’d never taken it, the flushes might be over by now.”
If you are unable or decide not to take hormone replacement therapy (HRT), alternative approaches and treatments are available that may help control your menopausal symptoms.
Making changes to your lifestyle may help ease your menopausal symptoms. For example, you should:
Tibolone is a synthetic (man-made) hormone that can be used as an alternative to HRT. It contains a combination of oestrogen and progestogen, so you only need take one tablet.
If you are unable to take HRT for medical reasons, for example, if you have a history of breast cancer or heart disease, it is likely you will not be able to take tibolone.
The following antidepressants have proven effective in treating hot flushes in some menopausal women:
Side effects of these antidepressants include:
SSRIs have also been associated with a loss of libido (sex drive).
Any side effects will usually improve over time, but visit your doctor if they do not.
You may need to have regular blood tests or blood pressure checks when taking antidepressants, particularly if you also take the anti-clotting medicine, warfarin, or have high blood pressure (hypertension).
Clonidine is a medicine originally designed to treat high blood pressure, but research shows it may reduce hot flushes in some menopausal women.
Side effects of clonidine include:
Using clonidine is not recommended if you have depression or insomnia because it could make these conditions worse.
Gabapentin is a medicine originally designed to treat pain and epileptic seizures. However, as with clonidine, gabapentin has been shown to help ease hot flushes in some menopausal women.
Side effects of gabapentin can include:
In some menopausal women, a medicine called pregabalin has been shown to reduce the frequency and severity of hot flushes.
Side effects of pregabalin can include:
These side effects are usually mild.
Some products are sold in health shops for treating menopausal symptoms. These herbal remedies include ginseng, black cohosh, red clover and evening primrose oil.
These products are often marketed as "natural", but this does not necessarily mean they are safe to use. Concerns exist over the quality of "natural products", and some may interact with other treatments and cause harmful side effects.
There is also very little evidence to show that these remedies are effective. Therefore, always consult your doctor before using a complementary therapy to treat menopausal symptoms.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.