Roughly 13 million women in the UK are currently perimenopausal or menopausal. That is around one third of the entire female population. Up to 90% of those women will experience symptoms, and around a quarter will describe them as severe and debilitating. Yet despite how common this experience is, half of all women in the UK are not treating their symptoms at all.

Hormone replacement therapy, more commonly known as HRT, remains one of the most effective and well-studied treatments available for menopause. But confusion, outdated fears and long NHS waiting times mean that many women are still suffering in silence. This article breaks down what HRT actually is, who should consider it, what the latest evidence says, and how to get started.

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What is HRT?

HRT is a treatment that replaces the hormones your body gradually stops producing as you approach and go through menopause. The main hormone replaced is oestrogen, which plays a role in hundreds of processes across the body, from regulating your body temperature to protecting your bones, brain and heart.

When oestrogen levels drop, you may begin to experience symptoms like hot flushes, night sweats, difficulty sleeping, low mood, brain fog, joint pain, vaginal dryness, reduced sex drive and anxiety. These symptoms can begin years before your periods actually stop, during a stage called perimenopause, and they can continue for years afterwards.

HRT works by topping up oestrogen levels to relieve these symptoms. If you still have your womb, you will also be prescribed a progestogen alongside oestrogen. This is to protect the lining of the womb from thickening, which oestrogen alone can cause. If you have had a hysterectomy, you can usually take oestrogen on its own.

HRT is available in several forms. These include skin patches, gels, sprays, tablets and vaginal creams, pessaries or rings. Your doctor will help you choose the type that best suits your symptoms and medical history.

Who should consider HRT?

HRT is recommended as a first-line treatment for women experiencing bothersome vasomotor symptoms of menopause. That means hot flushes, night sweats and the sleep disturbances that come with them. This is supported by the updated NICE guideline on menopause, published in November 2024, which recommends that HRT should be offered to people with vasomotor symptoms associated with menopause.

But HRT can also help with a much wider range of symptoms, including mood changes, brain fog, joint aches, vaginal dryness and discomfort during sex. The British Menopause Society recognises that HRT is the most effective treatment for these symptoms and encourages an individualised approach to prescribing.

You may want to consider HRT if you are experiencing any of the following.

Perimenopause symptoms. You do not need to wait until your periods have fully stopped. Many women begin to experience symptoms in their early to mid-forties, and sometimes earlier. If your symptoms are affecting your quality of life, sleep or ability to work, it is worth speaking to a doctor.

Menopause symptoms that affect your daily life. If hot flushes, sleep disruption, mood changes or other symptoms are interfering with how you feel and function, HRT may be the most effective option for relief.

Early menopause. If your periods stop before the age of 45, or before 40 in the case of premature ovarian insufficiency, HRT is particularly important. The loss of oestrogen at a younger age increases the risk of osteoporosis, cardiovascular disease and cognitive decline. NICE recommends that these women are offered HRT at least until the average age of natural menopause, which is 51.

Surgical menopause. If you have had your ovaries removed, your oestrogen levels will drop suddenly and symptoms can be severe. HRT is strongly recommended in this situation, especially if the surgery occurs before the age of natural menopause.

Bone health concerns. HRT has been shown to prevent bone loss and reduce the risk of fractures after menopause. If you are at risk of osteoporosis, this is an important benefit to discuss with your doctor.

What does the latest evidence say?

There was a time when HRT was viewed with caution. In 2002, the Women’s Health Initiative trial was halted early after it suggested that combined HRT increased the risk of heart disease and breast cancer. The findings were widely reported and led to a dramatic decline in HRT prescribing across the world.

But in the two decades since, further analysis of that trial and many subsequent studies have changed the picture significantly. The women in the original trial were mostly over the age of 60 and many years past menopause, which is not the group for whom HRT is typically prescribed today.

The evidence now shows that when HRT is started within 10 years of menopause onset, or before the age of 60, the benefits generally outweigh the risks for most women. A large body of randomised trial data supports the finding that early initiation of HRT is associated with reduced all-cause mortality and a lower risk of cardiovascular disease. Research published in the American Journal of Obstetrics and Gynecology found that women who start HRT close to the onset of menopause may reduce their cardiovascular risk by as much as 50%.

The NHS now states clearly that the benefits of HRT usually outweigh the risks, and that the risks of serious side effects are very low. The updated 2024 NICE guideline reinforces this, recommending that HRT should be offered for vasomotor symptoms and that the decision to prescribe should be based on an individualised assessment of benefits and risks.

In November 2025, the US FDA took the historic step of initiating the removal of broad “black box” warnings from HRT products, citing two decades of accumulated evidence showing that the original warnings were based on incomplete science.

Here is what the current evidence tells us about specific outcomes.

Breast cancer. There is a small increase in risk with combined HRT after around five years of use, estimated at roughly five extra cases per 1,000 women over five years. Oestrogen-only HRT carries little to no increased risk. The risk is comparable to other common lifestyle factors such as alcohol consumption or obesity. HRT patches, gels and sprays do not increase the risk of blood clots, unlike oral tablets.

Heart health. When started early, HRT does not increase heart disease risk and may in fact offer protection. The timing of initiation matters more than the therapy itself.

Bone health. HRT is proven to prevent bone loss and reduce fracture risk. This is especially important for women who go through menopause early.

Blood clots. HRT tablets can slightly increase the risk of blood clots, but this risk is very low. Transdermal options like patches, gels and sprays do not carry this risk.

Type 2 diabetes. Recent studies suggest HRT may slightly reduce the risk of developing type 2 diabetes.

Brain health. Emerging research suggests that HRT started around the time of menopause may help reduce the risk of neurodegenerative conditions such as Alzheimer’s disease, although more research is needed in this area.

Why are so many women still not getting HRT?

Despite the evidence, many women face barriers to starting treatment. A UCL study found that over 90% of postmenopausal women were never taught about menopause at school, and more than 60% only started looking for information once their symptoms had already begun. Almost half of women with menopause symptoms have never spoken to their GP about them.

Even among women who do seek help, 31% say it took multiple appointments before their GP recognised that their symptoms were related to menopause. NHS waiting times for GP appointments can make the process even slower, with many women waiting weeks just to get an initial consultation.

The result is that women are living with symptoms that could be treated effectively, and in many cases, quickly.

Getting HRT at The Wellness

At The Wellness, we believe you should not have to wait weeks to start feeling better. When you book a GP consultation with us, your doctor can assess your symptoms, discuss your medical history, explain the options available to you and, if appropriate, issue an HRT prescription on the same day.

There is no need for a referral and no long waiting list. Our doctors take an evidence-based and individualised approach, in line with the latest NICE guidelines and British Menopause Society recommendations. Whether you are just beginning to notice perimenopausal symptoms, struggling with severe hot flushes and sleep disruption, or looking to review and optimise an existing HRT prescription, we are here to help.

You can book a same-day or next-day GP consultation at our clinic in Marylebone. If HRT is right for you, your prescription can be issued during that appointment so you can start treatment without delay.

The bottom line

Menopause is not something you simply have to endure. HRT is a safe, effective and well-researched treatment for the majority of women, and the sooner you start, the greater the potential benefits.

If your symptoms are affecting your sleep, your mood, your relationships or your ability to get through the day, that is reason enough to have the conversation. And if getting an appointment with your NHS GP feels like a barrier in itself, know that there is a faster route available.

Book a GP consultation at The Wellness and take the first step today.

This article is for informational purposes only and does not replace individual medical advice. Always consult a qualified healthcare professional before starting any new treatment.