HRT replaces the oestrogen the ovaries stop making, with progestogen added if you have a womb. It is the most effective treatment for hot flushes and night sweats. A GP can start it at the first appointment. A telephone review is £59 and a 30 minute consultation £150.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
HRT is oestrogen, given as a patch, gel, spray or tablet. Anyone with a womb also takes a progestogen, because oestrogen alone thickens the lining of the womb and raises the risk of cancer there. After a hysterectomy, oestrogen alone is used.NICE NG23, 2024
Vaginal oestrogen is a separate treatment for dryness, soreness and recurrent urine infections. The dose is so low that it can be used for years, alongside HRT or on its own, and it does not need a progestogen.NICE NG23, 2024
HRT treats the symptoms of falling oestrogen. Flushes, sweats, disturbed sleep, low mood and joint aches respond, usually within weeks, and so does the loss of bone that follows the menopause.NICE NG23, 2024
The risk of a clot depends on the route. Oestrogen taken as a tablet raises it, and oestrogen through the skin as a patch or gel at standard doses does not appear to, which makes the route the first choice for anyone with a raised clot risk.The BMJ Vinogradova, 2019
Combined HRT carries a small increase in breast cancer risk that grows with the years of use and falls after stopping. Oestrogen alone carries little or no increase. The size of the difference is the conversation, not whether one exists.The BMJ Vinogradova, 2020
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Over 45, no blood test is needed to start HRT. The decision rests on your symptoms, your periods and your own history. A hormone level is useful under 45, when early menopause has to be confirmed.NICE NG23, 2024
The consultation covers migraine, clots, breast and womb cancer in you and in close family, blood pressure, and smoking. Those decide which type and route is safest, and in a few cases whether a specialist opinion is needed first.British Menopause Society BMS consensus statement, 2024
Until periods have stopped for a year, or two years under 50, contraception is still needed. HRT is not contraception, and the choice of coil or pill fits around it.Faculty of Sexual and Reproductive Healthcare UKMEC, 2016
No treatment
Symptoms ease for most women over a few years, and some prefer to wait. It is a fair choice when flushes are mild and sleep is intact.
Cognitive behavioural therapy
A structured course helps with flushes, sweats and low mood, and suits anyone who cannot or will not take hormones.NICE NG23, 2024
Non hormonal prescription
Some antidepressants and other medicines reduce flushes where HRT is not suitable, for example after breast cancer. They work less well than HRT.NICE NG23, 2024
Oestrogen through the skin
A patch, gel or spray, with a progestogen by tablet or a hormonal coil if you have a womb. The route with the lower clot risk.The BMJ Vinogradova, 2019
Oestrogen as a tablet
Simple to take and effective. It suits women without clot risk factors who prefer a tablet to a patch.The BMJ Vinogradova, 2019
Flushes and sweats usually improve within 4 weeks and the full effect is judged at 3 months. Irregular bleeding in the first 3 months of HRT is common and expected, and bleeding after that is investigated.NICE NG23, 2024
There is no fixed date to stop. HRT is reviewed once a year, and when it is stopped symptoms can come back. Coming off gradually or suddenly makes no difference to whether they return in the long run.NICE NG23, 2024
Keep a symptom diary for 2 weeks. Score flushes, night waking, mood and joint pain from 0 to 3 each day. The same diary repeated at 3 months is how you and the doctor will know whether the treatment is working.
Have your blood pressure measured on 2 separate days, at home or at a pharmacy, and bring the numbers. Raised blood pressure changes which route is safest, and 2 readings outside a consulting room are more reliable than 1 taken inside it.NICE NG136, 2023
Do not pay for a saliva hormone test to set a dose. Hormone levels swing through the day and a saliva level does not tell anyone which dose of HRT you need.NICE NG23, 2024
Do not buy compounded bioidentical hormones from an unregulated supplier. They are not licensed, the dose is not checked, and the regulated body identical oestrogen and progesterone do the same job with evidence behind them.British Menopause Society BMS consensus statement, 2024
Step 1
A consultation by telephone or in person. Your periods, your symptoms and the history that decides which HRT is safest for you.
Step 2
Patch, gel or tablet, with the progestogen that suits you. A prescription is sent to your pharmacy the same day.
Step 3
A call to check the diary against the start, adjust the dose, and sort out any bleeding. Then once a year while you take it.
Ask before you book if you are not sure this is the right appointment.
Yes. A GP with women’s health training can assess you and prescribe HRT at the first appointment, by telephone for £59 or in person for 30 minutes at £150. The prescription goes to the pharmacy you choose and the medicine is priced by them.
Not if you are over 45 and have menopausal symptoms. The diagnosis is made from your symptoms and your periods. Under 45 a hormone test helps confirm early menopause, and it is repeated because a single result can mislead.
Combined HRT slightly increases the risk, and the increase grows with longer use and falls after stopping. Oestrogen alone, used after a hysterectomy, carries little or no increase. The doctor puts the numbers for your age and history in front of you before you decide.
For clots, yes. Oestrogen through the skin at standard doses does not appear to raise the risk of a clot, and a tablet does. For anyone with a higher clot risk, including those who are overweight or have had a clot before, a patch or gel is the choice.
There is no set limit. The decision is reviewed each year against your symptoms and your risks. Many women take it for several years, some for much longer, and the right length is the one that still makes sense for you at each review.
Oestrogen and progesterone with the same structure as the hormones your body makes. They are licensed and regulated, made to a checked dose, and prescribed in the usual way. They are different from compounded bioidentical products, which are not licensed and whose dose nobody checks.
Weight often rises around the menopause whether or not HRT is taken, because of age and a change in where the body stores fat, and trials of HRT have not shown it to be the cause. Better sleep on HRT can make regular exercise easier to keep up.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
British Menopause Society
Tools for clinicians, hormone replacement therapy and the risk of breast cancerBMS consensus statement, 2024
Faculty of Sexual and Reproductive Healthcare
UK medical eligibility criteria for contraceptive useUKMEC, 2016
NICE
NICE
Menopause, identification and managementNG23, 2024
The BMJ
Use of hormone replacement therapy and risk of venous thromboembolism, nested case control studiesVinogradova, 2019
The BMJ
Use of hormone replacement therapy and risk of breast cancer, nested case control studiesVinogradova, 2020
Written and reviewed by the clinical team at The Wellness. Last reviewed 23 September 2026.
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