Hormone replacement therapy

The two jobs inside most hormone replacement therapy regimens

What HRT can help with and how choices are made

Clinical review September 2026

Hormone Replacement Therapy is often discussed as though it were one product and one decision. It is neither. It is a family of treatments, routes and regimens used mainly to replace oestrogen that is falling around menopause, and to replace hormones in earlier ovarian insufficiency. The best question is usually not “Should everyone take it?” but “What problem are we trying to solve, and what is the safest useful way to do that for me?”

The two jobs inside most regimens

Oestrogen is the component that helps most directly with hot flushes, sweats and many vaginal or urinary symptoms. It may be given through skin patches, gel, spray or tablets. If someone has a uterus, systemic oestrogen needs endometrial protection with a progestogen—given as a tablet, patch component or hormonal intrauterine system. Oestrogen-only HRT is generally used after total hysterectomy.

Regimens may be sequential, producing planned bleeding, or continuous combined, aiming for no bleed after the adjustment phase. Transdermal and oral treatments deliver the same broad hormonal aim through different routes; the choice can matter for side effects, convenience and clotting risk. There is no prize for choosing the most complicated arrangement.

What evidence supports

Systemic HRT is the most effective established treatment for vasomotor symptoms. Vaginal oestrogen treats vaginal dryness, discomfort during sex and some urinary symptoms locally, often with very low systemic absorption. Hormone therapy also helps prevent bone loss while it is taken; it is not prescribed solely as a lifetime osteoporosis plan for everyone.

Benefits and risks depend on age, time since menopause, dose, route, type of progestogen, duration and personal history. For people with certain cancers, unexplained vaginal bleeding, previous thrombosis, stroke, active liver disease or high cardiovascular risk, specialist input or alternatives may be needed. Decisions should be individualised rather than decided by a frightening headline or a reassuring Instagram reel.

Starting and reviewing safely

Before starting, the clinician should understand symptoms, bleeding pattern, medical and family history, medicines, blood pressure and relevant risk factors. Review normally follows after a few months and then at least annually, with earlier contact for troublesome side effects. Breast awareness and routine screening remain important, but HRT does not replace ordinary preventive care.

Bleeding can occur in the first months of systemic HRT or after changes. Seek review for heavy bleeding, bleeding that continues beyond the expected settling period, new bleeding after a period of no bleeding, or any postmenopausal bleeding before HRT is started. HRT is not contraception: pregnancy remains possible during perimenopause.

A treatment with room for nuance

Some people use HRT briefly, some for longer; there is no automatic stop date. The right duration is revisited as symptoms, health and priorities change. Future pages can explore types of oestrogen and progestogen, routes, vaginal oestrogen, unscheduled bleeding and HRT after cancer.

Important safety note

This page is for general education and cannot replace individual medical advice. Seek urgent help for severe symptoms, possible pregnancy with pain or bleeding, collapse, confusion, seizure, or any situation in which you feel acutely unwell. A clinician who knows your history can help tailor investigation and treatment.