HRT: what it is, what it does, who it is for

What it actually contains

Oestrogen is the part that treats the symptoms. Hot flushes, night sweats, disturbed sleep, mood changes, brain fog, joint aches, vaginal dryness: these are driven by the loss of oestrogen, and replacing it addresses the cause rather than each symptom separately.

Progesterone is included if you have a womb. Oestrogen on its own thickens the womb lining, which over time raises the risk of endometrial cancer. Progesterone protects against that. This is not optional and it is not negotiable: if you have a womb, you take both.

If you have had a hysterectomy, you generally take oestrogen alone.

The forms it comes in

Through the skin, as a patch worn for a few days at a time, or a gel or spray applied daily. The hormone is absorbed directly into the bloodstream, bypassing the liver.

By mouth, as a daily tablet.

Locally, as a vaginal cream, pessary or ring. This treats vaginal and urinary symptoms specifically and delivers very little hormone to the rest of the body, so it can often be used by women who cannot take other forms.

The route matters clinically. UK guidance recommends the through-the-skin route for women at increased risk of blood clots, including women with a BMI over 30, because transdermal oestrogen is not associated with the clot risk seen with oral treatment. For that reason, patches and gel are the default starting point for many women rather than a preference.

Body-identical

Modern UK HRT is usually body-identical: the oestrogen is estradiol, structurally the same molecule your ovaries made, and the progesterone is micronised progesterone, structurally identical to your own. These are regulated, licensed products.

That is a different thing from "bioidentical" hormones sold by compounding pharmacies as bespoke preparations, which are not regulated in the same way and are not recommended by UK bodies.

Who it suits

For most healthy women with menopausal symptoms, UK guidance recommends HRT as the first-line treatment. Symptoms alone are a legitimate reason to treat.

The case is stronger for women who reach menopause early, and stronger again under 40, because the long-term effects of losing oestrogen young are more significant. In that group treatment is generally recommended at least until the usual age of menopause.

Who needs a proper conversation first

Some histories change the answer or the format:

• Current or previous breast cancer or other oestrogen-sensitive cancer
• A history of blood clots, or a clotting disorder
• Liver disease
• Unexplained vaginal bleeding, which needs investigating before anything is prescribed
• Uncontrolled high blood pressure

None of these is automatically a no in every case, but each one means the decision needs a clinician looking at your specific history rather than a general rule.

Benefits and risks, honestly

The benefits for symptoms are well established, and there is good evidence for protection against bone loss.

On risk, the position that most people carry around dates from a 2002 study whose findings have been substantially reanalysed since, and whose participants were largely older women starting treatment well after menopause. Current UK guidance is that for most healthy women starting near menopause, the benefits outweigh the risks.

The specifics matter: risk differs by the type of progestogen used, by route, by age at starting, and by how long you take it. A meta-analysis has found that oestrogen combined with micronised progesterone is not associated with increased breast cancer risk in the first five years.

That is a summary, not your answer. The individual version comes from an assessment.

How long people take it

There is no fixed stopping point and no rule that you must come off at a particular age. Once you are stable, the sensible pattern is a review at least annually, weighing benefits and risks as they stand for you then.