If you’ve been Googling perimenopause, you’ve almost certainly landed on HRT — and probably found conflicting, confusing, or downright frightening information.
Let’s clear it up.
This is not a recommendation to take HRT or not to take it. That is a decision between you and your doctor. This is the honest, plain-English guide to what HRT actually is — so you can have an informed conversation rather than a bewildered one.
What is HRT?
HRT stands for Hormone Replacement Therapy. It replaces the hormones — primarily oestrogen and progesterone — that your body produces less of during perimenopause and menopause.
The idea is straightforward: if falling hormones are causing your symptoms, replacing them should help. And for most women, it does.
The types of HRT
Oestrogen-only HRT Used by women who have had a hysterectomy (removal of the womb). Because there’s no womb lining to protect, progesterone isn’t needed.
Combined HRT (oestrogen + progesterone) Used by women who still have their womb. Progesterone is included to protect the womb lining from the effects of oestrogen alone.
Testosterone Sometimes prescribed alongside HRT for women experiencing low libido, fatigue, or brain fog. Not yet licensed specifically for women in the UK, but widely used off-label.
The routes — how HRT is taken
Patches Worn on the skin (usually the lower abdomen or bottom) and changed once or twice a week. Deliver oestrogen directly into the bloodstream, bypassing the liver.
Gel Applied to the skin daily. Also bypasses the liver. Easy to adjust the dose.
Spray Similar to gel — applied to the skin daily.
Pills/tablets Taken orally. Pass through the liver, which can slightly increase the risk of blood clots compared to skin-applied options. Generally less recommended now.
Implants Small pellets inserted under the skin every few months. Less commonly used.
Vaginal oestrogen Cream, pessary, or ring used locally for vaginal dryness and urinary symptoms. Very low absorption into the bloodstream — generally considered safe for almost all women, including those who can’t take systemic HRT.
What about the risks?
The 2002 WHI study caused widespread fear about HRT by suggesting links to breast cancer, heart disease, and stroke. This led to a dramatic fall in HRT prescriptions worldwide.
Since then, the evidence has been significantly re-evaluated. Current guidance from the British Menopause Society and NICE (the body that sets UK medical guidelines) concludes:
- For most healthy women under 60, or within 10 years of menopause, the benefits of HRT outweigh the risks
- Body-identical HRT (using hormones that are chemically identical to those your body produces) carries lower risks than older synthetic versions
- Vaginal oestrogen carries minimal systemic risk
- The slight increase in breast cancer risk associated with combined HRT is similar to the risk associated with drinking one glass of wine per night
Every woman’s situation is different. Risk depends on your personal and family medical history, the type of HRT, the dose, and how long you take it. This is why the conversation with your doctor matters.
Body-identical vs synthetic HRT
Body-identical (or bioidentical) HRT uses hormones that are structurally identical to those your body produces. In the UK, regulated body-identical HRT is available on the NHS — brands like Utrogestan (progesterone) and Oestrogel or Lenzetto (oestrogen).
Compounded bioidentical HRT is made to order by specialist pharmacies and is not regulated by the MHRA. The British Menopause Society does not recommend it due to lack of evidence on safety and efficacy.
How do I know if HRT is right for me?
Questions to ask your GP or specialist:
- Am I a good candidate for HRT given my medical history?
- Which type and route would you recommend for me?
- What are the risks for me specifically?
- How long would I take it?
- What are my alternatives if I can’t or don’t want to take HRT?
You are entitled to an informed conversation — not a dismissal.
What if I can’t take HRT?
Some women can’t take HRT — for example, those with a history of certain hormone-sensitive cancers. Alternatives include:
- SSRIs and SNRIs (antidepressants that can help with hot flushes and mood)
- Clonidine (for hot flushes)
- Cognitive behavioural therapy (CBT) — shown to help with mood and hot flush perception
- Lifestyle changes — exercise, diet, sleep hygiene
- Some supplements — though evidence varies considerably
None of these are as comprehensively effective as HRT for most women, but they can make a meaningful difference.
Where to find a menopause specialist in the UK
If your GP is not knowledgeable about menopause, you can ask for a referral to a specialist. The British Menopause Society has a directory of accredited specialists at thebms.org.uk.
This article is for informational purposes only and does not constitute medical advice. Please speak to your GP or a qualified healthcare professional before making any decisions about HRT.
