Menopause simplified – is HRT a good option for me?

Written by Dr Camilla Janssen - updated May 2024

Since April 2023 you can get a Prescription Prepayment Certificate to cover your HRT medication.

For more information and to apply online click here.

  • 25% women will get no menopausal symptoms
  • 25% women will get severe or debilitating menoapausal symptoms

The menopause is a natural part of ageing that usually occurs between 45 and 55 years as a result of woman's oestrogen levels declining. In the UK, the average age for a woman to reach the menopause is 51. The perimenopausal stage normally lasts for a few years leading up to this.

You are thought to be “post-menopausal” when you have had a year since your last period. Note, you may not know what stage you are at if you are taking hormones or contraception that affect your periods. This does not matter. We are more interested in what symptoms you are experiencing and how it is affecting you, rather than what exact stage you are at.

If you have read the information below and you feel HRT would be beneficial

1. Book an appointment to discuss this with your GP surgery and have the following information available.

2. An up-to-date blood pressure from a home machine, the pharmacy or your GP surgery waiting room.

3. An up-to-date weight.

4. Fill out this questionnaire and bring it to the appointment with you or send back to your practices' inbox before your consultation.

Symptoms may include some or all of the below and they can be intermittent initially

  • Hot flushes / Night sweats
  • Anxiety
  • Mood changes / Irritability / Tearfulness
  • Forgetfulness / Poor sleep
  • Brain fog
  • Skin dryness/ crawling sensation
  • Joint aches
  • Poor or no libido / Vaginal dryness
  • Urine infections / Urinary incontinence
  • Hair loss

We typically diagnose menopause from symptoms alone and don't need to do blood tests.


When should you start on HRT?  

It is beneficial to start HRT when menopausal symptoms impact on your home, work, social or sex life and you deem that the benefits of HRT will outweigh the risks. The menopausal symptoms may start a few years before your periods actually stop, so it may be beneficial to start HRT at this time. You don't have to wait until your periods have stopped to start HRT.


If you have had a Surgical Menopause - i.e. your ovaries have been removed surgically, then you should replace the hormones that your body is no longer producing until the time a natural menopause would occur at the earliest -i.e. 51yrs. There are no increased risks related to HRT as you are replacing the hormones that your body would otherwise produce. 


Early Menopause is when your periods stop before the age of 45.

Primary Ovarian Insufficiency (POI) also known as Premature Menopause, affects up to 1 in 100 women and this is when your periods stop before the age of 40. It means your ovaries are not working well and the lack of hormones cause many associated troublesome symptoms and health conditions if left untreated. It is important to replace the hormones that your body is no longer producing until the age of natural menopause at the earliest i.e. 51yrs old. There are no increased risks related to HRT before age of natural menopause, as you are replacing the hormones that your body would otherwise produce. Daisy Network is dedicated to providing information and support to women diagnosed with Premature Ovarian Insufficiency.


What are the Benefits and Risks?      

This advice has fluctuated over the years and has caused considerable confusion. More recently published findings show that although not entirely risk free, it remains that HRT is the most effective solution for the relief of menopausal symptoms, and it also works to prevent future diseases that can be triggered or exacerbated by low hormone levels. Link to Women's Health Concerns Fact Sheet on the Risks and Benefits of HRT.




  • Reduction of the symptoms of the Menopause with resultant improved quality of life.
  • Prevention of osteoporosis.
  • Protection against heart disease in certain age groups. The risk of heart disease increases with age, and it is the leading cause of death for women. HRT has been shown to reduce the risk of women developing heart disease by 30-50% if started within 10 years of menopause.
  • Reduction of the risk of developing type 2 diabetes, bowel cancer, dementia, and depression suggested in some studies.



  • Breast Cancer is more complex and many women worry about this in relation to HRT. Essentially 1 in 7 women born after 1960 will experience breast cancer at some point in their lives. Age is the biggest risk factor for developing breast cancer. In trials, obesity or drinking 2 glasses of wine a night posed a bigger risk factor in respect to the risk of getting breast cancer, than being on HRT and there is a direct correlation with the amount of alcohol intake. Trials have also looked at the risk of getting breast cancer when taking different combinations of HRT. The results showed that ladies taking HRT for 5 yrs, had different risks of developing breast cancer, depending on the type of HRT they took. Interestingly it showed that those that took oestrogen only HRT (only applicable if you have no uterus, i.e. have had a hysterectomy) had a reduction in risk of being diagnosed or dying from breast cancer. In those that took a combination oestrogen and progesterone HRT, they had a slight increased risk of being diagnosed with breast cancer but no increased risk of dying from breast cancer. Of note, in these trials ladies were using synthetic progesterones rather than the newer body identical Utrogestan.
  • Click here to see British Menopause Society info and chart.
  • Blood Clots - older studies have suggested an increased clotting link with older forms of oral HRT, this risk is not evident if newer formulations of HRT are taken through the skin. For more information see this link.

HRT Myths vs Fact link

Blood Pressure and HRT link

Other personal characteristics can play a bigger part than HRT in increasing the risk for many conditions such as Breast Cancer, Stroke and Venous Thromboembolic events, such as a Deep Vein Thrombosis or Pulmonary Embolus. These characteristics include Obesity, Smoking and Alcohol. It is important to manage these risks independently. Click on this infographic to see the comparison of lifestyle risk factors versus Hormone Replacement Therapy (HRT) treatment and the risk of Breast Cancer 


Many lifestyle factors can improve the symptoms of the menopause. A lower carbohydrate diet is a good way to stabilise blood sugars and help with menopausal symptoms as well as addressing obesity and hence other risk factors. Sleep, physical exercise, mental wellbeing, with a healthy out look on life, have a huge impact on how we feel. We suggest looking at our lower carbohydrate pages link here as well as all the health and wellbeing resources embedded in this website. It is worth optimising how you are running your body before adding medications. 


Alternatives to HRT for menopause symptoms click this link and this link

Non hormonal prescribed HRT alternatives options to address the menopausal symptoms click this link and this link.

Natural Alternatives to HRT beware, natural doesn't mean safe - arsenic is natural. This Menopause Matters website has a wealth of information on menopause, including information on natural alternatives to HRT. Most GPs are not trained in this area and are not able to prescribe these, so you may have to do your own research on these products.

HRT - what should I take?

Do you still have a uterus? - Do you have a history of Endometriosis? Do you still have a cervix?

If the answer is “NO” to all the above, then you will typically need Oestrogen only HRT.

If the answer is “YES” to one of the above, then you will typically need to have a combined HRT containing both Oestrogen and Progesterone.

The oestrogen is the active component of HRT that will help your menopausal symptoms, BUT if you take oestrogen alone, this may cause thickening of your uterus lining. If the oestrogen is used on its own without progesterone, this could increase your chance of endometrial cancer. Progesterone stops the lining of the womb thickening and hence prevents the chances of endometrial cancer. Hence it is very important if you still have a uterus or a cervix, or if you have a history of endometriosis, that you take both Oestrogen and Progesterone.

Cyclical or Continuous Regime?

Depending on your age and when your last period was, you will be advised to either take these hormones cyclically, ie continual oestrogen through the month and adding in the progesterone for 2 weeks out of every 4 weeks of the cycle. A monthly bleed is normal in these circumstances. If you are on cyclical patches, you will have 2 different types of patches in the packet. It is important to put them on in the correct order for this reason.

If you are older or have not had periods for a long time, then you may be advised to take a continuous regime of oestrogen and progesterone, at the same dose daily which doesn’t vary over the month. You should not have any bleeding with this combination, and you should speak to your doctor if you get bleeding 3-6 months after starting a new combination.

Pills or transdermal application (ie Patches, Gel, or spray)?

There are slightly higher risks associated with blood clots if you take your HRT in a pill form.

If you opt for a transdermal method, there is no increased blood clot risk, and it is your choice as to which of these methods is most acceptable. Patches you only have to change twice a week. You can swim and shower with these on. But - dosing is less flexible and some people get an allergy to the glue or find they don’t stick well, particularly if they are “hot” people.

Gels you need to rub on daily, rub onto both inner mid thighs or outer arm and shoulder. Leave for 5 mins to dry before covering with clothes. If you shower or swim within a few hrs of application this may dilute the dose.

Sprays are another good daily option, and dry more quickly than gels. Many GP practices are not allowed to prescribe these at present due to cost implications.

Common Side effects of HRT - These are common in the first 3 months of starting HRT and tend to improve with time.

  • Breast tenderness
  • Change in skin/acne
  • Bloating, mood swings

Bleeding on HRT - Common in first 3 – 6 months of any new HRT regime. It typically does not indicate anything abnormal and usually settles with time.  If it persists for more than 3-6 months, then please discuss with a doctor. We can tweak your hormone combination to improve things and we may need to investigate to ensure nothing else is causing the bleeding at this point. For more info click here.

Body Identical vs Bioidentical - Body identical HRT are medicines that have been subjected to safety testing and quality control and are regulated by the Medicines Regulatory Agency. This is the HRT we prescribe in the NHS. It comes as a transdermal preparation (i.e. one that you take via the skin) either as a gel that you rub on daily or as a patch that you change twice a week. Utrogestan is the body identical progesterone. Bioidentical HRT products are unregulated and is a term used for products which are marketed as being "natural" or "individualised" or "customised" for women. These products are unregulated by the Medicines Regulatory Agency and are unlicensed. They have not been subject to the same safety testing or quality control as the regulated HRT products in body identical HRT. The use of bioidentical compounded hormones is not recommended by the British Menopause Society.

How long should you continue with HRT? - People's menopausal symptoms vary greatly from none at all to lifelong debilitating symptoms. Menopausal symptoms tend to naturally improve with time however the minority will get lifelong flushing and debilitating symptoms. Symptoms are often worse during the perimenopausal years and tend to subside as your body gets used to lower oestrogen levels. As you get older you may need a lower dose of HRT or it may be appropriate to stop all together. HRT should be continued for as long as the benefits of symptom control and improved quality of life outweigh the risks. This balance is directly related to your own personal health and should be assessed on and individual level, typically on an annual basis or if you have a change in your health. The ongoing benefits from HRT with respect to heart disease, bones and brain etc will only continue while you continue to take HRT.

Stopping HRT - You may want to stop HRT and see how your body responds. You can either stop abruptly (expect some initial symptoms) or gradually reduce over time. There are no long-term differences in the outcome between stopping abruptly versus gradually decreasing your dose. If you do stop abruptly, it is normal to have some initial symptoms due to the relative lack of oestrogen, but this should settle over time – over a few weeks to a couple of months, so please do expect this.

Please ensure that you participate in regular breast and cervical screening programmes.

Once started on HRT, we would suggest a follow up with your GP in 3 months’ time with an up-to-date blood pressure reading. Once things are stabilised, an annual review, including and up to date blood pressure, is perfectly appropriate.

If you get new bleeding once established on HRT for more than 6 months, please discuss this with your doctor, as this usually needs investigating.


Health and Wellbeing - Hampshire and Isle of Wight menopause page. A good source of reliable information on many aspects of health and wellbeing including menopause. You can access one on one support from a menopause advisor, join a virtual menopause support group as well as have access to a variety of exercise videos and live classes.

Women's Health Concern is the patients arm of the British Menopause Society (BMS) and is a good source of reliable information on women's health including a comprehensive fact sheets and other helpful resources page.

The British Menopause Society (BMS) educates and informs healthcare professionals on menopause and post reproductive health. BMS tools for clinicians has a useful range of resources that summarise the NICE Guideline, provide guidance on HRT prescribing and other treatment options.

Newson Health is a private Menopause and Wellbeing Centre. There is a wealth of information on its website including a comprehensive resources page which features fact sheets, booklets and podcasts on many different areas of menopause.

Menopause Matters website has wealth of information on menopause, including information on natural alternatives to HRT.

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