What is HRT and who is it for?

What is HRT made of, and what are the alternatives?

Systemic HRT is estrogen that reaches the whole body, taken as a tablet, patch, gel or spray (NHS). Women with a uterus (womb in the UK) also take a progestogen, often called progestin or progesterone in the US, to protect the lining. Women without a uterus can use estrogen alone (US FDA, 2025; NHS).

Non-hormonal options suit women who can't use hormones or would rather not. One is fezolinetant, a daily tablet that blocks the brain's hot-flash signal. It is FDA-approved in the US, and in the UK NICE TA1143 (2026) recommends it when HRT isn't suitable or wanted. Some SSRIs, SNRIs and gabapentin also reduce flashes, and CBT helps with flashes, sleep and mood.

Low-dose vaginal estrogen cream, pessaries or rings are a local treatment for dryness, painful sex and urinary symptoms. Very little reaches the bloodstream, so most women can use it long term, often alongside HRT (NICE NG23, 2024).

What does the evidence say about HRT?

Feeling unsure about HRT is common. Estrogen is the part that does the work: The Menopause Society's 2022 position statement finds that it eases hot flashes and night sweats, and many women find mood and sleep symptoms lift too.

For milder flashes, many women find that layers, a fan and easing off triggers such as alcohol, spicy food and caffeine are enough. Low mood, anxiety and brain fog are also common, and brain fog usually improves afterward; HRT is one of the things that can help, alongside exercise and sleep.

Bone is the other main reason women consider it. The fastest bone loss of adult life happens in the years just before and after the final period (Greendale et al., 2012, from the SWAN study). HRT protects bone through those years, and heavy and impact loading, calcium and vitamin D work alongside it.

Combined HRT, estrogen plus a progestogen, causes a small rise in breast cancer risk that grows with years of use, while estrogen-only HRT, used by women without a uterus, causes little or no change (Collaborative Group on Hormonal Factors in Breast Cancer, The Lancet, 2019). In the UK the NHS puts the rise at about 5 extra cases per 1,000 women over 5 years of combined HRT.

HRT tablets slightly raise the risk of blood clots, though it stays very low. Patches, gels and sprays, known as transdermal HRT because the estrogen is absorbed through the skin, do not raise it (The Menopause Society, 2022; NHS). The form is a fair question to bring to a first appointment.

How much HRT, and for how long?

There is no single dose of HRT and no fixed age to stop; the one set interval is a yearly review (NICE NG23, 2024). A prescriber, meaning an OB-GYN or primary care doctor in the US or a GP in the UK, usually starts from your symptoms, your health history and whether you have a uterus. The review covers symptom control, side effects and bleeding pattern, and is a good time to revisit the dose and type.

Many women carry on beyond 60 if the benefits still outweigh the risks, ideally with transdermal estrogen, while a first start after 60 carries higher risks.

HRT usually runs longer after early menopause. If periods stop before 45, and especially before 40 (premature ovarian insufficiency), HRT is usually recommended until at least the average age of menopause, to protect bones, heart and brain.

Do it yourself HRT usually means hormones ordered online without a prescription, or custom-mixed (compounded) 'bioidentical' creams and pellets arranged outside the usual route. It's understandable to look there when appointments are hard to get. What a prescription adds is the matching of dose and type to you: with a uterus, estrogen on its own leaves the lining unprotected, the one risk the FDA kept a boxed warning for in 2025. The NHS in the UK gives the same advice on adding a progestogen.

What did the studies show, and what did they not?

The US label changed to reflect updated evidence. In November 2025 the FDA dropped the breast cancer, cardiovascular disease and probable dementia language from the boxed warning, and the old advice to use the lowest dose for the shortest time. The revised label adds a consideration of starting under 60, or within 10 years of the last period, for moderate to severe hot flashes. The endometrial cancer warning on systemic estrogen taken alone stays.

The breast cancer studies showed a risk that rises with age as well as with years of use, and falls after a woman stops (NHS). These are findings about groups, so your own health history is what turns them into a personal decision.

On weight, the studies did not show that most types of HRT cause weight gain (NHS).

Next steps

If HRT sounds worth exploring, a good place to start is a short list of the symptoms that bother you most, plus your own and your family's health history, to bring to an OB-GYN, primary care doctor or GP. Many women also ask which form is on offer, whether a progestogen is needed and when the first review will be. If either red flag on this page applies, it is worth booking a visit promptly. HRT, non-hormonal options and vaginal estrogen are all reasonable paths, and not one size fits all, so the choice that fits you is yours to make.