Menopausal Hormone Therapy (HRT)

Menopausal hormone therapy, often called HRT, is a treatment some people use to manage symptoms of menopause. This page describes, in neutral terms, what it is, how it generally works, the common forms, how it is monitored, and the considerations that go into an individual decision with a clinician.

What menopausal hormone therapy is

Menopause is the natural stage when the ovaries gradually produce less estrogen and progesterone and menstrual periods stop. The decline in these hormones can cause symptoms such as hot flushes, night sweats, disturbed sleep, vaginal dryness, and changes in mood. Hormone therapy replaces some of the estrogen the body no longer makes, usually combined with a progestogen when the uterus is still present, to reduce these symptoms. For background on the underlying changes, see our overview of menopause.

Types of hormone therapy

The single most important distinction in menopausal hormone therapy is whether estrogen is given on its own or together with a progestogen. This choice is driven mainly by whether a person still has a uterus.

Estrogen-only therapy

Estrogen-only therapy supplies estrogen without an added progestogen. It is generally used by people who have had a hysterectomy (removal of the uterus). Without a uterus, there is no uterine lining (endometrium) that estrogen could over-stimulate, so a progestogen is not needed to protect it.

Estrogen plus progestogen therapy

When the uterus is still present, a progestogen is generally added to the estrogen. Estrogen on its own can cause the uterine lining to thicken, and over time this can lead to changes that are best avoided; the progestogen counterbalances that effect and helps keep the lining healthy. This combined approach can be given so that a regular monthly bleed occurs, or in a continuous way intended to avoid bleeding, depending on how recently menopause occurred and what suits the person.

Local (vaginal) therapy

For symptoms limited to the vaginal and urinary area, a clinician may discuss a local, low-dose option such as a vaginal preparation. This acts mainly where it is applied rather than throughout the body, and it is generally considered separately from therapy aimed at whole-body symptoms such as hot flushes.

This table is illustrative and general. It describes typical patterns only; it does not give doses or replace an individual assessment, and suitability is decided by a clinician.

Routes: how it is taken

Hormone therapy can be delivered by different routes, and the route can matter as much as the type. Described generally, the common forms include:

• Tablets taken by mouth (oral).
• Skin patches worn on the body (transdermal).
• Gels or sprays applied to the skin (also transdermal).
• Vaginal preparations such as creams, rings, or tablets for local symptoms.
• Combined products that contain both estrogen and a progestogen.

Oral versus transdermal, in general terms

Estrogen taken by mouth is absorbed through the gut and passes through the liver before reaching the rest of the body, which influences some of its effects. Estrogen delivered through the skin enters the bloodstream more directly. Because of this difference, a clinician may consider the route when matching therapy to a person's circumstances and health history. The route, the type, and the timing are all weighed together rather than in isolation. This page does not cover doses, which are individualized by a prescriber.

Who it may be considered for

Hormone therapy is generally considered for people with bothersome menopausal symptoms, and it tends to be discussed most readily for those who are within a number of years of the onset of menopause and do not have specific conditions that make it unsuitable. It may also be used in some people who reach menopause early, where the aim includes replacing hormones the body would normally still be making. The decision rests on weighing the potential relief of symptoms against individual considerations, which is why a clinical assessment comes first.

Timing considerations

The timing of when therapy is started relative to menopause is a recognised part of the discussion. In general, the balance of potential benefit and risk is considered more favourable when therapy is started closer to the onset of menopause and in people without specific contraindications; it is often considered less favourable when first started many years after menopause or at an older age. This is sometimes described informally as a "window" for the decision, though it is a general principle rather than a fixed rule, and every situation is assessed individually. People who reach menopause early are a distinct group in whom the considerations differ.

How it generally works

By supplying estrogen, therapy can ease symptoms driven by low estrogen, such as hot flushes and vaginal dryness. When the uterus is present, a progestogen is generally added because estrogen alone can over-stimulate the lining of the uterus; the progestogen helps protect it. People who have had a hysterectomy can often use estrogen on its own. The aim is to use an approach that controls symptoms while fitting each person's health profile.

How clinicians typically monitor it

Hormone therapy is usually reviewed periodically rather than relying on routine blood tests, since the decision to continue is generally guided by symptoms and overall health. Monitoring commonly includes:

• A review of symptom relief and any side effects.
• Discussion of any unexpected vaginal bleeding, which should always be reported.
• Keeping up with general screening such as blood pressure checks and recommended breast and cervical screening.
• Periodic reassessment of whether to continue, adjust, or stop therapy.

Blood hormone measurements are not usually needed for typical therapy but may be used in particular situations a clinician identifies.

Potential benefits

For people with bothersome symptoms, hormone therapy is generally regarded as an effective option for vasomotor symptoms such as hot flushes and night sweats, and it can help with vaginal dryness and related discomfort. By improving these symptoms, it may also indirectly help with sleep and quality of life. In people who reach menopause early, replacing hormones is part of a broader picture that a clinician discusses, including bone health over the longer term. These are general statements; the degree of benefit varies, and no treatment helps everyone equally.

Known considerations and risks

Hormone therapy carries considerations that are weighed for each individual. Possible side effects can include breast tenderness, bloating, headaches, and irregular bleeding, which often settle over time. The relationship between hormone therapy and conditions such as blood clots, stroke, and breast tissue changes depends on factors including the type of therapy (estrogen alone versus combined), the route used (for example oral versus through the skin), a person's age, and the time since menopause.

Because these factors interact, the balance of potential benefit and risk differs from person to person, and it can shift with age. Clinicians generally favour using therapy for clear symptom relief, at a level that controls symptoms, reviewing it regularly, and revisiting the decision over time. Therapy is usually approached cautiously or avoided in people with certain histories — for example some conditions affecting the breast, the uterine lining, the liver, or a history of certain clotting problems — which is part of the pre-treatment assessment. Any unexpected vaginal bleeding should always be reported, because it needs evaluation.

Shared decision-making

Choosing whether to start or continue hormone therapy is a shared decision that balances your symptoms, preferences, and health history with a clinician's guidance. You can read more in our conditions and hormones sections, review related testing under blood tests, and see other options in the treatments overview.