Hormone Replacement Therapy

What is hormone replacement therapy (HRT)?

Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause by replacing hormones that drop as you approach menopause. It primarily provides oestrogen and, in some cases, also progestogen and testosterone, depending on individual needs[1]. 

What is HRT used for?

HRT is mainly used to treat menopausal symptoms and prevent complications of low hormone levels. It is commonly prescribed for[1]: 

• Hot flushes 

• Night sweats 

• Vaginal dryness 

• Mood swings 

• Sleep disturbances 

• Reduced sex drive 

HRT also helps prevent osteoporosis (bone thinning) and may lower the risk of bowel cancer[1]. 

How does HRT work?

Timolol blocks beta-adrenergic receptors in the heart and blood vessels. This[1]: 

• Slows the heart rate 

• Reduces the force of heart contractions 

• Lowers blood pressure 

• Improves blood flow and reduces oxygen demand in the heart 

Who can take HRT?

HRT is suitable for most women experiencing menopause symptoms, particularly[1]: 

• Women under 60 

• Women with premature menopause (under age 40) 

• Women who have had a hysterectomy or surgical menopause 

However, HRT may not be recommended if you: 

• Have or had breast, womb, or ovarian cancer 

• Have a history of blood clots 

• Have liver disease 

• Have uncontrolled high blood pressure 

• Are pregnant – it's still possible to get pregnant while taking HRT, so it’s important that you use contraception until 2 years after your last period if you’re under 50, or 1 year if you’re over 50 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].  

What is the typical dosage of HRT?

HRT is tailored to the individual. Types of HRT include[1]: 

• Oestrogen-only – for women who’ve had their womb removed or have a Mirena coil 

• Combined HRT (oestrogen + progestogen) – for women with a womb 

• Sequential HRT – for women still having periods (perimenopausal)  

• Continuous combined HRT – for postmenopausal women 

You'll usually start with a low dose, which may be increased later. Your symptoms should improve after a few days or weeks. A GP will usually schedule a review appointment 3 months after you start taking HRT, or if you change your type of HRT. If everything is okay, you'll then have a review after a year. You’ll usually take HRT for 2 to 5 years although it can be longer[1]. 

How do you take HRT?

HRT is available in various forms, and the choice depends on your symptoms, medical history, and preferences[1]: 

• Tablets – once a day 

• Patches – change a patch every few days, but it depends on the brand 

• Gels or sprays – smoothed onto the skin once a day for gradual absorption. Avoid getting the medication on your breasts. 

• Vaginal creams, rings, or pessaries – low dose that you take as needed 

• Implants like the Mirena coil – for gradual release of progestogen 

Can you stop taking HRT?

Yes. You can stop HRT at any time, either suddenly or gradually. Gradual reduction may help prevent symptoms from returning. Always consult your doctor or pharmacist before stopping[1]. 

What do you do if you take too much HRT?

Accidental overdose is unlikely to cause serious harm but may lead to[1]: 

• Nausea 

• Breast tenderness 

• Vaginal bleeding 

Speak to your GP or call NHS 111 if you're concerned [1]. 

What do you do if you forget to take HRT?

The advice depends on the form of HRT[1]: 

• Tablets – take as soon as remembered. Skip it if it’s almost time for the next dose 

• Patches – apply a new patch as soon as possible 

• Gels/sprays – apply when remembered, unless close to your next dose 

How do you store HRT?

Storage depends on the form of HRT you’re taking. Tablets should be stored in their original packs out of the reach of children, in a dry, room temperature place. Gels and creams should be stored at room temperature. Similarly, keep patches in a cool, dry place, between 20°C and 30°C and away from light[1].  

What medicines can’t you take with HRT?

HRT can interact with certain medicines, so speak to your doctor first if you’re taking: 

• Epilepsy treatment 

• HIV medication 

• Tuberculosis medicine 

• Antibiotics 

• St John’s Wort (a herbal remedy) 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of HRT?

Common side effects include[1]: 

• Breast tenderness or pain 

• Headaches 

• Nausea 

• Bloating 

• Mood changes 

• Muscle cramps 

• Diarrhoea 

• Mild rash 

• Itching or hives 

• Unexpected vaginal bleeding 

Serious but less common risks include[1]: 

• Blood clots leading to pulmonary embolism or heart problems 

• Deep vein thrombosis 

• Stroke 

• Vaginal bleeding as a sign of womb cancer 

• Slightly increased risk of breast cancer with long-term combined HRT 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about HRT

Is HRT safe? 
Yes. For most women under 60, the benefits outweigh the risks[1]. 

Will HRT make me gain weight? 
There’s no direct link. However, weight gain is common around menopause due to hormonal changes[1]. 

How long can I take HRT? 
As long as you need it. Your doctor should review it annually[1]. 

Can I take HRT if I’ve had cancer? 
It depends on the type of cancer. Always consult your specialist[1]. 

Does HRT delay menopause? 
No – it treats symptoms but doesn’t delay menopause itself[1]. 

Can I still get pregnant on HRT? 
Yes. If you’re under 50, use contraception for 2 years after your last period[1]. 

Is there a natural alternative to HRT? 
Some herbal products and lifestyle changes may help, but evidence is limited. Speak to a doctor or pharmacist first[1]. 

Can HRT help with mood swings? 
Yes – especially if they’re related to hormonal changes[1]. 

Can men take HRT? 
Yes, in the form of testosterone replacement for specific conditions[1]. 

For the official NHS guide to hormone replacement therapy (HRT), visit their website.