There are different types of hormone replacement therapy (HRT) available.
These can:
- contain different hormones - oestrogen, progestogen or both (a doctor may also sometimes prescribe testosterone)
- be taken or used in different ways - tablets, patches, gel, spray, pessaries or cream
- be taken or used at different times - routines can be cyclical (sequential) or continuous
The type of HRT that's best for you can depend on:
- if you've had a hysterectomy
- the stage of menopause you're at
- your personal preferences
Talk to your GP about which options are suitable for you.
You can get HRT for free through some pharmacies. You need a prescription and a Drugs Payment Scheme card. Apply for one if you do not already have one.
How to apply for a Drugs Payment Scheme card
Find a pharmacy offering free HRT
HRT hormones
HRT replaces the hormones that your body produces less of as you go through menopause.
Menopause is when your periods stop due to lower hormone levels. It usually affects women between ages 45 and 55 but it can happen earlier. It affects anyone who has periods.
These hormones are mainly oestrogen and progestogen. These are essential to everything from period cycles, ovulation and pregnancy, to bone health.
Testosterone is not currently licensed to treat the symptoms of menopause. But a doctor may prescribe it off label.
What is off label use?
Off-label use is when a medicine is prescribed in a way that is different to how it was first licensed.
Your GP may prescribe a medicine off label if they think it will treat your condition effectively.
Off label use does not mean that the medicine is unsafe. Your GP will tell you if they are prescribing the medicine off label. They will only prescribe it if the benefits outweigh any risks.
Talk to your pharmacist or GP if you have any concerns or questions about off-label use.
Combined HRT or oestrogen-only HRT
HRT involves either taking:
- oestrogen and progestogen (combined HRT), or
- oestrogen (oestrogen-only HRT)
Protect your womb
Most women are prescribed combined HRT.
This means you must take both oestrogen and progestogen. You need to take progestogen to protect against the risk of womb cancer.
You can get your oestrogen from tablets, patches, spray or gel. Your progestogen can come from taking tablets or using an intrauterine system (IUS), such as the Mirena coil.
Using 2 separate types of hormone will provide the combined HRT you need.
You can also take or use HRT that already contains both oestrogen and progestogen.
If you've had a hysterectomy
Oestrogen-only HRT is recommended if you have had your womb removed during a hysterectomy.
Ways of taking HRT
HRT comes in different forms. There are pros and cons for each. You may need to try different brands and methods of taking HRT to find a treatment that suits you. Talk it through with your GP first.
You'll usually need to take HRT for 2 to 5 years, although it can be longer in some cases.
HRT shortages
HRT supply shortages may cause difficulties for women who need HRT. This can be a real issue for those whose HRT treatment has helped their menopause symptoms.
If you stop taking HRT, your menopause symptoms may return. You will also not have the other benefits of HRT, such as preventing weakening of the bones (osteoporosis).
If you find that you cannot get the HRT you were taking, talk to your pharmacist. Ask them what HRT medicines are available.
Ask your GP about trying another type or brand of HRT if it is suitable for you.
Tablets
Tablets are a common form of HRT. You usually take them once a day. Both oestrogen-only and combined HRT are available as tablets.
Advantages
Taking tablets once a day may be the easiest way of having treatment.
Disadvantages
Some of the risks of HRT, such as blood clots, are higher with tablets than with patches, gel or spray. But the overall risk is still small.
Patches
Skin patches are also a common way of taking HRT.
Skin patches work by sticking onto your skin below the waist. They gradually release small amounts of hormones into your body.
You wear them all day. You'll usually change your patch every few days, but each brand is different.
Both oestrogen-only and combined HRT are available as skin patches.
Advantages
Patches may be a better option than tablets if you have difficulty swallowing tablets, or are likely to forget to take it.
Using patches can also help to avoid some side effects of HRT, such as indigestion. Unlike tablets, they do not increase your risk of blood clots.
Disadvantages
You might find that skin patches do not always stick well, especially if you moisturise your skin. Patches can also cause redness or irritation, or leave a mark on the skin.
Applying the patch to dry, non-moisturised skin, or peeling it off slowly to avoid marks can help.
Oestrogen gel
Oestrogen gel is an increasingly popular form of HRT.
You take it by smoothing it onto your skin once a day. Oestrogen is gradually absorbed into your body.
You must use this gel along with progestogen, unless you had a hysterectomy.
Advantages
Like skin patches, gel can be a good way of taking HRT if you cannot take tablets. Using gel does not increase your risk of blood clots.
Disadvantages
It can take 5 minutes or more for the gel to dry on the skin, so you may have to wait a while before you can do anything else.
Oestrogen spray
Oestrogen-only HRT also comes as a spray you use once a day. You take it by spraying 1 to 3 sprays onto the inner side of your arm or your inner thigh.
You must use this spray along with progestogen, unless you had a hysterectomy.
Advantages
Using a spray is a good way of taking HRT if you cannot take tablets.
Using the spray does not increase your risk of blood clots.
Disadvantages
You can get dressed 2 minutes after using the spray. But you need to wait for 1 hour before having a bath or shower.
Intrauterine system (IUS), or Mirena coil
The Mirena coil is an intrauterine system (IUS). It may be suitable if you need progestogen and:
- you have a womb
- you're using oestrogen tablets, patches, gel or spray
The Mirena coil is inserted into your womb. It gradually releases a form of progestogen (levonorgestrel) into your body.
The Mirena coil is also used as contraception to prevent pregnancy, and to treat heavy periods.
Advantages
The Mirena coil can stay in place for up to 5 years and also acts as contraception.
It can be a good option if you do not want to take or use a medicine every day, or have difficulties with other forms of progestogen.
Disadvantages
Implants such as the Mirena coil can cause abdominal pain and bleeding.
Vaginal oestrogen
Low dose oestrogen is also available as a cream, gel, vaginal tablet, or pessary that you put inside your vagina. This can help with menopausal symptoms such as vaginal dryness or pain during sex.
Advantages
Vaginal oestrogen does not carry the usual risks of HRT and does not increase your risk of breast cancer. You can use it without taking progestogen, even if you still have a womb.
Disadvantages
This form of HRT will not help with other menopausal symptoms such as hot flushes, mood swings or sleeping problems.
Testosterone
Like oestrogen and progestogen, the menopause also causes levels of the sex hormone testosterone to fall. But this happens more gradually.
Having less testosterone can:
- make you feel tired
- affect your mood
- cause a low sex drive (libido)
- affect bone health
Testosterone is not currently licensed to treat symptoms of menopause, but a doctor may be able to prescribe it for you off label.
This is usually only recommended if:
- you're post-menopause
- you have problems with low sex drive
- HRT alone has not helped
Research is being done on whether testosterone could help with other menopause symptoms, but more evidence is needed.
Testosterone comes as a gel.
Possible side effects of using testosterone include acne, unwanted hair growth and weight gain. But these are not common.
Testosterone gel can also cause side effects in others if they come into contact with it regularly. To avoid this, wash your hands after using it and cover the area with clothing.
Talk to a GP if you think you might benefit from taking testosterone.
Tibolone
Tibolone (brand name Livial) is a prescription medicine that's similar to taking combined HRT (oestrogen and progestogen), but it also has a testosterone effect. You take it as a tablet once a day.
Tibolone can help relieve symptoms such as hot flushes and low mood. But some studies have suggested it may not be as effective as combined HRT.
It's only suitable if you had your last period more than a year ago (post-menopause).
HRT treatment routines
The way you take HRT depends on if:
- you've have had a hysterectomy
- you're in the early stages of menopause and still have periods (perimenopause)
- you have not had a period for more than 1 year (post-menopause)
If you've had a hysterectomy and take oestrogen-only HRT, you'll take it every day.
If you need both oestrogen and progestogen, your routine for taking HRT will depend on whether:
- you're in the earlier stages of the menopause and still having periods (perimenopause)
- you have not had a period for 1 year or more (post-menopause)
Sequential combined HRT
You'll usually be recommended to take sequential (cyclical) combined HRT if you have menopause symptoms but still have periods. This comes as tablets or patches.
You should have a period at the end of each progestogen cycle. If there is no bleeding at these times, talk to your GP.
If you started on sequential HRT during perimenopause your GP may recommend changing to continuous combined HRT post-menopause.
Continuous combined HRT
Continuous combined HRT is usually recommended if you're post-menopause. This is when you have not had a period for 1 year.
Continuous combined HRT involves taking oestrogen and progestogen every day without a break.