You can take hormone replacement therapy (HRT) if you have menopause symptoms. This includes during perimenopause and after your periods stop (post-menopause).
Menopause usually affects women between ages 45 and 55, but it can happen earlier. It affects anyone who has periods.
HRT helps with symptoms and has other benefits, including helping to prevent weakening of the bones (osteoporosis).
The type of HRT that's right for you depends on the stage of menopause you're at.
When to start HRT
If you have menopause symptoms that are bothering you, consider talking to your GP about starting HRT.
It's your choice whether to take HRT and when to start. You do not need to wait until your symptoms are severe, or until your periods stop completely.
Your GP should explain the benefits and risks and help you decide.
If you're going through early or premature menopause
It's particularly important to take either HRT or the combined pill if you have:
- premature menopause (when your periods stop before age 40)
- early menopause (when your periods stop before age 45)
This increases your level of oestrogen, which helps protect you from conditions such as osteoporosis.
You'll usually be advised to take HRT until you're at least age 51.
If you take the contraceptive pill
If you take hormonal contraception such as the combined pill or progestogen-only pill, you may not know when you reach perimenopause or menopause. This is because the contraception can affect your periods.
The combined pill can mask or improve menopause symptoms, as it contains oestrogen, which is also used in HRT.
You cannot take HRT at the same time as the combined pill. Your GP may recommend that you keep taking the combined pill until age 50, and then switch to HRT. You may be advised to take the pill continuously rather than stopping for a week in a 4-week cycle.
If you're taking the progestogen-only pill (mini pill), you can usually take HRT alongside it.
You'll no longer need contraception after age 55 as it's very rare to get pregnant naturally. You may need to use barrier methods such as condoms to protect you from sexually transmitted infections (STIs).
How long to take HRT for
It's best to only take HRT for as long as the benefits outweigh the risks. This depends on your symptoms, your age and any risk factors you have.
Taking HRT for a long time can increase the risk of breast cancer.
Talk to your GP for advice. You'll usually have a review of your treatment every year.
For symptoms such as hot flushes, you'll usually need to take HRT for 2 to 5 years. But it can be longer in some cases.
Vaginal oestrogen does not have the same risks as other types of HRT. You can keep taking it for as long as you need it to control vaginal dryness.
Benefits and risks if you're older
As you get older, and particularly after age 60, the risks of HRT may start to outweigh the benefits.
This is because menopause symptoms often improve as you get older, so you're less likely to need HRT to help. Meanwhile the risk of breast cancer increases the longer you take combined HRT.
If you want to keep taking HRT or start taking it over age 60, your GP may recommend:
- taking a low dose
- using patches or gel rather than tablets
Stopping HRT
Talk to your GP if you're thinking about stopping HRT.
Your GP might suggest that you try stopping every 2 to 3 years if you're:
- over age 50
- taking HRT to relieve menopause symptoms
This is to check if you still need it or if your symptoms have improved.
You can keep taking HRT for longer if:
- your menopause symptoms return when you stop HRT
- you decide that the benefits of HRT still outweigh the risks
What happens when you stop taking HRT
When you decide to stop taking HRT, you can choose to stop suddenly. But it's usually recommended to reduce your dose gradually over 3 to 6 months.
You may find that symptoms come back for a short time when you stop taking it. This is less likely to happen if you reduce your dose gradually.
If your symptoms come back and do not go away after 3 months, speak to your GP. They may suggest other treatments or restarting a low dose of HRT.