HRT replaces the hormones that a woman's body no longer produces because of the menopause.
The 2 main hormones used in HRT are:
- oestrogen – types used include estradiol, estrone and estriol
- progestogen – a synthetic version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel
HRT involves either taking both of these hormones (combined HRT) or just taking oestrogen (oestrogen-only HRT).
Most women take combined HRT because taking oestrogen on its own can increase your risk of developing womb (endometrial) cancer. Taking progestogen alongside oestrogen minimises this risk.
Oestrogen-only HRT is usually only recommended for women who have had their womb removed during a hysterectomy.
Ways of taking HRT
HRT comes in several different forms. Talk to a GP about the pros and cons of each option.
Tablets are 1 of the most common forms of HRT. They are usually taken once a day.
Both oestrogen-only and combined HRT are available as tablets. For some women this may be the simplest way of having treatment.
Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days.
Oestrogen-only and combined HRT patches are available.
Skin patches may be a better option than tablets if you find it inconvenient to take a tablet every day.
Oestrogen gel is an increasingly popular form of HRT. It's rubbed onto your skin once a day.
Like skin patches, gel can be a convenient way of taking HRT and does not increase your risk of blood clots.
But if you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.
HRT also comes as small pellet-like implants that are inserted under your skin (usually in the tummy area) after your skin has been numbed with local anaesthetic.
The implant releases oestrogen gradually and lasts for several months before needing to be replaced.
This may be a convenient option if you do not want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.
If you're taking a different form of oestrogen and need to take progestogen alongside it, another implant option is the intrauterine system (IUS). An IUS releases a progestogen hormone into the womb. It can stay in place for 3 to 5 years and also acts as a contraceptive.
Implants of HRT are not widely available and are not used very often.
Oestrogen is also available as a cream, pessary or ring that is placed inside your vagina.
This can help relieve vaginal dryness, but will not help with other symptoms such as hot flushes.
It does not carry the usual risks of HRT and does not increase your risk of breast cancer, so you can use it without taking progestogen, even if you still have a womb.
Testosterone is available as a gel that you rub onto your skin. It is usually only recommended for women whose low sex drive (libido) does not improve after using HRT. It is used alongside another type of HRT.
Current testosterone products available in the UK (such as Tostran and Testogel) are currently unlicensed for the treatment of low sex drive. This means the manufacturers of these products have not specified that they can be used in this way. Despite this, there is evidence that testosterone can be effective.
Ask a GP for more information on testosterone products.
HRT treatment routines
Your treatment routine for HRT depends on whether you're in the early stages of the menopause or have had menopausal symptoms for some time.
The 2 types of routines are cyclical (or sequential) HRT and continuous combined HRT.
Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT who have menopausal symptoms but still have their periods.
There are 2 types of cyclical HRT:
- monthly HRT – you take oestrogen every day, and take progestogen alongside it for the last 14 days of your menstrual cycle
- 3-monthly HRT – you take oestrogen every day, and take progestogen alongside it for around 14 days every 3 months
Monthly HRT is usually recommended for women having regular periods.
3-monthly HRT is usually recommended for women having irregular periods. You should have a period every 3 months.
It's useful to maintain regular periods so you know when your periods naturally stop and when you're likely to progress to the last stage of the menopause.
Continuous combined HRT
Continuous combined HRT is usually recommended for women who are postmenopausal. A woman is usually said to be postmenopausal if she has not had a period for 1 year.
Continuous combined HRT involves taking oestrogen and progestogen every day without a break.
Oestrogen-only HRT is also usually taken every day without a break.