HRT explained — what it is, who it's for, and how to feel like yourself again
A calm, evidence-based guide to hormone replacement therapy: what perimenopause and menopause do to your body, the real benefits and risks (including the truth about the old scare stories), the ways HRT is given, and how to find a licensed clinic.
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Mood & clarity
Sleep & energy
Hot flushes
Bone strength
FIG. 01 — WHERE OESTROGEN'S DECLINE IS FELT
Where this page fits in your journey
tap a step to jump →What is hormone replacement therapy?
Hormone replacement therapy (HRT) tops up the hormones — mainly oestrogen, usually with progesterone, and sometimes testosterone — that naturally decline during perimenopause and menopause. By restoring them to a steadier level, it relieves symptoms like hot flushes (hot flashes), broken sleep, low mood, brain fog and joint aches, and protects long-term bone health.
Modern HRT is usually body-identical: hormones with the same molecular structure as the ones your body makes, regulated and prescribed by a doctor. It isn't the same as the older, higher-dose regimens behind the scare headlines of the early 2000s.
Perimenopause vs menopause
They're not the same thing — and knowing which stage you're in changes everything about your options.
Perimenopause
The transition towards menopause — often starting in your early-to-mid 40s (sometimes late 30s). Hormones fluctuate rather than simply fall, which is why symptoms can be unpredictable: irregular periods, anxiety, broken sleep, brain fog and mood swings. You can still have periods — and still get pregnant.
Menopause
Officially, the point 12 months after your last period. On average around age 51. After this, oestrogen stays low, and symptoms like hot flushes, vaginal dryness and bone thinning can continue for years — which is where HRT often helps most.
Who HRT is — and isn't — for
For most women under 60, or within 10 years of menopause, the benefits of HRT outweigh the risks. But it isn't right for everyone.
Often a good option if…
- You have troublesome menopause or perimenopause symptoms
- You're under 60, or within 10 years of your last period
- You had early or premature menopause (HRT is usually recommended)
- You want to protect long-term bone health
Needs specialist advice if…
- You have, or have had, a hormone-sensitive breast cancer
- You have unexplained vaginal bleeding (get it checked first)
- You have active blood clots or certain liver conditions
- You have a higher clot risk — where transdermal (skin) HRT may still suit
This is general education, not a diagnosis. A doctor can weigh your personal history and find an option that fits.
The benefits of HRT
For symptomatic women, HRT is the most effective treatment for menopause symptoms — and does more than ease hot flushes.
Hot flushes & night sweats
The most effective treatment for the flushes and sweats that disrupt days and nights.
Sleep & energy
Better sleep and steadier energy as night sweats and hormonal swings settle.
Mood & clarity
Many women find low mood, anxiety and brain fog ease as oestrogen steadies.
Bone protection
Oestrogen protects bone density, lowering the risk of osteoporosis and fractures.
Vaginal & urinary comfort
Local or systemic oestrogen relieves dryness, discomfort and recurrent urinary symptoms.
Heart & long-term health
Started around menopause, HRT may support cardiovascular and metabolic health — the "timing" matters.
Evidence: NICE NG23; British Menopause Society; The Menopause Society (2022) position statement. Benefits are greatest when HRT is started near menopause.
Risks — what the evidence actually says today
Much of the fear around HRT dates back to one 2002 study (the WHI) that was widely misreported. It used older women, higher doses and oral-only hormones — and the way its findings were presented caused a generation of women to avoid HRT unnecessarily. Here's the modern picture:
Breast cancer
Any increase in risk is small, depends on the type of HRT, and for many women is smaller than the risk from drinking a couple of glasses of wine a night or being overweight. Oestrogen-only HRT carries little or no added risk. It's a real consideration to discuss — not a reason for blanket fear.
Blood clots
This risk comes mainly from oral HRT. Transdermal HRT (patches, gels, sprays) is not associated with an increased clot risk — which is why it's often the preferred route, especially if you have other risk factors.
The bigger picture
For most healthy women under 60, or within 10 years of menopause, the benefits of HRT outweigh the risks. That's the current position of the UK and international menopause societies.
Types & ways HRT is delivered
There's no single "best" HRT — it's tailored to your stage, symptoms and health history.
| Type / method | How it works | Often suits women who… |
|---|---|---|
| Patches, gels & sprays | Oestrogen absorbed through the skin (transdermal) | Want the lowest clot risk — often first choice |
| Tablets (oral) | Oestrogen (and progesterone) taken by mouth | Prefer a simple daily pill and have low clot risk |
| Micronised progesterone | Body-identical progesterone to protect the womb lining | Still have a womb and take oestrogen |
| Vaginal (local) oestrogen | Cream, pessary or ring applied locally | Mainly have dryness, discomfort or urinary symptoms |
| Testosterone (for women) | Low-dose gel or cream, often off-label | Have persistent low libido despite oestrogen |
Availability varies by clinic and country. We explain the options — your doctor prescribes what's right for you.
Body-identical vs compounded "bioidentical"
These sound alike but aren't the same — and the difference matters for your safety.
Body-identical (regulated)
Prescription HRT with the same molecular structure as your own hormones, made to pharmaceutical standards and tested for dose and safety. This is what mainstream menopause guidelines recommend.
Compounded "bioidentical" (cBHRT)
Custom-mixed hormones sold privately, often marketed as "natural" or "personalised". They're not regulated the same way, doses can be inconsistent, and menopause societies advise against them. "Natural" doesn't mean safer.