Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause.

Benefits of HRT

The main benefit of HRT is that it can help relieve most of the menopausal symptoms, such as:

• hot flushes
• night sweats
• mood swings
• vaginal dryness
• reduced sex drive

Many of these symptoms pass in a few years, but they can be very unpleasant and taking HRT can offer relief for many women.

It can also help prevent weakening of the bones (osteoporosis), which is more common after the menopause.

How to get started on HRT

Speak to your GP if you're interested in starting HRT.

You can normally begin HRT as soon as you start experiencing menopausal symptoms and won't usually need to have any tests first.

Your GP can explain the different types of HRT available and help you choose one that's suitable for you.

You'll usually be started off on a low dose, which can be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.

Your GP will normally recommend trying treatment for three months to see if it helps. If it doesn't, they may suggest changing your dose or changing the type of HRT you're taking.

Who can take HRT

Most women can have HRT if they're experiencing symptoms associated with the menopause.

But HRT may not be suitable if you:

• have a history of breast cancer, ovarian cancer or womb cancer
• have a history of blood clots
• have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
• have liver disease
• are pregnant – it's still possible to get pregnant while on HRT, so you should use contraception until two years after your last period if you're under 50 or for one year after the age of 50

In these circumstances, alternatives to HRT may be recommended instead.

Types of HRT

There are many different types of HRT and finding the right one for you can be tricky.

There are different:

• HRT hormones – most women take a combination of the hormones oestrogen and progestogen, although women who don't have a womb can take oestrogen on its own 
• ways of taking HRT – including tablets, skin patches, gels and vaginal creams, pessaries or rings
• HRT treatment regimens – HRT medication may be taken continuously without a break, or in cycles where you take oestrogen continuously and only take progestogen every few weeks

Your GP can give you advice to help you choose which type is best for you. You may need to try more than one type before you find one that works best.

Read more about the different types of HRT.

Stopping HRT

There's no limit on how long you can take HRT, but talk to your GP about the duration of treatment they recommend.

Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.

When you decide to stop, you can choose to do so suddenly or gradually.

Gradually decreasing your HRT dose is usually recommended because it's less likely to cause your symptoms to come back in the short term.

Contact your GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again.

Risks and side effects of HRT

As with any medication, HRT can cause side effects. But these will usually pass within three months of starting treatment.

Common side effects include:

• breast tenderness
• headaches
• nausea
• indigestion
• abdominal (tummy) pain
• vaginal bleeding

Some types of HRT can also cause a small increase in your risk of certain serious problems, such as blood clots and breast cancer.

The benefits of HRT are generally felt to outweigh the risks. But speak to your GP if you have any concerns about taking HRT.

Read more about side effects of HRT and risks of HRT.

Alternatives to HRT

If you're unable to take HRT or decide not to, you may want to consider alternative ways of controlling your menopausal symptoms.

Alternatives to HRT include:

• lifestyle measures – such as exercising regularly, eating a healthy diet, cutting down on coffee, alcohol and spicy foods, and stopping smoking
• tibolone – a medication that's similar to combined HRT (oestrogen and progestogen), but may not be as effective and is only suitable for women who had their last period more than a year ago
• antidepressants – some antidepressants can help with hot flushes and night sweats, although they can also cause unpleasant side effects such as agitation and dizziness
• clonidine – a non-hormonal medicine that may help reduce hot flushes and night sweats in some women, although any benefits are likely to be small

Several remedies (such as bioidentical hormones) are claimed to help with menopausal symptoms, but these aren't recommended because it's not clear how safe and effective they are.

Read more about alternatives to HRT.