Hormone Replacement Therapy (HRT): the complete guide

HRT delivers estrogen (and sometimes progesterone) to your body through patches, gels, tablets, or sprays. By restoring hormone levels, it directly addresses the root cause of menopausal symptoms rather than treating them individually.

Combined HRT (estrogen + progestogen) — for women with a uterus. The progestogen protects the uterine lining.

Estrogen-only HRT — for women who have had a hysterectomy.

• Reduces hot flashes by 75-95%
• Dramatically improves sleep quality
• Protects against osteoporosis and fractures
• Improves vaginal and urinary health
• Positive effects on mood, energy, and cognitive function
• May reduce risk of colon cancer and type 2 diabetes
• Cardiovascular protection when started early

The 2002 WHI study created widespread fear of HRT. Two decades of follow-up research paint a much more nuanced picture:

• Breast cancer — combined HRT shows a small increased risk after 5+ years of use (similar to drinking 2 glasses of wine daily). Estrogen-only actually showed a decreased risk.
• Blood clots — oral estrogen increases risk slightly. Transdermal delivery (patches, gels) carries virtually no additional risk — this is a game-changer.
• Stroke — small increased risk with oral forms; transdermal appears neutral.
• Heart disease — when started within 10 years of menopause or before age 60, HRT may actually protect the heart.

Transdermal (patches, gels, sprays) — generally safest. Avoids liver processing, lower clot risk. Recommended as first choice.

Oral tablets — convenient but slightly higher clot and stroke risk.

Vaginal (creams, pessaries, rings) — local treatment for vaginal dryness. Very low systemic absorption. Can be used alongside other HRT or alone.

Mirena coil — can provide the progestogen component while also acting as contraception.

HRT is most beneficial for women who are under 60 or within 10 years of menopause with moderate to severe symptoms.

It may not be suitable if you have a history of breast cancer, blood clots, stroke, or liver disease. Your doctor will assess your individual risk profile.

The decision is personal and should be made with your doctor based on your symptoms, risk factors, and preferences.

1. Track your symptoms for at least 2 weeks — frequency, severity, impact on daily life.

2. Book an appointment — bring your symptom data.

3. Discuss options — your doctor will recommend a type and dose based on your profile.

4. Review after 3 months — adjust if needed. HRT is not one-size-fits-all.