# Hormone replacement therapy for menopause · Unpaused > Source: https://unpaused.cc/articles/hormone-replacement-therapy-for-menopause Hormone therapy ## Hormone replacement therapy for menopause Hormone replacement therapy replaces the oestrogen and progestogen that fall in perimenopause and menopause, to treat the symptoms that follow. If you have a womb, you usually take both hormones, and after a hysterectomy the prescription is often oestrogen alone. By Ines Kovac. Published 18 October 2026\. 6 minute read. ### What is hormone replacement therapy? The NHS describes women's hormone replacement therapy as treatment that replaces oestrogen and progesterone, which fall to low levels as you approach the menopause ([NHS: about HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/)). If you are unsure of the stage, the [perimenopause or menopause stage checker](/articles/perimenopause-or-menopause-a-stage-checker-from-your-age-and-your-last-period) uses your age and the months since you last had a period. The [perimenopause topic hub](/topics/perimenopause) covers the years when you are still having periods. ### What HRT is used for HRT can help with hot flushes, night sweats, sleep problems, mood swings, anxiety, low mood and vaginal dryness ([NHS: about HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/)). Anxiety and low mood, including when HRT is considered and when mood changes are a side effect, are in [HRT, anxiety and low mood in menopause](/articles/depression-and-hormone-replacement-therapy). From age 40, NICE says to offer HRT to people with vasomotor symptoms associated with menopause, the hot flushes and sweats ([NICE NG23 recommendations](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations)). The November 2024 update calls it the most effective treatment for those symptoms ([NICE: HRT discussion aid, 2024](https://www.nice.org.uk/news/articles/discussion-aid-to-support-clinical-conversations-about-hrt-published-alongside-updated-guidance)). That offer is made in a consultation, with your history in front of the clinician. If HRT is not suitable, the NHS says other options may include menopause-specific cognitive behavioural therapy, clonidine or antidepressants for flushes ([NHS: menopause treatment](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/)). CBT and the other non-hormone options named in the guidance are covered in our [guide to hot flushes](/topics/hot-flashes). How long flushes usually continue is in [how long menopause lasts](/articles/how-long-does-menopause-last). ### Oestrogen, progestogen and who needs which Oestrogen is the main hormone being replaced. Progestogen is added if you still have a uterus, which makes the prescription a combined one. NICE says to offer combined HRT to people with a uterus, and oestrogen-only HRT after a total hysterectomy ([NICE NG23 recommendations](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations)). Oestrogen for hormone replacement therapy is oestrogen given so it reaches the whole body. American writing spells it estrogen. For symptoms that affect the whole body, it is given as tablets, a patch, a gel or a spray ([NHS: types of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)). ### Hormone replacement therapy pills and other systemic forms Hormone replacement therapy pills are tablets you swallow. Tablets can increase the risk of blood clots, and the NHS says that risk is still very low. Patches, sprays and gels do not increase the risk of blood clots, because the oestrogen is absorbed through the skin ([NHS: benefits and risks of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/)). NICE Clinical Knowledge Summaries make the same distinction for venous thromboembolism. Standard-dose transdermal oestrogen, on its own or combined, does not increase VTE risk compared with no HRT. Oral HRT does, and the oral route carries a greater VTE risk than the transdermal route. Where that risk is already higher, including a BMI over 30, CKS says to consider transdermal HRT rather than oral ([NICE CKS: managing menopause](https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/)). Patches release the hormone gradually and are changed every few days. They can irritate the skin or fail to stick ([NHS: types of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)). The same page also lists gel and spray as ways to put oestrogen on the skin. Some people switch to another form when a patch irritates the skin or flushes continue. A prescriber chooses the form based on your symptoms and your clot risk. The extra cases per 1,000 women are in [HRT risks in plain numbers per 1,000 women](/articles/hrt-risks-in-plain-numbers-breast-cancer-clots-and-stroke-per-1-000-women). ### Hormone therapy in menopause: cyclical or continuous Sequential combined HRT, also called cyclical, is usually advised when you still have periods, or your last period was less than 12 months ago. Oestrogen is taken every day, and progestogen for part of each cycle ([NHS: types of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)). Hormone replacement therapy for postmenopausal women is usually continuous combined HRT. Oestrogen and progestogen are both taken every day, once there has been no period for a year or more. That schedule is not suitable if you are still bleeding, or if you have had a period in the past year ([NHS: about continuous combined HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/continuous-combined-hormone-replacement-therapy-hrt-tablets-capsules-and-patches/about-continuous-combined-hrt/)). ### Vaginal oestrogen when flushes are not the problem Low-dose vaginal oestrogen comes as a ring, a pessary or a cream. It treats dryness and painful sex. Little of it enters the bloodstream, so a progestogen is usually not needed even with a womb ([NHS: types of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)). This low dose does not treat hot flushes, mood swings or sleep problems. The NHS types page also says it does not carry the usual HRT risks, and it does not increase breast cancer risk. ### Who HRT is usually discussed with, and when it is started Discuss HRT with a clinician. A GP or a menopause clinic is the usual place for that talk ([NHS: menopause treatment](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/)). The [menopause symptom checklist for your GP](/articles/menopause-symptom-checklist-to-print-and-take-to-your-gp) lists how often each problem happens, on a sheet you can take to the appointment. For women under 60, or within 10 years of menopause onset, with no contraindications, the Menopause Society's 2022 position statement finds the benefit-risk ratio favourable for bothersome vasomotor symptoms and for prevention of bone loss. Starting more than 10 years after menopause, or after age 60, looks less favourable, because the absolute risks of coronary heart disease, stroke, venous thromboembolism and dementia are higher ([The Menopause Society, 2022 hormone therapy position statement](https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf)). Use that age and timing as context in the appointment, alongside your own history. The extra cases per 1,000 women are on the risks page linked above. ### Bioidentical hormones, weight and where to read next Our guide to [bioidentical and compounded hormone therapy](/articles/bioidentical-hormone-replacement-therapy) separates regulated body-identical hormones from compounded mixes. The article on [whether HRT causes weight gain](/articles/will-hormone-replacement-therapy-cause-weight-gain) goes through the trial results. Weight at the waist in these years is covered in [menopause weight gain and belly fat](/articles/menopause-weight-gain). The wider set of guides is on the [hormone therapy (HRT) topic hub](/topics/hrt). Whether to start, change or stop a prescription is a decision for a GP or a menopause clinic. ### My take I would start with systemic HRT when flushes or night sweats are the reason for the visit. I would skip tablets when clot risk is already higher, and ask for a patch, gel or spray. If vaginal dryness or painful sex is the only problem, I would start with vaginal oestrogen. I would bring the symptom checklist to the appointment, and the figures per 1,000 women. ### Sources * [NHS: about HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/about-hormone-replacement-therapy-hrt/) * [NHS: types of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/) * [NHS: benefits and risks of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/) * [NHS: about continuous combined HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/continuous-combined-hormone-replacement-therapy-hrt-tablets-capsules-and-patches/about-continuous-combined-hrt/) * [NHS: menopause treatment](https://www.nhs.uk/conditions/menopause-and-perimenopause/treatment/) * [NICE NG23 recommendations](https://www.nice.org.uk/guidance/ng23/chapter/Recommendations) * [NICE: HRT discussion aid, 2024](https://www.nice.org.uk/news/articles/discussion-aid-to-support-clinical-conversations-about-hrt-published-alongside-updated-guidance) * [NICE CKS: managing menopause](https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/) * [The Menopause Society: 2022 hormone therapy position statement](https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf) ### Quick answers Which problems is HRT offered for? From age 40, NICE offers it for hot flushes and sweats. The NHS list also includes sleep trouble, mood changes, anxiety, low mood and vaginal dryness. Do HRT tablets and patches carry the same clot risk? Tablets can raise clot risk, and the NHS still calls that rise very low. Patches, gel and spray are not tied to the same rise. When clot risk is already higher, CKS points to a skin route. Which schedule follows a year without periods? Continuous combined HRT, both hormones each day. The cyclical pattern is the one used while periods are still coming, or in the first year after the last one. Written by Ines Kovac Menopause guides: symptoms, HRT, sleep and everyday changes Ines Kovac writes the practical guides on Unpaused: perimenopause, symptoms, hormone therapy, sleep, hot flushes and weight. She builds each piece from NHS and NICE pages, The Menopause Society's position statements and the studies behind them, and links every claim a reader might want to check. She says plainly what the evidence supports and where it runs out, and she never tells a reader to start or stop a medicine. Corrections are added to the page that had the error. [ikovac@unpaused.cc](mailto:ikovac@unpaused.cc) Last checked 2026-10-18 --- Plain, practical menopause advice Plain, practical guides to perimenopause and menopause: symptoms, hormone therapy, sleep, hot flashes, weight and food, each checked against health services and medical societies. [desk@unpaused.cc](mailto:desk@unpaused.cc) ### Topics * [Perimenopause](/topics/perimenopause) * [Symptoms](/topics/symptoms) * [Hormone therapy (HRT)](/topics/hrt) * [Hot flashes](/topics/hot-flashes) * [Sleep](/topics/sleep) * [Weight and diet](/topics/weight-and-diet) * [All guides](/articles) ### About us * [About](/about) * [Authors](/authors) * [Editorial policy](/editorial-policy) * [How we make money](/how-we-make-money) ### Legal * [Terms](/terms) * [Privacy](/privacy) * [Contact](/contact) Unpaused © 2026 Unpaused. General health information, written from sources we link. It does not replace advice from your own doctor, nurse or pharmacist. [How we make money](/how-we-make-money) [Editorial policy](/editorial-policy) [Who writes here](/authors)