Hormone Replacement Therapy (HRT): Types, Suitability, Pros, and Cons

What Is HRT for Menopause? A Complete Guide to Hormone Replacement Therapy

Hormone Replacement Therapy, commonly known as HRT, is one of the most effective and widely used treatments for managing menopause symptoms. It is often prescribed to relieve hot flushes, night sweats, mood changes, sleep disruption, vaginal dryness and to support long-term bone health.

HRT works by replacing hormones that naturally decline during perimenopause and menopause, mainly oestrogen and progesterone. However, HRT is not a single treatment. There are several different types, each suited to different stages of menopause, medical histories and individual symptoms.

This guide explains what HRT is, the different types available, who each option may be suitable for, and the potential benefits and risks. This information is intended to support informed discussions with a healthcare professional.

What Is Hormone Replacement Therapy (HRT)?

Hormone Replacement Therapy is a medical treatment that supplements hormones the body no longer produces in sufficient amounts during menopause. Falling hormone levels can affect physical health, emotional wellbeing and overall quality of life.

HRT may be prescribed to:

• Reduce menopause symptoms

• Improve sleep and mood

• Protect bone density and reduce the risk of osteoporosis

• Improve vaginal and urinary symptoms

HRT is available in several forms, including tablets, patches, gels, sprays, implants and vaginal preparations.

HRT Suitability

Oestrogen Only HRT

Oestrogen only HRT contains oestrogen without progesterone. It is usually prescribed for women who have had a hysterectomy, meaning their uterus has been removed.

Who Is It Suitable For?

• Women who have had a hysterectomy

  
  

Pros

• Highly effective at relieving menopause symptoms

• Helps maintain bone density

• Reduces the risk of osteoporosis

Cons

• Not suitable for women with a uterus when taken alone

• May slightly increase the risk of stroke, blood clots or heart disease depending on individual risk factors

  
  

Combined HRT (Oestrogen and Progesterone)

Combined HRT contains both oestrogen and progesterone. Progesterone is needed to protect the lining of the uterus from overgrowth, which can increase the risk of endometrial cancer if oestrogen is taken on its own.

Who Is It Suitable For?

• Women who still have their uterus

  
  

Pros

• Reduces hot flushes, night sweats, mood changes and vaginal dryness

• Protects the uterus

• Helps reduce the risk of osteoporosis

Cons

• Slightly increased risk of breast cancer with long-term use

• Possible side effects include bloating, breast tenderness or mood changes

  
  

Sequential (Cyclical) HRT

Sequential HRT involves taking oestrogen continuously and adding progesterone for part of the month, usually for 10 to 14 days. This approach mimics the natural menstrual cycle and usually results in monthly bleeding.

Who Is It Suitable For?

• Perimenopausal women who still have periods, even if they are irregular

  
  

Pros

• Effective symptom relief

• Mimics the natural hormone cycle, which some women prefer

Cons

• Monthly bleeding may be inconvenient

• Possible side effects such as bloating or breast tenderness

  
  

Continuous Combined HRT

Continuous combined HRT involves taking oestrogen and progesterone together every day without breaks. Over time, this usually stops periods altogether.

Who Is It Suitable For?

• Postmenopausal women, defined as 12 months after their last period

  
  

Pros

• No regular periods

• Provides consistent symptom relief

Cons

• Breakthrough bleeding can occur, particularly during the first year

• Slightly increased breast cancer risk with long-term use

  
  

Local Oestrogen (Vaginal Oestrogen)

Local oestrogen is applied directly to the vagina in the form of creams, tablets, pessaries or rings. It is used to treat vaginal dryness, discomfort during sex and urinary symptoms.

Who Is It Suitable For?

• Women whose main symptoms are vaginal or urinary

• Women who cannot take systemic HRT

  
  

Pros

• Targets symptoms directly

• Minimal absorption into the bloodstream

• Very low risk of side effects

• Does not increase breast cancer risk

Cons

• Does not relieve symptoms such as hot flushes or night sweats

• Needs to be used regularly

  
  

Bioidentical HRT

Bioidentical hormones are chemically identical to those produced naturally by the body. These are available as regulated prescription products and as custom compounded formulations.

Who Is It Suitable For?

• Women interested in hormones that are structurally identical to those produced by the body

  
  

Pros

• Regulated bioidentical HRT has proven effectiveness

• Some women report good symptom control

Cons

• Custom compounded bioidentical HRT is not well regulated

• Dosage and safety may vary

• Risks are similar to standard HRT when prescribed

  
  

Tibolone

Tibolone is a synthetic hormone with oestrogenic, progestogenic and androgenic effects. It is sometimes prescribed to treat menopause symptoms and to help maintain bone density.

Who Is It Suitable For?

• Postmenopausal women who are at least one year past their last period

  
  

Pros

• Effective for hot flushes and mood changes

• Helps maintain bone density

• No monthly bleeding

Cons

• Increased risk of stroke in older women

• Slightly increased risk of breast cancer and heart disease

  
  

Testosterone Therapy and Menopause

Testosterone therapy is not a standard form of HRT, but it may be prescribed for women experiencing low libido linked to menopause.

Who Is It Suitable For?

• Women with diagnosed low sexual desire that has not improved with other treatments

  
  

Pros

• May improve libido and sexual satisfaction

• Can improve energy levels and wellbeing

Cons

• Possible side effects include acne or unwanted hair growth

• Long-term safety in women is still being studied

  
  

Choosing the Right HRT for Menopause

There is no single HRT option that suits everyone. The most appropriate treatment depends on:

• Stage of menopause

• Whether you have a uterus

• Personal and family medical history

• Individual symptoms and preferences

  
  

Some women choose not to use HRT and prefer lifestyle or non-hormonal approaches. Both choices are valid. The key is making an informed decision with professional medical advice

Final Thoughts: Is HRT Right for You?

Understanding what HRT is and how different types work can help women make informed choices about managing menopause symptoms and protecting long-term health.

HRT can significantly improve quality of life for many women, but it is not suitable for everyone. Whether you choose HRT, non-hormonal treatments or holistic approaches, professional guidance is essential.

References and Further Reading

• NHS Hormone Replacement Therapy

• National Institute for Health and Care Excellence Menopause diagnosis and management (NG23)

• Royal College of Obstetricians and Gynaecologists HRT and alternatives

• Cleveland Clinic Hormone Replacement Therapy

• North American Menopause Society HRT information