Types of hormone replacement therapy (HRT)
There are different types of hormone replacement therapy (HRT) available.
- contain different hormones – oestrogen, progestogen or both (a specialist doctor may also sometimes prescribe testosterone)
- be taken or used in different ways – tablets, patches, gel, spray or vaginal rings, pessaries or cream
- be taken or used at different times – routines can be cyclical (sequential) or continuous
The type of HRT that's best for you depends on different factors, like if you've had a hysterectomy, what stage of menopause you're at, and your personal preferences.
If you're considering taking HRT, talk to a GP about the options suitable for you.
HRT replaces the hormones that your body produces less of as you go through menopause.
Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55 but it can happen earlier. It affects anyone who has periods.
These hormones are mainly oestrogen and progestogen, which are essential to everything from period cycles, ovulation and pregnancy, to bone health.
Testosterone is not currently licensed to treat the symptoms of menopause, but a specialist doctor can prescribe it.
Combined HRT or oestrogen-only HRT
HRT involves either taking oestrogen and progestogen (combined HRT) or just taking oestrogen (oestrogen-only HRT).
If you've had a hysterectomy
If you have not had a hysterectomy
If you still have your womb you'll need to take both oestrogen and progestogen. Taking both helps to protect against the risk of womb cancer.
You can get your oestrogen from tablets, patches, spray or gel. Your progestogen can come from taking tablets or using an intrauterine system (IUS) such as the Mirena coil. Using 2 separate types of hormone will provide the combined HRT you need.
You can also take or use an HRT that already contains both oestrogen and progestogen.
Ways of taking HRT
HRT comes in several different forms. There are pros and cons for each and you may need to try different brands and methods of taking HRT to find the one that suits you. Talk it through with a GP first.
You'll usually need to take HRT for 2 to 5 years, although it can be longer in some cases. Find out more about when to take HRT.
HRT supply shortages have caused difficulties for women who need HRT. This has been a real issue for those whose HRT treatment has helped their menopause symptoms.
If you find that you cannot get the HRT you were taking before, it's important that you do not stop taking HRT. Your menopause symptoms may return and you will not have the other benefits of HRT, such as preventing osteoporosis.
Speak to a pharmacist or GP about trying another type or brand of HRT that may be suitable for you.
Tablets are one of the most common forms of HRT. You usually take them once a day. Both oestrogen-only and combined HRT are available as tablets.
Taking tablets once a day may be the easiest way of having treatment.
Some of the risks of HRT, such as blood clots, are higher with tablets than with patches, gel or spray (although the overall risk is still small). Find out more about the benefits and risks of HRT.
Skin patches are also a common way of taking HRT. They work by sticking onto your skin on the lower part of your body and they gradually release small amounts of hormones into your body.
You'll usually change your patch every few days, but each brand is different.
Both oestrogen-only and combined HRT are available as skin patches.
Patches may be a better option than tablets if you have difficulty swallowing tablets, or are likely to forget to take it.
Using patches can also help to avoid some side effects of HRT, such as indigestion, and unlike tablets, they do not increase your risk of blood clots.
You might find that skin patches do not always stick well, especially if you moisturise your skin. Patches can also cause redness or irritation, or leave a mark on the skin.
Applying the patch to dry, non-moisturised skin, or peeling it off slowly to avoid marks can help.
Oestrogen gel is an increasingly popular form of HRT. You take it by smoothing it onto your skin once a day. Oestrogen is gradually absorbed into your body.
If you have not had a hysterectomy, you must use this gel with a progestogen.
Like skin patches, gel can be a good way of taking HRT if you cannot take tablets. Using gel does not increase your risk of blood clots.
It can take 5 minutes or more for the gel to dry on the skin, so you may have to wait a while before you can do anything else.
Oestrogen-only HRT also comes as a spray you use once a day. You take it by spraying 1 to 3 sprays onto the inner side of your arm or your inner thigh.
If you have not had a hysterectomy, you must use this spray with a progestogen.
This is a good way of taking HRT if you cannot take tablets.
Using the spray does not increase your risk of blood clots.
Although you can get dressed 2 minutes after using the spray, you need to wait for 1 hour before having a bath or shower.
Intrauterine system (IUS), or Mirena coil
If you have a womb and are taking or using oestrogen tablets, patches, gel or spray, the Mirena coil, an intrauterine system (IUS), may be a suitable way to give you the progestogen you need.
The Mirena coil is inserted into your womb and it gradually releases a form of progestogen (levonorgestrel) into your body.
The Mirena coil is also used as contraception to prevent pregnancy, and to treat heavy periods.
The Mirena coil can stay in place for up to 5 years and also acts as contraception.
It can be a good option if you do not want to take or use a medicine every day, or have difficulties with other forms of progestogen.
Implants such as the Mirena coil can cause abdominal pain and bleeding. Find out more about the side effects of using an IUS.
Low dose oestrogen is also available as a cream, gel, vaginal tablet, pessary or ring that you put inside your vagina. This can help with menopausal symptoms such as vaginal dryness, a burning sensation, or pain during sex.
Vaginal oestrogen does not carry the usual risks of HRT and does not increase your risk of breast cancer. You can use it without taking progestogen, even if you still have a womb.
This form of HRT will not help with other menopausal symptoms such as hot flushes, mood swings or sleeping problems.
Like oestrogen and progestogen, the menopause also causes levels of the sex hormone testosterone to fall, although this happens more gradually. This can make you feel tired, affect your mood and cause a low sex drive (libido). It can also affect bone health.
Testosterone is not currently licensed to treat symptoms of menopause, but a specialist doctor may be able to prescribe it for you. This is usually only recommended if:
- you're post-menopause
- you have problems with low sex drive
- HRT alone has not helped
Research is being done on whether testosterone could help with other menopause symptoms, but more evidence is needed.
Testosterone comes as a gel.
Possible side effects of using testosterone include acne, unwanted hair growth and weight gain, but these are not common.
Testosterone gel can also cause side effects in others if they come into contact with it regularly. To avoid this, wash your hands after using it and cover the area with clothing.
Speak to a GP if you think you might benefit from taking testosterone.
Tibolone (brand name Livial) is a prescription medicine that's similar to taking combined HRT (oestrogen and progestogen) but it also has a testosterone effect. You take it as a tablet once a day.
It can help relieve symptoms such as hot flushes and low mood, although some studies have suggested it may not be as effective as combined HRT.
It's only suitable if you had your last period more than a year ago (post-menopause).
HRT treatment routines
The way you take HRT depends on different things, such as if you've had a hysterectomy, if you're in the early stages of menopause and still have periods (perimenopause) or if you have not had a period for more than 1 year (post-menopause).
If you've had a hysterectomy and take oestrogen-only HRT, you'll take it every day.
If you need both oestrogen and progestogen, your routine for taking HRT depends on various things, including whether you're in the earlier stages of the menopause and still having periods (perimenopause) or have not had a period for 1 year or more (post-menopause).
Sequential combined HRT
You'll usually be recommended to take sequential (cyclical) combined HRT if you have menopause symptoms but still have periods.
It comes as tablets or patches.
There are 2 types:
- monthly HRT if you're having regular periods – you take oestrogen every day, and take progestogen alongside it for the last 10 to 14 days of your menstrual cycle every month
- 3-monthly HRT if you're having irregular periods – you take oestrogen every day, and take progestogen alongside it for around 10 to 14 days every 3 months
You should have a period at the end of each progestogen cycle. If there is no bleeding at these times, speak to your doctor.
If you started on sequential HRT during perimenopause your doctor may recommend changing to continuous combined HRT post-menopause.
Continuous combined HRT
Continuous combined HRT is usually recommended if you're post-menopause. This is when you have not had a period for 1 year.
Continuous combined HRT involves taking oestrogen and progestogen every day without a break.