Patient information from BMJ

Menopause: should I take HRT?

Last published:Mar 27, 2025

The menopause is the name for when your periods stop for good. It isn't an illness, but will be part of every woman's life at some point. Some people feel well throughout the menopause and don’t need any treatment. Some people will have mild symptoms. And others may have more extreme symptoms that can be distressing. 

Treatments for the symptoms of the menopause include hormone replacement therapy (HRT). This can work well, but it can increases your chance of some serious health problems. There are some alternative treatments available if you choose not to take HRT.

If you are worried about your symptoms, you can talk to your doctor about what treatments are right for you.

What is hormone replacement therapy (HRT)?

HRT stands for hormone replacement therapy. Sometimes it's just called hormone therapy, or HT. Women can take HRT to help with menopausal symptoms.

HRT is mainly designed to replace oestrogen. The drop in oestrogen at the menopause is what causes symptoms such as hot flushes and vaginal dryness.

Many women take combined HRT, which means they take a combination of oestrogen and progestin. Progestin is designed to mimic the effects of the hormone progesterone. This helps mimic the level of hormones women have before the menopause. Taking oestrogen and progesterone together also helps protect against cancer of the uterus (also called womb cancer or endometrial cancer).

The balance of hormones that work best for you will depend on your unique symptoms and medical history.

There are different ways of taking HRT. You can take it as a skin patch, a tablet, a gel, an implant, or a vaginal cream or ring. Some types work best for certain symptoms.

Depending on what type of HRT you take, you might be able to take it in a way that copies your natural cycle and gives you a period. This is called cyclical HRT. It's often prescribed for women who are having menopausal symptoms but who are still having periods.

Or you can take HRT every day without a break and have no period. This is called continuous HRT. It's more suitable for women who haven't had periods for a year or more.

How can HRT help?

HRT can help relieve several symptoms of the menopause. It also has other benefits, such as reducing your chances of bone fractures.

HRT for hot flushes

HRT is highly effective in reducing hot flushes. Many women find that it cuts the number of hot flushes they have by up to 90 percent.[1]

HRT for vaginal and urinary symptoms

The menopause can cause several vaginal symptoms, including dryness. It can also cause urinary tract infections (UTIs), and other problems with urination, such as needing a wee more often.

​If you have these symptoms and don’t have hot flushes, you may be offered HRT treatments that are applied directly to the area, rather than tablets you take by mouth.

For example, HRT can be taken as a cream, as pessaries (tablets that dissolve when placed in the vagina), or as a small, flexible ring placed inside the vagina. This ring gradually releases the HRT medication into the vagina for three months, after which you replace it with a new one.

This approach reduces the chances of side effects. It also seems to work better than tablets at relieving urinary symptoms and vaginal dryness.

HRT for sleep problems and mood symptoms

Some women find that their menopausal symptoms include disturbed sleep. This may be partly because of hot flushes at night, or may be directly caused by hormone changes. HRT does seem to help some women sleep better.

Many women experience changes to their mood when they go through the menopause. This is due to the hormonal imbalance that happens during the menopause. HRT can help with mood changes by balancing out the hormones again.

If you find you have a low mood or depressive symptoms during or just after the menopause, talk to your doctor. They will discuss other treatment options for you, such as cognitive behavioural therapy or antidepressants.

Can HRT be harmful?

Research has highlighted two main areas where HRT can increase the chance of serious problems. These are:

Heart disease and circulation problems. The effects of HRT on your heart and circulation is complicated. It's not simply a case of HRT increasing the chance of something going wrong. For example, research suggests that HRT increases your chance of a stroke or deep vein thrombosis (DVT). A DVT is a blood clot in a vein. These usually happen in the leg. If you have a blood clot in your leg that travels to your lung it can be very dangerous. But for some people, starting HRT in perimenopause or early menopause can actually help protect against heart disease.

Breast cancer. Taking HRT slightly increases your chances of being diagnosed with breast cancer. Once you stop taking HRT your chances of getting breast cancer falls. Within a few years of stopping HRT your chance of getting breast cancer is the same as it was before you took HRT.

Your doctor will ask you about whether anyone in your family has had breast cancer or blood clots before prescribing you HRT. For most women the increased risk of these conditions is still very small. But because they are serious conditions, doctors usually recommend that women who take HRT have the lowest possible dose for the shortest possible time.

Some women feel that the risks that come with HRT are too much for them. While other women feel their menopausal symptoms are so unpleasant they are willing to accept those risks. You can discuss all the risks and benefits for you as an individual with your doctor before deciding whether HRT is right for you.

Other side effects

There are some less-serious side effects associated with HRT. These include unexpected vaginal bleeding, tender breasts, headaches, and mood swings. Sometimes they go away when you have been on HRT for a while. Sometimes a change to the type of HRT you are using helps.

Some women put on a little weight when they first start HRT. But this usually doesn't last and most women's weight soon returns to what it was before they started HRT.

Taking HRT for a year or more could make you more likely to develop gallbladder disease, such as gallstones. It may also increase urinary incontinence. These are some of the risks your doctor will discuss with you to work out the most appropriate treatment, based on your individual medical history and symptoms.

What are the alternatives to HRT?

There are also some non-HRT treatments that may help, particularly with hot flushes. Some are prescription medicines while others are supplements you can buy over the counter. You can talk to your doctor about them if you would rather not take HRT.

Antidepressants are usually used to treat depression, but some of them can help reduce hot flushes. Antidepressants can cause side effects in some people, including nausea, dizziness, and a reduced interest in sex. 

Gabapentin is a drug normally used to treat epilepsy and neuropathic pain (pain caused by problems with your nerves). But it can help reduce hot flushes. Gabapentin can cause side effects, including dizziness and drowsiness.

Clonidine is a drug usually used to treat high blood pressure. It can help reduce hot flushes, but it can cause side effects, including lowering your blood pressure too much. If you use this treatment your doctor should regularly monitor your blood pressure.

Alternative treatments such as phyto-oestrogens, acupuncture, and reflexology have not been shown to significantly improve hot flushes. You should always tell your doctor if you're taking herbal treatments with prescription medicines, because some combinations can be unsafe.

Some prescription medicines can also help with symptoms like night sweats, low mood, or anxiety. But they may not be suitable for everyone. You can ask your doctor about your options.

There are some things you can do that might make symptoms easier to deal with. For example, you could try avoiding certain things known to be triggers. For hot flushes, this might include avoiding spicy foods, caffeine, warm environments, and stress. Other tips to help ease hot flushes and night sweats include wearing light, layered clothing, taking cool showers, and drinking cold water.

Doctors recommend regular exercise for women during menopause. It might not help with specific symptoms, but it contributes to general wellbeing. Exercise can also help with weight loss, which can help relieve menopausal symptoms in some women.

How do I decide if treatment is right for me?

If you are thinking of getting treatment for menopausal symptoms, you might want to consider the following questions, and discuss them with your doctor.

• How much do your menopause symptoms bother you?

• What are the symptoms that bother you most?

• Which type of treatment is likely to work best for these symptoms?

If you are thinking of taking HRT, you might want to discuss the following:

• Do some ways of taking HRT have fewer side effects than others?

• What are the potential health risks associated with taking HRT?

• Are you at high risk or low risk of getting health problems from HRT?

• How long will you need to take HRT?

• What side effects might you get with HRT?

For more questions to help you prepare for a chat with your doctor, see our patient information: Menopause: questions to ask your doctor.

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