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What is HRT, and How Does It Work?

When you are facing the hormonal hard yards of menopause, finding relief from intense symptoms will jump to the top of your ‘to-do’ list.

Some women turn to hormone replacement therapy (HRT) to help them manage hormonal fluctuations in the body.

There are several different types of HRT designed to suit the needs of the individual, so it’s crucial to find the right one for you.

So, let’s look at what HRT is and how it works.

What we’ll be looking into:

  • What happens to the body during menopause
  • What is Hormone Replacement Therapy
  • The different types of HRT
  • What are the side effects of HRT
  • The risks associated with HRT

What happens to the body during menopause?

You officially enter menopause 12 months after you’ve had your last period.

During the transitional time between regular menstruation and menopause, you’ll likely have experienced disruption to the frequency and flow of your periods.

By the time you reach menopause, your ovaries will produce far less oestrogen and progesterone and stop releasing eggs.

As the hormone levels change dramatically, you may experience a host of symptoms such as hot flushes, night sweats, vaginal dryness, mood changes and brain fog.

Fascinating Fact:

The US National Institute of Ageing reports that the menopausal transition most often begins between the ages of 45 and 55 and lasts an average of seven years.

What is Hormone Replacement Therapy (HRT)?

The purpose of HRT is to boost the levels of the sex hormones in your body.

As the Royal College of Obstetricians and Gynaecologists explains, “The aim of HRT is to ‘top up’ the body’s natural supply of oestrogen.”

“Oestrogen also stimulates the lining of the womb, so you will also need to take another hormone, progesterone, at the same time to protect your womb lining.”

The symptoms women experience during menopause are linked to the decreasing levels of oestrogen and other sex hormones in the body.

By replenishing the supply, HRT can help women feel much better.


Fascinating Fact:

Oestrogen isn’t just vital to the reproductive system – it also helps control other body functions, including bone density, skin temperature and vaginal moistness and elasticity.

What are the different types of HRT?

Although there are many different HRT treatments out there, there are two main types.

The first is a combination of oestrogen and progesterone, which is typically prescribed if you still have a womb.

The Menopause Charity explains why the combination is so important:

“When you take oestrogen, the lining of your womb can build up, which can increase your risk of cancer.

“However, taking progesterone prevents this build-up, which means there is no increased risk of cancer when you take HRT.”

What if I’ve had a hysterectomy?

Women who have undergone a hysterectomy will be offered an oestrogen-only HRT.

This is because there is no need for progesterone as there is no womb lining to shed.

According to The Menopause Charity, “The optimal oestrogen in HRT is a type of oestrogen called ’17 beta oestradiol’.

“This is a body identical oestrogen and has the same molecular structure as the oestrogen which decreases in your body during the menopause.”

Fascinating Fact:

In some cases, women are prescribed testosterone in gel form alongside HRT to help restore their libido.

How do I take HRT?

There is a range of ways in which you can take HRT – orally, skin patches, gels, long-lasting implant or vaginally.


You can take either the combination HRT or oestrogen-only versions in tablet form.

If you take oestrogen-only, the tablet is usually taken once a day.

If you are on the combined HRT, the UK’s Women’s Health Concern explains that you take oestrogen every day and then progesterone for 12 to 14 days.

They write: “Cyclical HRT mimics the normal menstrual cycle. At the end of each course of progesterone there is some bleeding as the body “withdraws” from the hormone and the womb lining (endometrium) is shed. Progesterone regulates bleeding and protects the endometrium from harmful pre-cancerous changes.”

There are two types of cyclical HRT: a monthly and a three-monthly option.

Again, you take oestrogen every day during the three months but will take progesterone for 14 days every three months.

Skin Patches

You can also take HRT via skin patches that you replace every few days.

The NHS website explains that one of the benefits of skin patches is that you don’t have to take them daily, and they do not increase your risk of blood clots, unlike tablets


Some women prefer to use oestrogen gel which is rubbed into the skin daily.

This can be particularly useful for those who have undergone a hysterectomy, but women with a womb must also take progesterone.

Long-lasting implants

Another choice available is an oestrogen implant which will be located under the skin of your stomach.

You’ll be given a local anaesthetic for the procedure, and the implant will release oestrogen over time.

Again, you would need to take progesterone additionally if you still have a womb.

Vaginal oestrogen

The NHS website points out that vaginal oestrogen – in cream, pessary, or ring form – can help to relieve one particular menopause symptom.

You may find relief from vaginal dryness by using this HRT, but this version will not help with the other symptoms.

Fascinating Fact:

Once you begin a course of HRT, it should take between one to three months for your symptoms to improve. If this doesn’t happen, speak to your GP.

What are the side effects of HRT?

When you begin a course of HRT, you may experience side effects in the first few weeks.

The side effects may differ depending on whether the HRT is oestrogen-only or a combination of oestrogen and progesterone.

If the side effects don’t settle after three months of treatment, seek advice from your GP to discover if you need to change your dosage or switch to a different form of HRT.

The US Office of Women’s Health lists some common side effects that you may experience.

  • Nausea
  • Breast pain and tenderness
  • Vaginal spotting
  • Bloated stomach and cramps
  • Hair loss
  • Fluid retention
  • Vaginal yeast infection

It’s important to note that these symptoms are the less serious and more commonplace ones experienced by women on HRT.

Fascinating Fact:

Hormonal changes can lead to weight gain around the abdomen as the way the body distributes fat changes. Fat gets stored around the stomach rather than the hips or thighs.

What are the risks of HRT?

It’s important to know that there are risks associated with HRT. Here are a few to consider:

The National Institute for Health and Care Excellence goes into detail about each one, but here’s an overview of three major concerns.

Blood Clots

The risk of blood clots is specifically linked to HRT in its tablet form.

Other factors, including family history and excess weight, can also heighten the risk of blood clots.

When you speak to your doctor about HRT, they can advise you on whether it’s safe to take tablets or if you should opt for patches or gels instead.


Once again, it’s the tablet form of HRT that increases the risk of suffering from a stroke.

However, NICE points out that “the risk of stroke in women under 60 is very low“.

Breast Cancer

According to the Women’s Health Concern fact sheet, the combined HRT tablet does bring a slightly increased risk of developing breast cancer if used for over five years.

However, they also say, “the risk of breast cancer with combined HRT is less than that associated with being overweight over the age of 50 or that associated with drinking two or more units of alcohol per day.

“Approximately 2% of breast cancer cases in the UK are thought to be attributable to the current or past use of HRT.”

Consult your doctor if you have concerns about the risk of breast cancer.

Women who have had breast, ovarian or womb cancer may be advised not to take HRT.

Should I take HRT?

Every woman should make her own decision about whether to begin HRT to relieve menopause symptoms.

We encourage you to speak to medical professionals, read extensively and make an informed decision based on your needs.

HRT can be a lifeline for women experiencing intense menopause symptoms.

But each person is an individual, so take the time to explore the choices that would work best for you.

Evidence Based
This article has been reviewed by our Kari Health Experts and Editorial Board to ensure accuracy and reliability of the information presented. However, please note that the content provided is for informational purposes only and should not replace advice from your medical professional.

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