LIVE WELL • HRT

Common questions about HRT,
answered from NHS guidance.

LAST REVIEWED: 2026-10-25 • By the LatelyWell editorial team • How we write & review

Hormone replacement therapy (HRT, called MHT in some countries) raises lots of questions: what types there are, how it is taken, and what the risks are. Here are plain answers drawn from NHS guidance, to help you prepare for a conversation with your own doctor.

What is HRT?

The NHS describes HRT as treatment that replaces the hormones your body produces less of as you go through menopause, mainly oestrogen and progestogen. In the US and Australia it is often called menopausal hormone therapy (MHT).

What types of HRT are there?

According to the NHS, HRT can:

• contain different hormones: oestrogen, progestogen or both
• be taken in different ways: tablets, patches, gel, spray, or vaginal rings, pessaries or cream
• follow different routines: cyclical (sequential) or continuous

The NHS says oestrogen-only HRT is recommended if you have had a hysterectomy. If you still have your womb, you will need both oestrogen and progestogen, which helps protect against the risk of womb cancer. Progestogen can come from tablets or an intrauterine system (IUS) such as the Mirena coil.

Patches, gel, spray or tablets?

The NHS sets out pros and cons for each form:

• Tablets are usually taken once a day and may be the easiest. Some risks, such as blood clots, are higher with tablets than with patches, gel or spray, although the overall risk is still small.
• Patches are changed every few days, depending on the brand. They do not increase the risk of blood clots, but may not always stick well or may irritate skin.
• Gel is smoothed onto the skin once a day and does not increase the risk of blood clots. It can take 5 minutes or more to dry.
• Spray (oestrogen-only) is used once a day. You need to wait 1 hour before a bath or shower.

The NHS notes you may need to try different brands and methods to find what suits you.

What are sequential and continuous HRT?

The NHS explains that sequential (cyclical) combined HRT is usually recommended if you have symptoms but still have periods: oestrogen every day, with progestogen for the last 10 to 14 days of the cycle, followed by a bleed. Continuous combined HRT, taken every day without a break, is usually recommended once you have not had a period for a year.

What are the benefits?

The NHS says the main benefit is that HRT is effective at relieving most perimenopause and menopause symptoms, such as hot flushes, night sweats, sleep problems caused by menopause, anxiety and low mood caused by menopause, and vaginal dryness. It also helps prevent osteoporosis, which the NHS says is particularly important if your periods stop before 45.

What are the risks?

The NHS says the risks of serious side effects are usually very low and depend on the type of HRT, how long you take it and your own health. In summary:

• Breast cancer: combined HRT can slightly increase the risk; the NHS gives a figure of around 5 extra cases per 1,000 women taking combined HRT for 5 years. There is little or no increase with oestrogen-only HRT. Keep up with breast screening.
• Blood clots: tablets can increase the risk, though it is still very low. Patches, sprays and gels do not.
• Stroke: tablets slightly increase the risk, but not patches, gel or spray.

The NHS says that if you are under 60, have menopause symptoms and are not at high risk of breast cancer or blood clots, the benefits are likely to outweigh the risks. Your own doctor is the person to weigh this for you.

What about vaginal oestrogen?

The NHS says low-dose vaginal oestrogen helps with vaginal dryness and does not carry the usual risks of HRT. It will not help with hot flushes or mood. See vaginal dryness in menopause.

How long do people take HRT?

The NHS says you will usually take HRT for 2 to 5 years, although it can be longer in some cases. Your doctor will review it with you; NICE suggests a review three months after starting a new treatment, then at least once a year.

Questions to take to your appointment

• Is HRT a suitable option for me, given my history?
• Which type and form would you suggest, and why?
• What side effects should I look out for, and when should I come back?
• What are the non-hormone options if HRT is not right for me?

Our appointment guide has a fuller checklist.

Frequently asked questions

Is HRT the same as MHT?

Yes. MHT (menopausal hormone therapy) is the term often used in the US and Australia for the same type of treatment.

Do HRT patches increase the risk of blood clots?

The NHS says HRT patches, sprays and gels do not increase the risk of blood clots. Tablets can, although the risk is still very low.

Do I need progestogen if I have had a hysterectomy?

The NHS says oestrogen-only HRT is recommended if you have had your womb removed. If you still have your womb, you need progestogen as well.

How quickly does HRT work?

The NHS says you should find your symptoms improve after a few days or weeks.

Where to find reliable information

If you want to read further, these organisations publish free, evidence-based information for the public:

• UK: the NHS menopause pages, the NICE menopause guideline and the Women's Health Concern factsheets from the British Menopause Society.
• US: The Menopause Society, ACOG and the National Institute on Aging.
• Australia: Jean Hailes for Women's Health and the Australasian Menopause Society.

Guidance differs a little between countries, and treatment names and availability vary, so check what applies where you live and talk to a clinician about your own situation.

The bottom line

HRT comes in several types and forms, and the right choice depends on your history, stage of menopause and preferences. NHS guidance says the risks of serious side effects are usually very low and, for many people under 60, the benefits outweigh them, but that decision belongs to you and your clinician.

Educational information only; not medical advice, diagnosis or treatment. Seek professional care for symptoms that are severe, persistent, worsening or concerning.