Patient information
Menopause and HRT: your options
This leaflet explains the menopause, the symptoms it can cause, and the treatments that can help, including hormone replacement therapy (HRT). It is for anyone going through the menopause or perimenopause.
Your plan
Name:
Treatment:
How to take it:
Review appointment: (usually 3 months after starting, then once a year)
What is the menopause?
The menopause is when your periods stop because your ovaries make less of the hormone oestrogen. It is usually confirmed when you have not had a period for 12 months. For most people it happens between 45 and 55, and the average age in the UK is 51. It can happen earlier, either naturally or after surgery or treatments such as chemotherapy.
The perimenopause is the time leading up to it, when hormone levels go up and down and periods often become irregular. Symptoms often start during this time and can last several years.
If you are 45 or over, your doctor or nurse can usually diagnose the perimenopause or menopause from your symptoms and periods. You do not normally need a blood test.
Common symptoms
- hot flushes and night sweats
- vaginal dryness, discomfort or pain during sex, and needing to pass urine more often
- low mood, anxiety, mood swings and irritability
- difficulty sleeping
- problems with memory or concentration ("brain fog")
- joint and muscle aches
- reduced interest in sex
Everyone is different. Some people have few symptoms, while others find them very disruptive. Support is available whatever your symptoms.
Hormone replacement therapy (HRT)
HRT replaces the oestrogen your body is no longer making. It is the most effective treatment for hot flushes and night sweats, and it can also help mood, sleep, joint aches and vaginal symptoms.
Types of HRT
- Oestrogen-only HRT is for people who have had their womb (uterus) removed.
- Combined HRT (oestrogen plus a progestogen) is for people who still have a womb. The progestogen protects the lining of the womb. A hormonal coil (such as Mirena) can provide the progestogen part.
- Sequential (cyclical) HRT is usually used if you still have periods or had one in the last year. You will have a monthly bleed.
- Continuous combined HRT is usually used once your periods have stopped for a year. It is designed to give no bleeds.
How it is taken
Oestrogen can be taken as tablets, or through the skin as a patch, gel or spray (transdermal). Transdermal HRT does not increase the risk of blood clots or stroke, so it is usually recommended if you are overweight, smoke, have had a blood clot, or have migraines with aura. We will start with the lowest dose that controls your symptoms.
What to expect
- It can take a few weeks to feel the benefit and up to 3 months for the full effect.
- Side effects such as breast tenderness, bloating or headaches are common at first and usually settle.
- Irregular bleeding is common in the first 3 months. Tell us if it carries on after that.
- You will have a review after 3 months, then at least once a year.
- There is no fixed time limit on HRT. We will talk about how long to take it at each review. If you stop and your symptoms come back, you can restart.
Benefits and risks of HRT
For most people, the benefits of HRT outweigh the risks, especially if started before 60. Taking HRT is unlikely to change how long you live.
- Bones: HRT lowers the risk of broken bones from osteoporosis while you take it.
- Breast cancer: combined HRT slightly increases the risk, and the risk is higher the longer you take it. Oestrogen-only HRT causes little or no increase. Keep going to breast screening and check your breasts regularly.
- Blood clots and stroke: HRT tablets slightly increase the risk. Patches, gels and sprays do not appear to.
- Heart disease: HRT does not increase your risk of heart disease. However, it is not used to prevent it.
- Womb (endometrial) cancer: taking oestrogen without a progestogen raises the risk if you have a womb, which is why combined HRT is used.
Your clinician can go through the numbers with you using NICE's decision aid.
HRT may not be suitable if you have had breast cancer or some other cancers, a recent blood clot, or certain liver problems. A specialist can advise.
Vaginal and urinary symptoms
Vaginal oestrogen, as a cream, gel, pessary, tablet or ring, treats dryness, soreness, painful sex and some urinary symptoms. Very little is absorbed into the body, so it is safe for most people and can be used alongside HRT or on its own for as long as you need it. Symptoms often come back if you stop. Vaginal moisturisers and lubricants, available from pharmacies, can also help.
Other treatments
- Cognitive behavioural therapy (CBT) designed for the menopause can help with hot flushes, low mood and sleep. It is available in person, online or as self-help.
- Non-hormonal medicines may be offered if HRT is not suitable for you.
- Testosterone may be considered for low sex drive if HRT alone has not helped.
- Herbal remedies such as black cohosh, red clover, soy isoflavones and St John's wort are not regulated. Their safety is uncertain and they can interact with other medicines, including some breast cancer treatments.
Looking after yourself
- Keep active: aim for 150 minutes of moderate activity a week, including weight-bearing and strengthening exercise on at least 2 days. This protects your bones, muscles, heart and mood.
- Eat for your bones: include calcium-rich foods such as dairy or fortified alternatives, and consider a vitamin D supplement in autumn and winter.
- Stop smoking and keep alcohol to no more than 14 units a week.
- Hot flushes: wear layers, keep your bedroom cool, and notice triggers such as alcohol, caffeine and spicy food.
- Sleep: keep regular hours and limit screens and caffeine late in the day.
- Talk about it: with family, friends or your employer. Many workplaces now offer menopause support.
Contraception
HRT is not a contraceptive. You can still get pregnant during the perimenopause. Keep using contraception until you are 55, or until you have had no periods for 1 year if you are over 50 (2 years if under 50). Ask us which methods are suitable for you.
When to get help
Contact your GP practice if you have:
- any bleeding after your periods have stopped for a year, if you are not on HRT
- bleeding on HRT that continues after the first 3 months, or that is heavy or unexpected
- a new breast lump or any change in your breasts
- symptoms that are not improving, or side effects that worry you
Get urgent help (call 999 or go to A&E) if you have a painful, swollen leg, chest pain, sudden breathlessness or coughing up blood, or signs of a stroke such as face drooping, arm weakness or slurred speech.
Where to find more help
- NHS – menopause: nhs.uk/conditions/menopause
- Women's Health Concern (the patient arm of the British Menopause Society): womens-health-concern.org
- Menopause Matters: menopausematters.co.uk
- The Daisy Network (premature ovarian insufficiency): daisynetwork.org
- NHS Better Health (activity, weight, alcohol, smoking): nhs.uk/better-health
Based on NICE guideline NG23, Menopause: identification and management (November 2024), and NHS advice. This leaflet is general information and does not replace advice from your own healthcare team.