Different types of hormone replacement therapy (HRT) are available.
If you're considering HRT, talk to your GP about the options suitable for you, as well as possible alternatives to HRT.
This page covers the different:
Ways you can take HRT
HRT treatment regimens
HRT replaces the hormones that a woman's body no longer produces because of the menopause.
The two main hormones used in HRT are:
- oestrogen – types used include estradiol, estrone and estriol
- progestogen – a synthetic version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel
HRT involves either taking both of these hormones (combined HRT) or just taking oestrogen (oestrogen-only HRT).
Most women take combined HRT because taking oestrogen on its own can increase your risk of developing womb (endometrial) cancer. Taking progestogen alongside oestrogen minimises this risk.
Oestrogen-only HRT is usually only recommended for women who have had their womb removed during a hysterectomy.
Ways of taking HRT
HRT is available in several preparations that are taken in different ways. Talk to your GP about the pros and cons of each option.
The main forms of HRT are outlined below.
Tablets, which are usually taken once a day, are one of the most common ways of taking HRT.
Oestrogen-only and combined HRT tablets are available. For some women this may be the simplest way of having treatment.
However, it's important to be aware that some of the risks of HRT, such as blood clots, are higher with tablets than with other forms of HRT (although the overall risk is still small).
Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days. Oestrogen-only and combined HRT patches are available.
Patches may be a better option than tablets if you think you might find it inconvenient to take a tablet every day.
Using patches can also help avoid some side effects of HRT, such as indigestion, and unlike tablets they don't increase your risk of blood clots.
Oestrogen gel is an increasingly popular form of HRT. It's applied to the skin once a day and is absorbed by the body.
Like skin patches, this can be a convenient way of taking HRT while avoiding an increased risk of blood clots.
But if you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.
HRT can be given using small pellet-like implants inserted under your skin (usually in the tummy area) while your skin is numbed with local anaesthetic, although these aren't widely available and aren't used very often.
The implants release oestrogen gradually over time and can stay in place for several months before needing to be replaced.
This may be a convenient option if you don't want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.
If you're taking a different form of oestrogen and need to take progestogen alongside it, another implant option is the intrauterine system (IUS). An IUS releases a progestogen hormone into the womb. It can remain in place for a few years and also acts as a contraceptive.
Oestrogen is also available in the form of a cream, pessary or ring that is placed inside your vagina.
This can help relieve vaginal dryness, but won't help with other symptoms such as hot flushes.
It doesn't carry the usual risks of HRT and can be used without taking progestogen even if you still have a womb.
HRT treatment regimens
Different treatment courses of HRT are also available, depending on whether you're still in the early stages of the menopause or have had menopausal symptoms for some time.
The two types are cyclical (or sequential) HRT and continuous HRT.
Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT who have menopausal symptoms but still have their periods.
There are two types of cyclical HRT:
- monthly HRT – you take oestrogen every day, and take progestogen alongside it for the last 14 days of your menstrual cycle
- three-monthly HRT – you take oestrogen every day, and take progestogen alongside it for around 14 days every three months
Monthly HRT is usually recommended for women having regular periods.
Three-monthly HRT is usually recommended for women experiencing irregular periods. You should have a period every three months.
It's useful to maintain regular periods so you know when your periods naturally stop and when you're likely to progress to the last stage of the menopause.
Continuous combined HRT
Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually said to be post-menopausal if she has not had a period for a year.
As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.
Oestrogen-only HRT is also usually taken continuously.