HRT for Menopause: Benefits, Risks and Alternatives

Medically reviewed by Puja Vyas, Senior Clinical Pharmacist.

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HRT or hormone replacement therapy replaces the oestrogen and progesterone in your body that it stops producing during menopause. Currently, it is the most effective treatment available for menopausal symptoms, and it also helps maintain bone density.

Yes, there are certain risks associated (which we will talk about in this article). But they are smaller and more nuanced than older headlines suggested. They depend completely on the type of HRT you go for, your age and when you start.

We’ll try to paint a fair and full, evidence based picture, so you can have an informed conversation with your clinician.

Key Takeaways

• HRT is the most effective treatment for hot flushes, night sweats, mood changes, and sleep disruption caused by menopause
• The British Menopause Society (February 2026) states that for healthy women under 60, the benefits of HRT outweigh the risks when started within a few years of menopause
• Transdermal HRT (patches, gels, sprays) has a different and generally lower risk profile than oral tablets, particularly for blood clot risk
• Breast cancer risk from combined HRT is real but modest and context-dependent; oestrogen-only HRT carries no increased risk
• If you take GLP-1 medications (Wegovy, Mounjaro) alongside oral progestogen HRT, the British Menopause Society advises a clinical review, as GLP-1s may reduce oral progestogen absorption
• Non-hormonal options exist for women who cannot or choose not to take HRT

What Is HRT and Why Do You Need It?

During menopause, your body slowly stops producing oestrogen and progesterone, the hormones that regulated your body since puberty. Unlike what many women believe, these hormones don’t just manage your periods, but affect your brain, your bones, your cardiovascular system, your skin, your sleep, and your mood. When they decline, everything becomes evident. HRT is simply the process of replacing these two hormones.

The type you need depends on whether you still have a womb.

If yes - you need both oestrogen and a form of progesterone (called progestogen). Oestrogen on its own would stimulate the womb lining to thicken, which over time increases the risk of womb cancer. Progestogen prevents that by keeping the lining stable and protected.

If no (you've had a hysterectomy) - you only need oestrogen. There's no womb lining to protect, so progestogen isn't required. This is also why oestrogen-only HRT is considered to be less risky than the combined one for most women.

The Different Forms of HRT

HRT is available in several forms, and they decide how it gets into your body. The route of delivery matters clinically, and not just for convenience.

• Patches: worn on the skin and changed every 1 to 3.5 days. They deliver oestrogen (and sometimes combined oestrogen and progestogen) transdermally (through the skin), bypassing the liver. These are usually preferred for women with metabolic risk factors.
• Gels and sprays: applied to the skin daily. These are also transdermal and come with flexible delivery options.
• Tablets: They are convenient but processed through the liver first, which affects the risk profile compared with transdermal forms.
• Intrauterine system (hormonal coil): This releases progestogen directly into the womb lining. Very little of it reaches the rest of your body and is often used alongside a separate oestrogen patch or gel.
• Implants: These are small pellets inserted under the skin. They are less commonly used now given other options.

The method of delivery should, of course, be decided based on your convenience, but more so with your individual risk profile and metabolic factors. An honest conversation with your clinician helps here.

Benefits of HRT

Symptom Relief

HRT is the most effective treatment for the core symptoms of menopause as of today (July 2026). The evidence is consistent and long-standing. Let’s look at some of the symptoms and what studies have shown regarding them:

• Hot flushes and night sweats: HRT reduces frequency and severity by up to 80% in most women
• Sleep disruption: HRT improves sleep quality significantly as it eases night sweats and works on the direct effects of oestrogen loss on sleep architecture.
• Mood changes and anxiety: Oestrogen has a direct effect on brain chemistry including serotonin and dopamine. Many women report significant improvement in low moods, irritability, and anxiety with HRT
• Brain fog and concentration: Oestrogen is important for cognitive function. Restoring it automatically improves these symptoms.
• Vaginal and urinary symptoms: Oestrogen, particularly in topical form applied locally, restores tissue health in the vaginal area and reduces urinary discomfort.

Bone Health

After menopause, the rate of bone loss accelerates significantly. This increases the risk of osteoporosis and fractures. HRT is an effective preventive intervention for bone loss, as oestrogen protects bone density. It has been shown to reduce fracture risk when taken during and after the menopause transition.

Read about: GLP-1 agonists and bone health in postmenopausal women →

Cardiovascular Considerations

The relationship between HRT and cardiovascular health is still evolving. The current evidence, including the British Menopause Society's February 2026 guidance, supports the following position:

• HRT started before age 60 or within 10 years of menopause onset does not increase cardiovascular disease risk. It may actually have a protective effect
• Transdermal oestrogen is generally preferred for women with elevated cardiovascular or metabolic risk factors, as it does not increase clotting risk that the oral version has
• Starting HRT later in life, or in women with established cardiovascular disease, requires individual assessment

The context worth knowing for women: a lot of you hesitate about HRT because of  research published in the early 2000s (the WHI trial) that generated alarming headlines.

What those headlines rarely included was that the women in that study were predominantly older, on oral oestrogen combined with a specific synthetic progestogen, and had been in menopause for longer before starting.

The evidence since then has substantially revised the picture, particularly for transdermal HRT started within the first decade of menopause.

If you've been avoiding HRT based on something you read 15 years ago, it's time to rethink and start a new conversation.

Having said that, it doesn’t mean that HRT is absolutely risk free now. It’s equally important for you to know the risks associated with it.

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Risks and Considerations

Breast Cancer Risk

HRT and breast cancer is something that is commonly written about, but is yet misunderstood as a topic in women's health. Here’s what the evidence currently says -

Combined HRT (oestrogen plus progestogen) is associated with a small increased risk of breast cancer. The magnitude depends on the type of progestogen, the duration of use, and the delivery method. Micronised progesterone (the closest to the body's own progesterone) appears to carry a lower risk than synthetic progestogens. Transdermal progestogen may have a lower risk as compared to the oral version.

Oestrogen-only HRT (for women who have had a hysterectomy) is not associated with an increased breast cancer risk. Some data suggest that it may even be protective.

To give you some numbers: the absolute increase in risk from 5 years of combined HRT can be compared to the risk associated with drinking a glass of wine a day, or being moderately overweight. It is a real risk that deserves to be part of your decision. It is not the only factor.

Blood Clot and Stroke Risk

Oral oestrogen tablets can increase the risk of venous thromboembolism (blood clots) compared with not taking HRT. Transdermal oestrogen versions, including patches, gels, and sprays do not carry this increased risk, because they simply avoid the liver and do not trigger the same changes in clotting factors.

This is why women with risk factors for clots, including women who are overweight or have a history of clotting disorders chose the transdermal options for HRT.

We can see that given the right choices, HRT can be a really good option for most women. We say ‘most’ for a reason. There are some cases where HRT may not be the best option.

Who HRT May Not Be Suitable For

• Women with a personal history of oestrogen-receptor positive breast cancer (some exceptions may apply under specialist supervision)
• Women with unexplained vaginal bleeding (this needs investigation before starting HRT)
• Women with active liver disease
• Women with a history of blood clots who cannot use transdermal HRT

Note: These are starting points for a clinical conversation, not absolute exclusions in all cases. A clinician who knows your full history is better placed to advise than any general guide.

HRT and GLP-1 Medications: What You Need to Know

This part now is specifically for you if you take or are considering taking a GLP-1 medication (such as Wegovy or Mounjaro) alongside HRT. The British Menopause Society issued guidance on this in April 2025.

Why Oral Progestogen Absorption May Be Affected

GLP-1 medications work by slowing how quickly food moves in your stomach. By food, we also mean other medications. For most medicines, however, this is clinically insignificant. But for oral progestogen, taken as a part of HRT, it may not be.

The reduced absorption of the progestogen component of oral HRT could mean your womb lining is not being adequately protected. This is particularly relevant for tirzepatide (Mounjaro), where reduced bioavailability of combined oral contraceptives has been documented. There isn’t enough data for semaglutide (Wegovy), but the BMS advises caution with all GLP-1 medications.

What the BMS Recommends

For women taking both, a GLP-1 medication and oral progestogen HRT, here’s what The British Menopause Society's current guidance states -

• Switch to a non-oral form of progestogen where possible. The Mirena coil (intrauterine system) is the most reliable option as progestogen is delivered directly to the womb lining and is not affected by gastric absorption
• A combined oestrogen and progestogen patch is a good alternative
• A temporary increase in dose for four weeks when starting or increasing the GLP-1 dose may be advised if staying on oral progestogen
• Transdermal oestrogen options like a patch, gel, or spray can be better as they do not carry the same interaction concern as oral oestrogen
• Discuss with your clinician immediately if there is any unscheduled or breakthrough bleeding on HRT while taking a GLP-1 medication. This may indicate hormonal fluctuations related to the interaction

The answer is not to avoid HRT or GLP-1 treatment. Both can be used safely and effectively together with the right formulations. What it does mean is that a clinical review before or shortly after starting both treatments is important, not optional.

This is why we, at SheMed, do not skip a blood test before prescribing anything. If you're considering both: SheMed treatment plans → include a free blood test and clinician review as standard.

Related: PCOS and menopause: what changes and what doesn't →

If you’ve come across other options beyond HRT on social media, or some other blog, or are waiting for a clinical review, and feel like more about them, here’s a bit from us -

Lifestyle approaches

·      CBT or cognitive behavioural therapy is NICE-recommended for mood symptoms and hot flushes, and you can self-refer via NHS Talking Therapies without a GP.

·      Paced breathing (slow, deep breaths during a hot flush) genuinely helps reduce intensity.

·      Resistance training protects bone density and muscle mass.

·      Cutting back on alcohol and caffeine in the evening often makes a bigger difference to night sweats than people expect.

Non-hormonal prescription options

·      Certain antidepressants like venlafaxine, paroxetine can reduce hot flush frequency and are useful for women who can't take HRT.

·      Fezolinetant (Veoza), approved by the MHRA in 2023, is the newer non-hormonal option specifically licensed for hot flushes. You can discuss this with your clinician if other approaches haven't worked.

Natural remedies

·      Phytoestrogens (soy isoflavones, red clover) have some evidence for reducing hot flush frequency, though the effect is inconsistent.

·      Black cohosh also has some supporting evidence but also some safety concerns with long-term use.

·      Magnesium and evening primrose oil are widely used but the evidence is limited.

Having said that, none of these provide the bone or cardiovascular protection that HRT does. You can think of them as complements to clinical treatments for managing symptoms rather than a replacement.

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How to Decide What's Right for You

You simply need to ask yourself three questions:

• Which of my symptoms are affecting my quality of life most significantly?
• Are there any contraindications or risk factors my clinician needs to know about?
• Do I have a preference for hormonal or non-hormonal approaches, and am I open to revisiting that preference based on clinical advice?

HRT may not be the best option for every one of you. But for most women under 60 with significant menopausal symptoms and no strong contraindications, the current evidence supports that it as the most effective available option.

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Feel like knowing more about menopause and how it affects various parts of your life? Keep reading!

Menopause symptoms, causes and what to expect →

Menopause and weight gain →

Average age of menopause → 

Menopause testing → 

Here’s a clinical team that understands the full picture.

At SheMed, our clinician-led programme includes a free at-home blood test covering thyroid, HbA1c, cholesterol, and liver enzymes before anything is prescribed.

Whether you're managing menopause symptoms alongside weight management, or considering how GLP-1 treatment fits with your existing HRT, our clinical team reviews your full metabolic picture, not just one part of it.

Start your journey only from £59 for your first month →

Frequently Asked Questions

Is HRT safe long-term?

For healthy women under 60 who start HRT within 10 years of menopause, the current guidance (British Menopause Society February 2026) is that the benefits outweigh the risks. Long-term use requires periodic review with a clinician, as risk-benefit assessment changes with age and individual health factors.

Can I take HRT if I'm also on weight loss medication?

Yes, HRT and GLP-1 medications can be used together, but the combination requires a clinical review if you take oral progestogen. GLP-1 medications may reduce the absorption of oral progestogen, which is the component of HRT that protects your womb lining. Switching to a non-oral progestogen (such as the Mirena coil or a combined patch) is generally preferred.

What's the difference between HRT and testosterone therapy for women?

HRT replaces oestrogen (and where needed, progesterone). Testosterone therapy for women is a separate and additional treatment, sometimes prescribed for low libido or reduced energy where these are attributed to testosterone decline. It is currently off-licence for women in the UK (licensed only for men) but prescribed by menopause specialists. It is not a replacement for or equivalent to oestrogen-based HRT.

How long do women usually stay on HRT?

There is no fixed duration. Many women use HRT for the duration of their most significant symptoms, typically several years. Some continue longer for bone protection or ongoing wellbeing. The decision to continue or stop should be reviewed with a clinician at least annually, taking into account current symptoms and any changes in health status.

Sources and Further Reading

1. British Menopause Society HRT Guide (February 2026)

2. British Menopause Society – Use of Incretin-Based Therapies in Women Using HRT (April 2025)

3. NHS – Hormone Replacement Therapy (HRT): Side Effects

4. NHS – Menopause and Perimenopause Treatment

5. NICE NG23 – Menopause: Identification and Management (updated 2024)

6. NHS Lothian RefHelp – HRT and Incretin-Based Therapies (GLP-1 and GIP RAs)

7. RAND Corporation – GLP-1 Agonists in Perimenopause (August 2025)

8. WHO – Menopause Fact Sheet

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