Hormone Replacement Therapy: The Practical To-Do List
Hormone Replacement Therapy: what is worth doing, what is worth avoiding, and when to stop and see a doctor.
Replacing oestrogen, with progestogen where the womb is present, to treat menopausal symptoms. The risk picture was widely misreported for two decades, and the current position depends heavily on age and time since menopause.
Key takeaways
- Most effective treatment: for vasomotor symptoms such as flushes
- Under 60 or within 10 years of menopause: benefits generally outweigh risks for most
- Most useful single change: Discuss your individual risk rather than relying on headlines.
- Commonest mistake: Oestrogen without progestogen if you have a womb.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Do
- Discuss your individual risk rather than relying on headlines
- Ask about transdermal routes if clot risk is a concern
- Ask about vaginal oestrogen for genitourinary symptoms specifically
- Review annually rather than continuing or stopping by default
Do not
- Oestrogen without progestogen if you have a womb
- Compounded bioidentical hormones from unregulated sources
- Stopping abruptly rather than discussing a plan
The numbers behind the list
Here are the figures the checklist is drawn from.
| Measure | Figure |
|---|---|
| Most effective treatment | for vasomotor symptoms such as flushes |
| Under 60 or within 10 years of menopause | benefits generally outweigh risks for most |
| Progestogen | needed alongside oestrogen if you have a womb |
| Transdermal oestrogen | not associated with the clot risk seen with tablets |
| Vaginal oestrogen | acts locally; suitable for many who cannot take systemic HRT |
If you change one thing
Discuss your individual risk rather than relying on headlines. It heads the list. If you take nothing else from this page, take that.
Where to go next
- Hormone Replacement Therapy: Sorting the Evidence From the Noise
- Understanding Hormone Replacement Therapy: A Plain-English Explainer
- Hormone Replacement Therapy — the reference entry
- What the Guidance Really Says About Underactive Thyroid
- Overactive Thyroid: Sorting the Evidence From the Noise
When to speak to a doctor
Always report bleeding after the menopause, unexpected bleeding on HRT, bleeding between periods or after sex — these need investigation. Seek urgent help for calf pain or swelling, chest pain, severe breathlessness, sudden severe headache, weakness on one side or vision loss. Report new breast lumps promptly.
Where this comes from
- NICE — Menopause: diagnosis and management
- British Menopause Society — HRT guidance
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
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