The Evidence · Hormones
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HRT: what it is, and who it actually suits

HRT is not one treatment. The hormone, the dose, the route and the timing all change who it suits.

Dr Edith Loo, Lead Clinician · MBBS, GDFM
Published 21 August 20261 min read
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What HRT is

Hormone replacement therapy replaces hormones the ovaries stop producing around menopause. Usually that means oestrogen, and progesterone alongside it if you still have a womb.

It is not one treatment. The hormone, the dose and the way it is delivered all change the answer for a given person.

The progesterone is not optional if you have a womb. Oestrogen alone thickens the womb lining. Progesterone protects it, which is why the two are prescribed together.

What it is for

Its clearest use is symptoms. Hot flushes, night sweats, disturbed sleep and vaginal dryness respond well.

It also protects bone density, which falls quickly in the years after menopause. That matters more the earlier menopause arrives.

The form changes the risk

THE ROUTE MATTERS AS MUCH AS THE DOSE
How the hormone enters the body changes what it does on the way.
TABLET
By mouth
Passes through the liver before reaching the rest of the body
PATCH OR GEL
Through the skin
Enters the bloodstream directly, bypassing that first pass
LOCAL
Vaginal
Acts where it is applied, with very little reaching the rest of the body
This is why two people on HRT can be on quite different footing.
Ask which route you are on. It changes the conversation about risk.

A tablet, a patch and a vaginal preparation are not interchangeable. Your doctor chooses between them based on your symptoms and your history.

Timing matters

01
Starting near menopause
Most guidance favours starting within a few years of the last period, when symptoms are active.
02
Starting much later
Beginning many years after menopause changes the balance of benefit and risk. It is a different conversation.
03
Early menopause
If menopause comes early, replacing hormones until the usual age is generally recommended rather than optional.
04
Reviewed, not set and forgotten
Symptoms change. So does your health. HRT is reviewed periodically, not left running unexamined.

What about the risks

Much of the public fear traces back to early reporting of a large trial in the early 2000s, in a population older than most women starting HRT today.

Later analysis softened that picture considerably, particularly for women starting near menopause. The risks are real but smaller and more specific than the headlines suggested.

Risk is personal, not general. Your age, how long since menopause, the route, the type of hormone, and your own history all change the answer. This is exactly the sort of decision that needs a consultation rather than an article.

Who it may not suit

Some histories make HRT unsuitable or require caution, including certain hormone sensitive cancers, some clotting disorders and active liver disease.

None of that is absolute, and alternatives exist. It is a discussion to have with your doctor rather than a rule you apply to yourself.

What it is not

It is not an anti ageing treatment, and it is not taken to slow ageing. Its purpose is symptoms and bone protection.

It is also not a decision you make once and never revisit. Most women who use it do so for a defined period, reviewed along the way.

What to ask

Ask which route you are being offered and why. Ask whether progesterone is included and what it is protecting.

Ask what the plan is for review, and what would make you stop. Those three questions cover most of what matters.

The bottom line

HRT is not one treatment, and the form, dose and timing all change the answer.

Its clearest use is symptoms and bone. Whether it suits you is a personal decision, made with a doctor who has your full history.

Dr Edith Loo
Lead Clinician · MBBS, GDFM
Edith leads the clinical side of PROTOCOL. She sets the reference ranges we report against, sees patients at 71 Robinson Road, and signs off every clinical claim we publish. She writes about screening, cardiovascular risk and the results patients bring her that nobody has explained.
Written and clinically reviewed by Dr Edith Loo, Lead Clinician, on 21 August 2026. General health information, not medical advice, and not a substitute for consultation with your own doctor.
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