HRT: the most common questions, answered clearly
9 min read
The evidence on hormone replacement therapy has changed significantly in the last two decades. Many women are making decisions based on outdated information. Here's what we know now.
Is HRT safe?
For many people with menopause symptoms, the benefits of HRT may outweigh the risks. The balance depends on age, time since menopause, symptoms, medical history, the type of HRT and how it is taken. A qualified healthcare professional should assess this with you rather than applying one rule to everyone.
What are the risks?
Risk varies by formulation, route, duration and individual health factors. Combined HRT is associated with a small increase in breast-cancer risk, while oral HRT can increase blood-clot risk. Transdermal options may have a different risk profile. Ask your clinician to explain the absolute benefits and risks for your situation.
Types of HRT
Oestrogen-only HRT: for women who have had a hysterectomy. Combined HRT (oestrogen + progesterone): for women with a uterus — progesterone protects the uterine lining. Local oestrogen: applied vaginally as a cream, pessary, or ring — for urogenital symptoms only, with minimal systemic absorption and a very safe profile. Transdermal vs oral: patches, gels, and sprays deliver oestrogen through the skin, avoiding first-pass liver metabolism. This lowers VTE (blood clot) risk compared to oral tablets.
How long can you take it?
There is no fixed time limit. Current guidance suggests reviewing annually and continuing for as long as the benefits outweigh the risks. Many women benefit from longer-term use, particularly for bone and heart protection. The old advice to stop after 5 years is not supported by current evidence for most women.
If HRT isn't right for you
Some women can't take or prefer not to take HRT — due to certain types of breast cancer, uncontrolled migraines with aura, or personal preference. Non-hormonal options include: SSRIs/SNRIs, gabapentin, clonidine, fezolinetant (a new non-hormonal medication specifically for hot flushes), and CBT-based approaches.
Clinical reference points
Reviewed against these public guidance sources in September 2026. Content is educational and is not represented as clinician-reviewed.
Educational content only. This guide is intended to inform, not to replace medical advice. Always discuss symptoms and treatment options with a qualified healthcare provider who knows your full history.
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