Oestrogen (in different forms) is the mainstay of HRT and is used to treat most of the menopausal symptoms, such as hot flushes, night sweats, and vaginal dryness. If it is taken alone, it can lead to a thickening of the lining of the womb (which increases the risk of endometrial cancer), and so it is combined with progesterone, either taken every day or for two weeks of each month. This is called combined HRT.

If a woman has had a hysterectomy to remove the womb then she could be treated with oestrogen-only HRT.
If you are still having periods or it has been less than a year since your last period, then HRT is given in a “cyclical” or “sequential” way which means you have oestrogen every day and progestogen for 12-14 days a month. This will cause a regular bleed.

Sometimes testosterone is added into an HRT regime if low libido (sex drive) remains a problem after the other symptoms of HRT have been treated.

There is another available synthetic hormone called Tibolone which can be used in women whose last period was over a year previously. It acts like a combination of oestrogen, progestogen and testosterone.

HRT comes in a variety of physical forms, such as gels, sprays, tablets, patches, coils, pessaries and creams. Over the years there has been a great deal of study into the benefits and potential risks of taking HRT. We know that using oestrogen transdermally (through the skin), in the form of a gel or a patch, is the safest way of taking oestrogen and there are very few women for whom this form of HRT would not be suitable. Oestrogen can also be given in an oral tablet, but it comes with additional risks which transdermal oestrogen does not have, such as an increase in the risk of blood clots.

HRT Patches can be both oestrogen-only and combined (oestrogen + progesterone). Some women find them to be very convenient, but some may find that the patches don’t adhere well to their skin or may cause irritation.

Oestrogen gels are a popular way to take oestrogen-only HRT. They need to be used with either a progesterone oral medication or the Mirena® (progesterone-containing coil) if the woman hasn’t undergone a hysterectomy. The gel is applied to the skin and can take a few minutes to dry.

There is also an oestrogen spray, which is easy to apply and very quick drying. As with oestrogen gels, it needs to be used with progesterone if a woman still has her womb.

Oestrogen creams and pessaries are a way of applying oestrogen directly to the vagina, which can be an effective way of treating vaginal dryness. There is almost no systemic absorption from using oestrogen in this way, which means it can used without the need for additional progesterone. A study has shown that this form of oestrogen is even safe for women who have had breast cancer: https://jamanetwork.com/journals/jamaoncology/article-abstract/2811413

To feel the full benefits of HRT takes a few months, but you may find that some symptoms, such as hot flushes and night sweats, start to improve after a few days. If you’ve been started on HRT, such as an oestrogen gel, you may be advised about parameters for increasing the dose before your next follow-up, so that you don’t have to wait for your next follow-up if your symptoms aren’t settling.