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Hormone therapy (HRT)

Hormone therapy is an effective treatment for bothersome hot flashes and night sweats. Whether it's right for you depends on your symptoms, preferences, and medical history.

On this page

6 min read

  1. 01What is HRT?
  2. 02Types of hormone therapy
  3. 03Benefits & considerations
  4. 04Frequently asked questions

What you will get

  • Potential benefits
  • Discuss with your doctor
  • Discuss HRT with your clinician
Informational

This information is purely informational and not medical advice. Discuss hormone therapy with your GP or gynecologist. Every situation is different.

01

What is HRT?

Hormone therapy for menopause uses estrogen, usually together with a progestogen if you have a uterus. There's a difference between treatment that works throughout the body and local vaginal treatment. Lifestyle and hormone therapy can complement each other.

02

Types of hormone therapy

Estrogen

Estrogen

Systemic estrogen works throughout the body and reduces hot flashes and night sweats. Low-dose vaginal estrogen mainly treats local dryness and pain; it doesn't treat hot flashes. So the two forms aren't interchangeable.

  • Systemic: tablets, patches, gel, or spray
  • Local: low-dose vaginal tablets, pessaries, cream, or a purpose-made ring

Progesterone

Progesterone and other progestogens

With systemic estrogen and a uterus present, a progestogen is usually also needed to protect the uterine lining. Progesterone is one option; levonorgestrel is another progestogen. With low-dose vaginal estrogen alone, an additional progestogen usually isn't needed. Your doctor determines what fits your situation.

  • Registered oral preparations containing progesterone or another progestogen
  • A suitable hormonal IUD with levonorgestrel, depending on indication and duration of use

Combined

Combined therapy

With combined therapy, you use both estrogen and a progestogen. This can follow a sequential or continuous schedule. The choice depends partly on your bleeding pattern and menopause status; don't adjust the schedule yourself.

  • Sequential: estrogen daily, progestogen for part of the month
  • Continuous: estrogen and progestogen daily

Testosterone

Testosterone

May be a discussion point for persistent reduced libido that does not improve with other support. Low dosing and monitoring belong with a specialist.

  • Gel (low dose)
  • Cream
03

Benefits & considerations

Potential benefits

  1. 01Reduces hot flashes and night sweats
  2. 02Can improve sleep, partly because night sweats decrease
  3. 03Helps counteract bone loss while you're using it
  4. 04Local vaginal treatment can reduce dryness and pain

Discuss with your doctor

  1. 01Your personal medical history
  2. 02Family history (breast, ovarian, uterine cancer)
  3. 03Risk of thrombosis or cardiovascular disease
  4. 04Timing: when to start and how long to use
  5. 05The right form and dosage for your situation
04

Frequently asked questions

  • When can I start HRT?

    You can discuss hormone therapy as soon as menopause symptoms interfere with your daily life; you don't have to wait until your periods stop. The often-cited favorable starting window applies to women under 60 or within 10 years of menopause, with no contraindications. This is not a timeframe counted from the start of perimenopause, and it's no guarantee that treatment is suitable for everyone.

  • How long do you use HRT?

    There's no fixed duration that applies to everyone. Regularly review with your doctor whether the benefits still outweigh the risks and what dose is still needed. Starting after age 60, or well after menopause, calls for a different consideration than continuing treatment you started earlier.

  • Are there side effects?

    As with all medicines, side effects are possible. Tender breasts, headache, or nausea can occur at first and often settle. Discuss concerns or persistent symptoms with your clinician.

  • Are there natural alternatives?

    Nutrition, movement, and sleep support your health, but aren't automatically as effective against hot flashes as hormone therapy. Herbs and supplements can have side effects and interactions. Also ask about proven non-hormonal options if hormone therapy isn't right for you.

Based on

Lifestyle or hormone therapy is not an either-or choice

A suitable treatment requires an individual assessment. The ten-year starting window refers to menopause, not to the start of perimenopause.

Distinguish between systemic oestrogen, local vaginal treatment and protection of the uterine lining. HRT is not contraception.

Next step

Bring your main symptoms, bleeding pattern, medication list and questions to a doctor's appointment. Do not change dosage or schedule based on this page.

Sources

Continue reading

07Rest & sleepRead how sleep symptoms and hormone therapy can be a discussion point01All about perimenopauseUnderstand the hormonal changes behind your symptoms