Understanding HRT

If you're experiencing troublesome menopause symptoms, you might come across the term Hormone Replacement Therapy (HRT). This treatment is used to help women* manage symptoms associated with menopause, such as hot flushes, night sweats and disrupted sleep.

Like any treatment, HRT isn't right for everyone, and you might have questions about how it works, the different types available and any potential side effects. We're here to help answer those questions and help you feel more informed when considering your options.

Hormone Replacement Therapy (HRT) works by replacing the hormones (primarily oestrogen) that naturally decline during the stages of menopause and perimenopause.

Symptoms are brought on by the hormonal changes in the body, so helping to restore these hormone levels can help reduce the physical and emotional effects of menopause.

There are different ways to take HRT, including in the form of:

• Tablets
• Skin patches
• Gels
• Sprays
• Vaginal creams
• Vaginal pessaries
• Vaginal rings

Each treatment option brings its own benefits along with potential side effects. A healthcare professional can help you decide which treatment option may be best for you.

There isn't just one type of HRT. The best option depends on factors such as your specific symptoms, age, medical history and whether you've had a hysterectomy (removal of the womb).

For many women, HRT can significantly improve quality of life before, during and after menopause. Potential benefits of taking HRT include:

• Reduced hot flushes and night sweats
• Improved sleep
• Reduced joint aches and pains
• Improved mood and emotional wellbeing
• Better concentration and mental clarity
• Less vaginal dryness and discomfort
• Protection against bone loss and osteoporosis

Not everyone experiences the same benefits, but you should typically find that your symptoms improve after a few days or weeks of taking HRT.¹

Like all medicines, HRT can cause side effects, although not everyone experiences them. Serious side effects are usually rare and can depend on the type of HRT you take, how long you take it for and your own health history.

Some side effects might include:

• Breast tenderness
• Headaches
• Nausea
• Bloating
• Mood changes
• Leg cramps
• Irregular bleeding, especially during the first few months**

Although it's a common misconception, there is no strong evidence to suggest that weight gain is an associated side effect of taking HRT. Menopause and weight management can be a challenge for a lot of women due to natural ageing and the hormonal changes in the body, but there is no direct correlation with HRT.

You might be advised to stick with HRT treatment for around 3 months to allow your body to adjust and for symptoms to improve, but you can speak to a healthcare professional if you're concerned.

More serious risks associated with HRT that are worth being aware of include:

• Breast cancer – HRT can slightly increase the risk of breast cancer, so if you have a history of it in the family then you might be advised to avoid HRT. However, to put the statistics into perspective, there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years.^1.1
• Blood clots – HRT tablets specifically can increase the risk of blood clots, but the risk is still very low. If you’re at risk of blood clots then you might be advised to use HRT patches, spray or gel rather than tablets.^1.2
• Stroke – HRT tablets specifically can increase the risk of stroke, but the risk is still very low, particularly if you’re under 60.^1.3

**While HRT can sometimes cause postmenopausal bleeding, it's important to get any instance of bleeding after menopause checked by a medical professional.

HRT is a prescription-only medicine, so you'll need to speak to your GP or a Pharmacy Independent Prescriber to understand whether the treatment is right for you. To help your appointment go as smoothly as possible, the following prompts might help you navigate the conversation:

• Explain the symptoms you’re experiencing and the effect they’re having on your daily life (it might help to write these down before your appointment)
• List any medications or supplements that you’re currently taking
• Note down any specific questions you’d like answered (remember, there are no ‘silly’ questions when it comes to your health!)

To get the most from your appointment, it's important to be as specific as you can. This might mean discussing quite intimate topics, such as your sexual health, and symptoms such as vaginal dryness or painful sex. Neither of these are things to be ashamed of, but we understand that they can feel uncomfortable to talk about. Your GP or pharmacist will help reassure you, and you can take a friend or family member into the appointment with you if you need a bit of extra support.

During the appointment, you might be asked about your medical history and lifestyle. If HRT is deemed unsuitable for you, don't worry – there are alternative treatment and support options that you can explore.

If you or your prescriber decide that HRT isn't the right fit for you, then don't worry – there are non-hormonal alternatives that can help you manage menopause symptoms.

Depending on your specific symptoms, recommended approaches might include:

• Non-hormonal prescription treatments (such as antidepressants that can help stabilise your mood, or medicines that can help treat moderate-to-severe hot flushes)
• Over-the-counter products to help treat vaginal dryness
• Cognitive Behavioural Therapy (CBT)
• Stress management techniques
• Eating a balanced diet
• Regular exercise

The HRT Prepayment Certificate (PPC) is a scheme that launched in 2023, allowing eligible patients across England to receive a year's supply of HRT medicine for the price of two single NHS prescriptions. Essentially, you can make a one-off payment of £19.80, then order and collect as many HRT medicines as you need over the following 12 months.

You can apply for your HRT PPC through the NHS website to get started, or ask in your local Well Pharmacy.

Once you have your PPC, simply show it in the pharmacy when collecting your prescription. A digital or paper copy will be accepted. You might then be asked to complete an exemption declaration.

Just a heads up that the HRT PPC is specific to HRT treatments, so you'll still need to pay separately for non-HRT prescriptions. Some HRT treatments might not be covered by the Prepayment Certificate either. You can find the full list of medicines covered by the HRT PPC on the NHS website.