Hormone replacement therapy (HRT)

You can order HRT medication safely and discreetly online with Asda Online Doctor, simply:

1. Complete a medical questionnaire – Share your health history and symptoms in a few minutes.
2. Doctor review – A registered doctor checks your answers and confirms if HRT is suitable.
3. Fast delivery or collection – Get your medication delivered to your home for free, or collect from your local Asda Pharmacy.
4. Ongoing care – You can message your doctor through your online account for follow-up advice or repeat prescriptions.

If you are unsure whether you have menopause, the Asda Online Doctor medical questionnaire can help a doctor assess your symptoms and, based on your answers, whether menopause treatment is suitable.

What is menopause and hormone replacement therapy?

Menopause is when periods stop due to falling hormone levels, usually between the ages of 45 and 55. There are different stages of the menopause. For example, perimenopause is the stage when symptoms start, and post-menopause is when it has been a year since your last period.

Hormone replacement therapy (HRT) replaces oestrogen and progesterone, and sometimes testosterone, to relieve symptoms you may experience as a result of the menopause and the changes occurring in the body, helping to protect long-term health.

If you have had a hysterectomy, oestrogen-only HRT is recommended. Combined HRT (oestrogen and progestogen) is needed if you still have your womb. This protects the lining of the uterus from becoming too thick, reducing the risk of womb cancer.

Stages and symptoms of menopause

Menopause happens in stages, starting with perimenopause, when hormone levels begin to fall and periods become irregular. Menopause itself is when you have not had a period for 12 months, while post-menopause refers to the years afterwards. Symptoms can appear at any stage and may last for several years.

Common symptoms include:

• hot flushes and night sweats
• changes to your periods, such as irregular or lighter bleeding
• difficulty sleeping and fatigue
• low mood, anxiety, or mood swings
• problems with memory or concentration ("brain fog")
• headaches or migraines
• joint or muscle pain
• vaginal dryness, itching, or pain during sex
• reduced sex drive
• recurrent urinary tract infections (UTIs)
• skin changes, including dryness or itchiness
• weight gain or changes in body shape

Symptoms vary from person to person. Some improve with time, while others, such as vaginal dryness or joint pain, can continue after menopause.

HRT can be prescribed in 2 main ways, depending on whether you are still having periods or are post-menopause.

Hormone replacement therapy (HRT) works by restoring the oestrogen and progesterone levels that fall during menopause. This helps relieve symptoms such as hot flushes, mood swings, and vaginal dryness, while also protecting bone strength and lowering the risk of osteoporosis.

Symptom relief timeline

Most people start to notice improvements in their symptoms on HRT within 2 to 6 weeks of starting HRT.

A doctor will usually review your treatment after 3 months to check how well it is working and adjust your dose or type of medication if needed.

Effectiveness of HRT

HRT is one of the most effective treatments for managing menopause symptoms in the short term and long term.

Short term

Studies show that HRT can:

• significantly reduce hot flushes by 77%
• improve sleep and mood swings

This is because HRT works by regulating oestrogen levels to normal levels.

Long term

Long-term use of HRT can help to maintain bone density, lowering the risk of fractures associated with osteoporosis.

HRT comes in different forms. These include:

• tablets
• patches
• gels
• sprays
• vaginal oestrogen
• intrauterine systems

Each type has benefits and drawbacks, so the best option depends on your symptoms, health risks, and personal preference. Some less common options include tibolone and testosterone, usually prescribed in specific circumstances.

Tablets

Tablets are one of the most common ways to take HRT and are available as oestrogen-only or combined options. Examples include Elleste Duet Conti, Kliofem, Femoston-conti, and Kliovance.

They are simple to use, but studies show a slightly higher risk of blood clots and stroke compared to patches or gels. Some people also experience indigestion or nausea.

Patches

Patches are applied to the skin and release hormones gradually into the bloodstream. Examples include Evorel Conti and Estradot.

They are convenient, easy to use, and do not increase the risk of blood clots. Some people may find they irritate the skin or do not stick well, especially on moisturised areas.

Gel and spray

Oestrogen gel and spray are absorbed through the skin, providing steady hormone levels. Like patches, they carry no increased clot risk.

Gel must be rubbed onto the skin and allowed to dry, while spray is quicker to apply but requires avoiding washing the area for a set time.

Vaginal oestrogen

Vaginal creams, pessaries, and rings deliver low-dose oestrogen directly to the vagina. Examples include Ovestin cream, Vagifem vaginal tablets, estriol cream, Vagirux vaginal tablets.

They are effective for symptoms such as dryness, irritation, or painful sex, but do not treat hot flushes or mood changes. Vaginal oestrogen does not carry the usual risks of systemic HRT and can be used long-term.

Intrauterine system (Mirena coil)

The Mirena coil releases progestogen into the womb and can be combined with oestrogen tablets, patches, or gels to provide complete HRT.

It also works as a contraception and can reduce heavy periods. Some women experience irregular bleeding or cramps after fitting, but it usually settles within a few months.

Tibolone

Tibolone is a tablet that acts like combined HRT, with added testosterone-like effects. It can relieve hot flushes, low mood, and reduced sex drive.

It is only suitable for women who are in the post-menopause stage and may not be as effective as standard combined HRT for some symptoms.

Testosterone

In certain cases, specialists may prescribe testosterone gel for women with low libido that does not improve with standard HRT. It is not licensed in the UK for menopause symptoms, but can be considered under specialist care. Possible side effects include acne, hair growth, or weight changes.

If you’re unsure which HRT may be best for you, here is a comparison overview table of different kinds of treatment to help you decide your next steps:

HRT is taken daily, either as tablets, patches, gels, sprays, or vaginal treatments. The method depends on your symptoms, health, and preferences. Most people start on a low dose, with treatment reviewed at 3 months and then yearly to check effectiveness and HRT side effects.

When to start HRT

You can start HRT as soon as menopause symptoms interfere with your daily life. If you are still having periods, your doctor may advise beginning at the start of your menstrual cycle. Those with premature or early menopause are usually advised to continue until at least age 51.

How to take HRT day to day

Tablets: Taken orally once a day, with or without food, at the same time each day.

Patches: Applied to clean, dry skin below the waist, usually changed once or twice a week.

Gel or spray: Smoothed or sprayed onto the skin daily; allow to dry fully before dressing.

Sequential combined HRT: Oestrogen every day, with progestogen for 10 to 14 days each month. Withdrawal bleeding is expected.

Continuous combined HRT: Oestrogen and progestogen taken daily without a break, suitable once you are post-menopause.

What to do if you miss a dose or patch

Tablets: If you forget a dose, take it as soon as you remember, unless it is nearly time for your next one. Do not double up.

Patches: If a patch falls off, apply a new one as soon as possible and continue on your usual schedule.

Gel or spray: If you miss an application, use it when you remember, then continue as normal the next day.

Missing a dose may cause spotting or irregular bleeding, but usually does not make treatment unsafe.

How long to take HRT

Most people take HRT for 2 to 5 years, although longer may be appropriate if symptoms persist.

Annual reviews with a doctor help balance benefits against risks. Vaginal oestrogen, used for dryness, can be continued long-term as it does not carry the same risks.

When to switch from sequential to continuous HRT

Sequential HRT is recommended if you still have periods or are within 12 months of your last one. Once you have been period-free for around a year, your doctor may suggest moving to continuous combined HRT to avoid monthly bleeding.

Stopping HRT

You can stop suddenly, but tapering gradually over 3 to 6 months often helps reduce the chance of symptoms returning. If symptoms reappear and are difficult to manage, your doctor may suggest restarting or adjusting your treatment.

The main benefits of HRT include:

✓ relief of menopause symptoms – such as hot flushes, mood swings, poor sleep, and vaginal dryness, usually within weeks

✓ protects long-term health by strengthening bones – HRT reduces the risk of any clinical fracture by around 28%, major osteoporotic fractures by 40%, and hip fractures by 34%

✓ supports muscle strength – HRT helps counteract menopause-related muscle loss, especially when paired with regular exercise

Like any medicine, HRT can cause side effects, but many people experience none or only mild symptoms. These usually settle within the first 3 months as your body adjusts.

If side effects persist or become severe, speak to your doctor, who may adjust your dose or type of HRT.

Common side effects of oestrogen include:

• headaches
• breast tenderness or pain
• unexpected vaginal bleeding or spotting
• feeling sick (nausea)
• mood changes, such as low mood or irritability
• leg cramps
• skin rash or itching
• diarrhoea
• hair thinning

Common side effects of progestogen include:

• changes in your periods, including spotting or breakthrough bleeding
• headaches
• nausea
• breast tenderness
• tiredness or dizziness
• low mood or depression
• mild skin changes, including rash or acne

Side effects of combined HRT

If you take combined HRT, you may notice a mix of oestrogen- and progestogen-related side effects.

Some people also experience irregular bleeding in the first 4 to 6 months, which usually settles with time.

Side effects of tibolone

Tibolone, a tablet that acts like combined HRT, can cause:

• breast tenderness
• stomach or pelvic pain
• unwanted hair growth
• vaginal discharge, itching, or thrush
• vaginal bleeding

Vaginal bleeding and HRT

Light or irregular bleeding is common in the first few months of treatment. With sequential HRT, you may have predictable monthly withdrawal bleeding. Whereas, with continuous HRT, bleeding often settles after 4 to 6 months.

Speak to your doctor if bleeding continues beyond this, becomes heavier, or starts after you have been period-free.

Weight changes

There is little evidence that HRT directly causes weight gain. Any changes are more likely linked to ageing and menopause itself. Research shows that the menopause can cause changes to body composition, particularly in the abdomen. Regular exercise and a balanced, healthy diet can help manage weight.

More serious risks

HRT has been linked to a slightly higher risk of:

• blood clots – rare, risk is lower with patches, sprays, or gel than with menopause tablets
• certain types of cancer, such as breast and ovarian – risk increases the longer HRT is taken, but returns to normal after stopping

Always attend recommended check-ups, and report suspected side effects through the Yellow Card scheme.

HRT is suitable for many people with menopause symptoms, but it is not recommended for everyone. A doctor will review your health and suggest the safest type, such as tablets, patches, or gels.

You may benefit from HRT if you:

• have frequent hot flushes, night sweats, or sleep problems
• reached menopause early (before 45) or prematurely (before 40)
• are at increased risk of osteoporosis or fractures
• find that menopause symptoms affect your quality of life

HRT may not be suitable if you:

• have had breast, ovarian, or womb cancer
• have a history of blood clots, heart attack, or stroke
• have untreated high blood pressure
• have liver disease
• are pregnant or breastfeeding

If HRT is not suitable for you, there are other ways to manage menopause symptoms. These include lifestyle adjustments, non-hormonal medicines, and complementary remedies. Some people may also benefit from regulated body-identical hormones prescribed by a doctor.

Lifestyle changes

Simple daily changes may ease common symptoms, like:

• exercising regularly to improve sleep and reduce hot flushes
• eating a balanced, healthy diet to support bone health and maintain weight
• wearing loose clothing and keeping your bedroom cool for night sweats
• cutting down on caffeine, alcohol, and spicy foods, which can trigger flushes
• stopping smoking to help reduce symptoms
• using vaginal lubricants or moisturisers for dryness

Other medication

Some prescription medications can help manage menopause symptoms without affecting hormone levels, such as:

• antidepressants (SSRIs and SNRIs) – may help with low mood, anxiety, or hot flushes and side effects can include nausea, dizziness, or reduced sex drive
• clonidine – can reduce hot flushes and night sweats, does not affect hormones, but can cause dry mouth, constipation, or drowsiness

Herbal and complementary remedies

Health shops sell products like black cohosh, red clover, evening primrose oil, ginseng, and St John’s wort. Some contain plant hormones that may act like oestrogen.

However:

• evidence for effectiveness is limited
• doses and long-term safety are unclear
• remedies like St John’s wort can interact with other medicines

You should always check with a GP or pharmacist before using herbal and complementary remedies.

Bioidentical vs body-identical hormones

When considering the best treatment for you and your menopause symptoms, knowing your options is key. Here is the difference between bioidentical and body identical hormones:

• bioidentical hormones – marketed as “natural,” but they are not regulated, and there is no evidence they are safer or more effective than standard HRT, and so are not recommended
• body identical hormones – regulated, thoroughly tested, and prescribed by doctors, and most HRT already contain body identical hormones

You should always consult your doctor if you are uncertain about medications that you feel could benefit you during the menopause. Finding safe treatment for your symptoms is important for your overall long-term health.