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Menopausal hormone replacement (estrogen, with progestogen if you have a womb)

Menopausal Hormone Therapy: uses, side effects & precautions

Also known as HRT, Hormone replacement therapy, MHT, estradiol, conjugated estrogens, Premarin, Estradot, Evorel.

This information is for general guidance only and does not constitute medical advice. Always consult a qualified healthcare professional for personal medical concerns. In an emergency, call your local emergency number.

What it is used for

  • Hot flushes and night sweats of menopause
  • Vaginal dryness and discomfort
  • Mood and sleep symptoms related to menopause
  • Protecting bone strength in some people at risk of osteoporosis

How it works

It replaces estrogen that falls at menopause, easing symptoms caused by low hormone levels. If you still have a womb, a progestogen is added to protect the womb lining.

How it is taken

Comes as tablets, skin patches, gels, sprays, and vaginal creams, rings, or pessaries for local symptoms. The right type and combination depend on your situation. Take or apply it exactly as your doctor or pharmacist directs, and have regular reviews.

No doses here on purpose. The right strength and schedule depend on you — only a doctor or pharmacist should set them. Always follow your prescription and the label.

Common side effects

  • Breast tenderness
  • Bloating
  • Nausea
  • Headache
  • Mood changes
  • Irregular bleeding or spotting in the early months
  • Leg cramps
  • Skin irritation with patches or gels

Serious effects — get help

  • Signs of a blood clot (painful swollen calf, sudden breathlessness, chest pain)
  • Signs of a stroke (face drooping, arm weakness, slurred speech)
  • Severe chest pain
  • A new breast lump
  • Unexpected or heavy vaginal bleeding

If a reaction is severe — for example trouble breathing, swelling of the face or throat, or collapse — go to the nearest emergency room now or call your local emergency number. Do not wait for an online consultation.

Interactions to watch

  • Liver-enzyme-inducing medicines (some epilepsy and TB drugs, St John's Wort)
  • Some thyroid medicines may need review
  • Tell your clinician about all medicines and supplements

Who should take care

  • Risks and benefits differ by age, type, and personal and family history, so discuss them with your clinician
  • Tell your clinician about any history of breast cancer, blood clots, stroke, liver disease, or unexplained vaginal bleeding
  • Patches and gels may carry a lower clot risk than tablets for some people
  • Report any unexpected vaginal bleeding promptly
  • Attend regular reviews and screening

Frequently asked questions

Is it safe to take?
For many people in their menopause years the benefits outweigh the risks, but this depends on your health and history, so it is an individual decision with your clinician.
Do I need the progestogen part?
If you still have a womb, a progestogen is usually needed to protect the womb lining. If you have had a hysterectomy you may take estrogen alone.
Will it help vaginal dryness?
Yes. Vaginal estrogen creams, rings, or pessaries treat local dryness and can be used alone or alongside other forms.
How long can I stay on it?
There is no fixed limit for everyone; you and your clinician should review the benefits and risks regularly.

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