About HRT
(Hormone Replacement Therapy)
Hormone Replacement Therapy (HRT) is an effective and well-established treatment for symptoms related to perimenopause and menopause. It works by replacing and supporting the hormones that naturally fluctuate and decline during this life stage, including oestrogen, progesterone and testosterone.
At Manchester Menopause Hive, we prescribe HRT where appropriate, thoughtfully and individually. Our approach is evidence-based, and tailored to your symptoms, medical history, lifestyle, and personal preferences.
The term body-identical HRT refers to hormones that are identical in molecular structure to those produced by the ovaries prior to menopause. These hormones are derived from plant sources, such as the yam plant.
Body-identical oestrogen and progesterone are considered very safe when prescribed appropriately. In particular, transdermal oestrogen (absorbed through the skin) does not carry the small increased risk of blood clots associated with older oral synthetic HRT.
This means that many people who may previously have been told they could not use HRT, for example due to age, migraine, body weight, or cardiovascular risk factors, may still be able to use it safely following specialist assessment.
Our prescribing approach
We often prescribe hormones separately rather than as combined preparations. This allows:
- Greater flexibility with dose adjustments
- More precise symptom control
- Easier identification and management of side effects
If changes are needed, we can adjust one element of your treatment without altering the entire regime.
Oestrogen
Fluctuating or declining oestrogen levels are responsible for many of the symptoms associated with perimenopause and menopause.
Oestrogen receptors are found throughout the body, including the brain, joints, skin, muscles, bladder, and cardiovascular system. This helps explain why symptoms can be wide-ranging and sometimes unexpected.
Symptoms may include hot flushes, night sweats, anxiety, low mood, sleep disturbance, joint pain, brain fog, headaches, frozen shoulder, palpitations, and changes in skin or hair, although this list is not exhaustive.
Symptoms can be more difficult to recognise in people using hormonal contraception, including the Mirena coil, which can suppress natural cycles.
How oestrogen is prescribed
We usually, but not always, prescribe oestrogen in transdermal form, meaning it is absorbed through the skin. Options include:
- Gels
- Patches
- Sprays
- Tablets
Transdermal oestrogen provides stable hormone levels and avoids first-pass metabolism through the liver, contributing to its favourable safety profile.
The most suitable preparation for you will be discussed during your consultation.
Things to consider
Oestrogen gels
Products such as Oestrogel and Sandrena are applied daily to the outer arms or inner thighs. They are particularly useful when starting HRT, as the dose can be adjusted easily. The oestrogen spray, Lenzetto is very similar in that it is also a daily preparation.
Oestrogen patches
Patches may be oestrogen-only (for example, Evorel or Estradot) or combined with a progestogen (for example, Evorel Conti). Patches are usually applied below the waist and changed twice weekly, making them convenient for many people.
Progesterone
If you have a womb and have not had a total hysterectomy, progesterone is required to protect the lining of the womb when using oestrogen.
We often use micronised progesterone (Utrogestan), which is body-identical and generally well tolerated. The most appropriate regimen for you, whether cyclical or continuous, will be discussed during your consultation. Micronised progesterone is very different to the synthetic progestins that are used in hormonal contraceptive pills and often is better tolerated. For some women other progestogen options may be more appropriate, such as drosperinone, dydrogestone.
The Mirena coil is another excellent way of using progestogen for endometrial protection and is excellent at managing problematic bleeding during perimenopause. Your specialist will talk you through the option that will best suit your individual needs.
In certain situations, progesterone may be recommended for medical reasons even after hysterectomy, for example in people with a history of endometriosis. This is assessed on an individual basis.
Progesterone can also provide additional benefits, particularly for sleep and anxiety and some women find it helpful to use micronised progesterone for this reason, even when they don’t need it for endometrial protection, for example with the Mirena coil, or after a hysterectomy. This is off licence but can be considered in individual circumstances. Similarly, some women in early perimenopause find that starting with a progesterone-only regime is helpful, but again this is off licence and needs to be considered on an individual basis.
Despite these benefits, around 1 in 20 people may experience progesterone intolerance, which can include low mood, irritability, or a sense of emotional flatness. In many cases, these symptoms improve as the body adapts, but if they persist or are severe, alternative options may need to be explored.
Local vaginal oestrogen
Low oestrogen levels can lead to changes in the vulva, vagina, bladder, and urinary tract. This is known as genitourinary syndrome of menopause (GSM). Symptoms may include:
- Vaginal dryness, itching, or soreness
- Discomfort during penetrative sex or cervical screening
- Recurrent urinary infections
- Urinary urgency or frequency
- Discomfort with sitting, cycling, or exercise
These symptoms can also occur after childbirth, during breastfeeding or with certain types of hormonal contraception.
Treatment options
Vaginal moisturisers and lubricants can be helpful, and we advise avoiding products with strong scents, or perfumed soaps, which can irritate sensitive skin.
Low-dose vaginal oestrogen treatments are very effective at restoring vaginal tissue health, bladder and pelvic floor function and natural lubrication. Absorption into the bloodstream is minimal, and these treatments are considered safe for the majority of people.
They can often also be used by many people who have had or are undergoing treatment for hormone-sensitive cancers, including breast cancer, although this may require liasing with your oncology team.
A range of preparations is available, and we will discuss the most suitable option based on dexterity, lifestyle, and preferences.
Testosterone
Testosterone is produced by the ovaries and adrenal glands and plays an important role in sexual desire, arousal, and orgasm. Levels naturally decline with age and may fall more abruptly following surgical or medical menopause, or in Premature Ovarian Insufficiency.
Guidelines suggest that a trial of testosterone may be considered if libido remains low despite optimised oestrogen and progesterone treatment and if vaginal symptoms have been adequately addressed.
Current research does not support the use of testosterone routinely for symptoms such as low mood, fatigue, or brain fog, although we do anecdotally see improvements in these areas for many women who use it and therefore we do prescribe it at Manchester Menopause Hive for these reasons when appropriate to consider this.
Prescribing testosterone
Testosterone is prescribed off-licence for women in the UK. It is important that baseline testosterone levels are assessed before starting treatment.
Options include:
- Androfeme, a testosterone cream licensed for female use in Australia and available in the UK on private prescription only.
- Testogel, a gel product which comes in a sachet, used in very small doses.
These are applied daily to the outer thigh or buttock. Blood tests are used to monitor levels and ensure they remain within the female physiological range.
Not all women who trial testosterone will experience a difference in their symptoms and so we would not recommend continuing it if no benefits have been achieved after 6 months
It may take up to 6 months to notice benefits. Many people who respond well describe testosterone as the missing piece in their HRT regime.
Meet our HRT specialists
Our BMS-registered menopause doctors and specialists are at the heart of everything we do.
We provide personalised consultations, expert guidance, and ongoing support across perimenopause, menopause, and PMDD, helping you feel informed, supported, and confident in your care.
HRT FAQs
Is HRT safe?
For the majority of people, HRT is a safe and effective treatment when prescribed appropriately. The type of hormones used, the route of administration, your age, time since menopause, and your individual health profile all matter.
Transdermal body-identical oestrogen, combined with micronised progesterone where needed, has a very favourable safety profile and is recommended by NICE and the British Menopause Society. HRT also offers benefits to your future health. Your clinician will assess your personal risks and benefits during your consultation.
Will HRT cause weight gain?
HRT itself does not cause weight gain. Many people notice changes in body composition during perimenopause and menopause due to hormonal shifts, ageing, stress, sleep disruption, and changes in metabolism.
For some, HRT may actually make weight management easier by improving sleep, energy levels, and joint comfort, which can support movement and activity.
Does HRT increase the risk of breast cancer?
The relationship between HRT and breast cancer depends on the type of HRT used and the duration of use.
For the majority of women, family history and lifestyle factors such as weight, alcohol intake, exercise are far more significant risks to us developing breast cancer than HRT is.
Your individual risk factors and any HRT related risks will be discussed with you in detail during your consultation
Can I take HRT if I have migraines?
Yes, many people with migraine can safely use HRT. In fact, stabilising hormone levels can improve migraine symptoms for some.
Transdermal oestrogen is generally recommended, as it provides more stable hormone levels and does not increase stroke or clot risk in the way that oral oestrogen can. Your migraine history will be explored in detail before prescribing.
Can I start HRT later in life?
HRT is most commonly started in perimenopause or within 10 years of menopause. However, there is no ‘time limit’ and it may still be appropriate to start HRT later in life for some people, depending on symptoms, health status, and individual risk factors.
This requires careful specialist assessment and a personalised discussion.
How long can I stay on HRT?
There is no fixed time limit for HRT use. Many people use HRT for several years, while others continue longer to support symptom control, bone health, and quality of life.
Annual reviews are required to reassess benefits, risks, and treatment choices. As long as benefits continue to outweigh risks, it is generally considered appropriate to continue HRT long term if needed.
What if HRT does not fully resolve my symptoms?
Commonly adjustments and tweaks to HRT are required following initiation in order to achieve the right dose and regime for you. We always recommend discussing with your specialist what changes may be required over time to ensure that your HRT is as helpful as it can be.
In addition, HRT can be very effective, but it is not usually the whole piece of the puzzle. Symptoms may be influenced by sleep, stress, mental health, life pressures, or underlying medical conditions and these often need to be addressed in order to see the extent of changes many women would like to.
We take a whole-person approach and may discuss lifestyle factors, non-hormonal treatments, or further investigations where appropriate.
Will I still have periods on HRT?
This depends on the type of HRT prescribed and where you are in your menopause transition.
People in perimenopause are often prescribed cyclical/sequential HRT and may continue to have regular or predictable bleeding. After menopause, continuous combined HRT is usually recommended, which aims to stop bleeding altogether.
Any unexpected bleeding on HRT should always be reviewed.
Can I take HRT if I have had cancer?
This depends on the type of cancer and the treatments you have received.
HRT may be appropriate after some cancers but is usually avoided after hormone-sensitive breast cancer. Vaginal oestrogen can often be used safely even in this context due to minimal absorption.
Specialist assessment and, where needed, discussion with your oncology team are essential.
How soon will I feel better after starting HRT?
Some symptoms, such as hot flushes and sleep disturbance, may improve within a few weeks. Others, including mood, energy, joint pain, and cognitive symptoms, can take several months.
Dose adjustments may be required over time so your dose can be titrated to your symptoms.
Do I need blood tests before starting HRT?
Routine blood tests are not usually required to diagnose perimenopause or menopause, as this is a clinical diagnosis based on symptoms and history.
Blood tests may be used in certain situations, for example in Premature Ovarian Insufficiency, complex cases, or when starting or monitoring testosterone treatment.
HRT & MENOPAUSE SUPPORT
Book an appointment with one of our menopause and HRT specialists to discuss your symptoms, treatment options, and next steps.
