What is HRT? What to know before your appointment

Hormone replacement therapy (HRT) — increasingly referred to as menopausal hormone therapy (MHT) — replaces the oestrogen and progesterone that the ovaries stop producing during menopause. It's the most effective treatment available for vasomotor symptoms like hot flashes and night sweats, and is also used to address mood, sleep, cognitive, and musculoskeletal symptoms associated with the menopause transition.

This article is an introduction to what HRT is, not a recommendation about whether you should take it. That decision involves your individual medical history and is a conversation for you and your GP or menopause specialist — ideally one where you arrive prepared.

Types of HRT

HRT comes in several forms, and what's appropriate depends on individual circumstances:

• Oestrogen-only HRT — typically for people who have had a hysterectomy, as oestrogen alone increases the risk of endometrial cancer in people with an intact uterus.
• Combined HRT — oestrogen plus progestogen, for people with an intact uterus. The progestogen protects the uterine lining.
• Routes of administration — patches, gels, sprays, tablets, pessaries, implants. Transdermal (skin-absorbed) oestrogen has a different risk profile from oral oestrogen — this is relevant to discussions about blood clot risk.

The risk conversation

HRT was significantly underused for many years following a 2002 study (the Women's Health Initiative) that reported increased risks of breast cancer and cardiovascular events. Subsequent analysis found that study had significant methodological issues — participants were older, many already had cardiovascular disease, and oral oestrogen was used. Current evidence suggests that for most people under 60 starting HRT within 10 years of menopause, the benefits substantially outweigh the risks.

This is a simplified summary. Risks are individual and depend on type of HRT, your personal and family medical history, and other factors. The point is that the conversation with your doctor should be based on current evidence — not on the narrative that dominated clinical practice for the decade following 2002.

Questions to ask your GP

Going into an appointment prepared makes a measurable difference. Useful questions include:

• Based on my symptom history, am I a good candidate for HRT?
• What type and route would you recommend for my situation and why?
• What are the specific risks given my personal and family medical history?
• How long would I be expected to take it, and what does the review process look like?
• What alternatives are available if HRT isn't appropriate for me?

Having a month or more of logged symptom data — frequency, severity, impact on sleep and daily life — also helps your GP understand the clinical picture before they start discussing options.