What is HRT (hormone replacement therapy)?

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All types of HRT contain an oestrogen hormone. If you take HRT it replaces the oestrogen that your ovaries no longer make after the menopause.

HRT is available as tablets, skin-patches, gels, nasal spray, or implants which are put under the skin. There are several brands for each of these types of HRT. All deliver a set dose of oestrogen into the bloodstream.
However, if you just take oestrogen then the lining of the uterus builds up. This increases the risk of developing cancer of the uterus. Therefore, the oestrogen in HRT is usually combined with a progestogen hormone. The risk of cancer of the uterus is very much reduced by adding in the progestogen. In many HRT products, the oestrogen and progestogen are combined in the same tablet or patch, but they can be taken separately. If you have had a hysterectomy, you do not need a progestogen.
An option to ease symptoms just in the vaginal area is to use a cream, pessary, or vaginal ring that contains oestrogen.

How do I take HRT?

Different women prefer different methods of taking
HRT. For example, some women prefer to wear a patch rather than take
tablets. You doctor or practice nurse can give you information about
the pros and cons of the different types of HRT. In general:

If you start HRT when you are still having periods, or have just finished periods

You will normally be advised to use a 'cyclical combined HRT' preparation. There are two types:

Monthly
cyclical HRT - you take oestrogen every day, but progestogen is added
in for 14 days of each 28-day treatment cycle. This causes a regular
bleed every 28 days, similar to a light period. (They are not 'true'
periods, as HRT does not cause ovulation or restore fertility. The
progestogen causes the lining of the uterus to build up which is then
shed as a 'withdrawal' bleed every 28 days when the progestogen part is
stopped.) Monthly cyclical HRT is normally advised for women who have
menopausal symptoms but are still having regular periods.
Three-monthly cyclical HRT - you take oestrogen every day and then
you also take progestogen for 14 days, every 13 weeks. This means that
you have a bleed every three months. This is normally advised for women
who have menopausal symptoms but are having irregular periods.

You may switch to a continuous combined HRT (see below) if you
have been taking cyclical combined HRT for some time but are now over
the age of 54. This is because at least 8 in 10 women are thought to be
postmenopausal by the age of 54.

If you start HRT a year or more after your periods have stopped

If
your periods have stopped for a year or more, you are considered to be
postmenopausal. If this is the case, you will normally be advised to
take a 'continuous combined HRT preparation'. This means that you take
both an oestrogen and a progestogen every day. The dose and type of the
oestrogen and progestogen are finely balanced so that they usually do
not cause a monthly bleed. However, you may have some irregular
bleeding when you start taking this form of HRT. You should see your
doctor if this bleeding continues for more than a few months after
starting HRT, or if you suddenly develop bleeding after some months
with no bleeding.

If you have had a hysterectomy

You will only
need to take HRT that contains oestrogen. The progestogen is only added
in to other types of HRT so that the lining of the uterus (womb) does
not build up and increase your risk of developing cancer of the uterus.
So, if your uterus has been totally removed, progestogen is not needed.

Note:
if you have had a sub-total hysterectomy (where the main part of your
uterus was removed, but your cervix was not) your GP may need to make
sure that there is no trace of uterine tissue left before prescribing
oestrogen-only HRT. It is not safe to take oestrogen-only HRT if you
have any uterine tissue remaining. Therefore, your GP may prescribe
cyclical combined HRT for three months or so. If you do not have any
bleeding during this time, it is unlikely that there is any uterine
tissue left and you can start oestrogen-only HRT.

If you mainly have genital symptoms

You may
choose to try some vaginal oestrogen cream to help your symptoms. This
alone may be enough to relieve symptoms in some women who would prefer
this option or who cannot take other forms of HRT for some reason.