UK Registered DoctorsHRT explained: Everything you need to know about hormone replacement therapy for menopause and hormone imbalances
Menopause is a natural process in which your periods stop due to aging. It affects anyone who has periods, and usually happens to women between the ages of 45 and 55.
As part of menopause, your levels of the sex hormones oestrogen, progesterone and testosterone decline. This can cause symptoms such as hot flushes, night sweats and mood swings. But you can soothe these problems and enjoy a higher quality of life with hormone replacement therapy (HRT).
HRT for menopause replenishes lost hormones, restoring your natural bodily functions. It’s a safe, effective menopause treatment that alleviates unwanted symptoms and even provides protection against heart disease and osteoporosis (bone thinning).
The Online Clinic is a UK licensed clinic. The doctors at The Online Clinic are all GPs, and some have a special interest in women’s health. This group of GPs run the menopause clinic for HRT that offers convenient hormone replacement therapy online. After a short consultation and thorough evaluation of your medical history, a doctor can provide you with an online HRT prescription to treat symptoms of menopause.
Understanding menopause and hormone imbalance
What happens to hormones during menopause?
If you’ve gone 12 consecutive months without a menstrual period, you’re undergoing menopause.
The average age of menopause in the UK is 51 years old. But it can happen before the age of 45 (early menopause) or after 55.
During this time, your ovaries stop producing oestrogen, progesterone and testosterone. Low levels of these hormones can cause your body to behave differently.
Menopause occurs in 3 stages:
- Perimenopause: Your ovaries gradually produce fewer sex hormones. This usually starts in your 40s, many years before menopause. You may start to experience menopause symptoms.
- Menopause: The point where you no longer have periods. Your ovaries don’t release eggs and your body doesn’t produce many sex hormones. It’s more a moment than a phase, and is diagnosed when you’ve gone 12 consecutive months without a menstrual period.
- Postmenopause: The time after menopause. Most symptoms have passed, though some people continue to experience mild symptoms for several years. Your risk of bone thinning and heart disease are higher due to low oestrogen levels.
What symptoms can hormone replacement therapy treat?
Menopause can cause a range of symptoms. An online HRT prescription can treat:
- Hot flushes
- Night sweats
- Sleep problems
- Mood swings or irritability
- Anxiety or low mood
- Vaginal dryness and painful sexual intercourse
- Leaking pee
- Bone thinning
Types of hormone replacement therapy
There are two main types of HRT: oestrogen-only HRT and combined oestrogen and progesterone HRT.
However, The Online Clinic can also provide testosterone replacement therapy.
Different types of HRT can:
- Contain different hormones
- Be administered in different ways
- Be taken or used at different times
The type of HRT menopause treatment that’s best for you depends on factors like:
- Your medical history
- What stage of menopause you’re at
- Whether you’ve had a hysterectomy (surgical removal of the womb)
- How you respond to treatment
- Your personal preferences
Oestrogen-only hormone replacement therapy
Oestrogen replacement therapy alone is recommended if you’ve had your womb removed.
Combined hormone replacement therapy
If you still have your womb, you’ll need to take both oestrogen and progesterone.
The combination of oestrogen replacement therapy and progesterone replacement therapy helps protect against the risk of womb cancer.
There are two types of combined HRT for menopause:
-
Sequential (cyclical) combined HRT is recommended if you have menopause symptoms but still have periods. You take oestrogen every day, as well as progesterone during the last 10-14 days of your menstrual cycle either:
- Every month if you have regular periods
- Every 3 months if you have irregular periods
- Continuous combined HRT is recommended if you’re in postmenopause. You take oestrogen and progesterone every day without taking a break
Testosterone replacement therapy
Testosterone replacement therapy is only recommended if:
- You’re in postmenopause
- You have low sex drive
- HRT alone hasn’t helped
At The Online Clinic, we only offer testosterone hormone replacement therapy online if you’ve also been stable on HRT for menopause for 3 months or more.
How is hormone replacement therapy delivered?
There are 5 main types of online HRT prescription in the UK: tablets, patches, gel, spray or vaginal rings. Each has their own advantages and disadvantages.
| Types | Description | Oestrogen-only HRT |
Combined HRT |
Testosterone replacement |
Benefits | Drawbacks |
|---|---|---|---|---|---|---|
| Tablets | Usually taken orally once a day | √ | √ | X | Easy to take | Very small increase in HRT risks, such as blood clots May cause nausea |
| Patches | Sticks to the skin on the lower part of your body, and each lasts for a few days | √ | √ | X | Doesn’t increase risk of side effects Steady delivery with fewer hormone fluctuations |
Patches might not stick well to moisturised skin Can cause redness or irritation, or leave a mark |
| Gel | Gently soothe into the skin once a day | √ | X | √ | Doesn’t increase risk of side effects Discreet topical medication |
You must wait several minutes for the gel to dry before moving around |
| Spray | Spray 1-3 times on the inner arm or inner thigh | √ | X | X | Doesn’t increase risk of side effects Discreet topical medication Lower risk of skin irritation than patches |
You must wait two minutes before dressing, and an hour before having a shower or bath |
| Vaginal ring | Place in the vaginal and leave for 3 months | √ | X | X | Helps with vaginal dryness, burning sensations and pain during sex Doesn’t carry the usual risks of HRT |
Doesn’t help with symptoms such as hot flushes, mood swings or sleeping difficulties Insertion can be uncomfortable |
Who is eligible for hormone replacement therapy?
Anyone experiencing menopause symptoms can take HRT for menopause. That includes those in the perimenopausal and postmenopausal stages.
However, HRT for menopause might not be suitable if you:
- Have a history of breast cancer, ovarian cancer or womb cancer
- Have a history of stroke, heart attack or cardiovascular disease
- Have a history of blood clots (you can still get a prescription for patches or gels rather than HRT tablets in the UK)
- Have untreated high blood pressure (must be lowered before starting your menopause treatment)
- Have gallbladder or liver disease
- Have abnormal vaginal bleeding
- Are pregnant
Book an online consultation with a UK-licensed doctor to discuss whether an online HRT prescription is right for you.
Alternatives to hormone replacement therapy
HRT is a safe, effective menopause treatment with minimal risks.
However, if you can’t or don’t want to take HRT, you have other options.
Lifestyle changes
- Exercise regularly to reduce hot flushes and improve sleep
- Eat a healthy diet to maintain recommended body weight and strengthen your bones
- Sleep in a cool, ventilated room and wear loose clothes to soothe hot flushes and night sweats
- Reduce caffeine, alcohol and spicy food as these can trigger hot flushes
- Quit smoking to reduce hot flushes
- Use vaginal lubricant or moisturiser to relieve dryness
Other medicines
- Antidepressants can help control mood swings if you’ve been diagnosed with anxiety or depression, and can reduce hot flushes
- Oxybutynin or clonidine soothe hot flushes and insomnia
- Selective oestrogen receptor modulators (SERMs) are useful for hot flushes and painful sex
- Fezolinetant or paroxetine can reduce hot flushes
Herbal or alternative medicines
- Evening primrose oil
- Black cohosh
- Angelica
- Ginseng
- St John’s wort
- Red clover
While there’s limited evidence to support these remedies, there’s no agreement on correct dosages or lasting health benefits.
These products are often marketed as “natural”. But the quality, purity and ingredients can’t always be guaranteed. They may cause unpleasant side effects with no real health benefits.
Benefits of hormone replacement therapy
Relieves symptoms of menopause
The main benefit of HRT for menopause is that it’s highly effective at relieving unwanted symptoms like hot flushes, night sweats, low mood and vaginal dryness.
Symptoms typically improve after just a few days or weeks of HRT menopause treatment.
Improves bone health
Oestrogen is necessary for healthy bones.
Low levels of oestrogen during menopause can cause bone loss. This makes you more likely to have a fracture.
HRT helps prevent osteoporosis by raising your levels of oestrogen. It’s particularly important to take HRT for bone thinning if your periods stop before the age of 45.
Improves heart health
Your risk of coronary heart disease increases after menopause.
Oestrogen has a protective effect on the heart. It helps control cholesterol levels, keeps your blood vessels healthy and reduces the risk of fat building up in your arteries.
As oestrogen falls, fat in your arteries can cause them to narrow. This increases your risk of coronary heart disease and heart attack.
HRT replaces this lost oestrogen and reduces your risk of heart conditions. The earlier you start, the lower your risk.
Other potential benefits
- Maintains muscle strength: It’s common to lose muscle strength as you reach menopause. When taken along with exercise, HRT can help your muscles stay strong (The Eurasian Journal of Medicine)
- Improves mood: Lower levels of ovarian hormones can affect the brain and cause mood swings. HRT replaces these hormones and help you prevent drops in mood (The Menopause Charity)
- Improves sleep: Hot flushes and night sweats can wake you up during the night. HRT helps relieve these symptoms so you can enjoy deep, restorative sleep (British Menopause Society)
- Lowers risk of colon cancer: The use of combined HRT shows a 33% reduction in the risk of colorectal cancer (Journal of Clinical Oncology)
- Reduces risk of diabetes: Hormonal changes during menopause can affect blood sugar levels. If you live with or are at risk of diabetes, HRT is an effective tool for controlling blood sugar (Diabetes UK)
Risks and side effects of hormone replacement therapy
Common risks of HRT
As with all medical treatments, HRT for menopause carries some risks.
However, the risk of serious side effects is usually very low. And it’s common to have no side effects at all. Any you do experience are likely to improve quickly.
Even when you request hormone replacement therapy online, your doctor will only prescribe it if the benefits outweigh the risks.
Common side effects of both oestrogen replacement therapy and combined HRT include:
- Headaches
- Breast pain or tenderness
- Unexpected vaginal bleeding or spotting
- Feeling sick
- Mood changes, including low mood or depression
- Muscle cramps
- Mild rash or itching
- Diarrhoea
- Hair loss
- Fluid retention
- Bloating
- Indigestion
If your doctor prescribes testosterone replacement therapy, you could also experience:
- Unwanted hair growth
- Acne
- Weight gain
Long-term risks of HRT
It’s highly uncommon to experience long-term side effects when taking any form of HRT. But your doctor might advise different treatment if you’re at risk for any of the following:
- Breast cancer: There are around 5 extra cases of breast cancer for every 1,000 women who take combined HRT for 5 years. The risk increases the longer you take it, but falls again after you stop. This doesn’t apply to oestrogen replacement therapy alone.
- Blood clots: Taking HRT tablets can slightly increase the risk of blood clots. But patches, sprays, gels and vaginal rings don’t. That’s because oestrogen is safer when absorbed through the skin.
- Stroke: HRT tablets also slightly increase the risk of stroke. But this risk is very low, especially if you’re under 60 years old.
How to minimise risk with doctor-supervised menopause treatment
Even though the risks of HRT for menopause are rare, doctor-supervised treatment is still recommended to help keep you safe.
A UK-licensed doctor will thoroughly screen your medical history before prescribing HRT. They’ll also help you choose the right type of HRT for your symptoms and health profile. That way, you can experience the many benefits of HRT for menopause with minimal side effects.
It’s also recommended that you schedule regular follow-up consultations to discuss your symptoms and side effects. This allows your doctor to adjust the dosage, delivery method or type of HRT to relieve your symptoms safely.
As long as you choose a reputable provider, you can also enjoy doctor-supervised menopause treatment when you request hormone replacement therapy online.
What to ask your doctor before starting hormone replacement therapy
Being prepared when you speak to your doctor can help you get all the information you need in a single consultation.
Ask these 8 questions to ensure you’re fully informed before starting HRT:
- Am I a good candidate for HRT based on my medical history?
- What type of HRT is right for me?
- How should I take it?
- What are the benefits and risks of HRT for me personally?
- How will we monitor my treatment?
- What symptoms should I expect as side effects?
- How long should I plan to stay on HRT?
- What happens if this treatment doesn’t suit me?
How to get a hormone replacement therapy prescription online
Many women in the UK are choosing to get their HRT prescriptions online. As well as being faster and more accessible, using an online platform makes it easier to schedule regular check-ins and access your treatment history.
If you already have a prescription, you can get hormone replacement therapy online with no extra steps.
But if you want an initial prescription, you’ll first need to register with an online HRT clinic and provide your medical history. A doctor will then review your information and, if appropriate, give you an online HRT prescription that suits you. You may also want to arrange a telephone consultation to discuss your options.
Not all online HRT providers meet the same standards of quality and care. So before you request hormone replacement therapy online, look out for these 5 signs of a trustworthy dispensary:
- CQC registration: Check if the provider is registered with the Care Quality Commission (CQC) to ensure they meet fundamental safety and quality standards
- Qualified prescribers: Ensure the service uses qualified doctors registered in the UK
- Comprehensive medical assessment: A trustworthy online consultation should include a full medical assessment
- Clear treatment protocols: Make sure your provider is upfront about the risks and treatment options
- Follow-up care: A quality provider will also schedule follow-up care to ensure you’re responding well to your treatment
Why choose The Online Clinic for hormone replacement therapy?
Tens of thousands of patients throughout the UK rely on The Online Clinic for safe, convenient access to approved medical prescriptions.
We are licensed and regulated by the CQC. In our latest CQC report, we achieved an overall rating of Good, meaning our service is “performing well and meeting expectations”.
Every doctor at The Online Clinic is also registered with the General Medical Council in the UK. So you can always expect the highest standards of care.
Our medical team provides online hormone replacement therapy for women aged 45-55, or up to 60 if you’ve been prescribed HRT elsewhere. Testosterone is prescribed up to 65. Simply register and complete a medical health questionnaire, and an experienced GP will review your answers free of charge to assess your suitability for the service.
We deal with most consultations in around 30-60 minutes during normal business hours, with same-day dispatch for orders placed before 3:30pm Monday to Friday (public holidays excluded) and before 10:45 on Saturdays.
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I wanted advice on HRT and the doctor I spoke to was knowledgeable, helpful and gave me lots of information on the issues I needed to talk about. She recommended medication and we have a 3 month review. I would not hesitate in recommending The Online Clinic. Vikki Wastell |
Book your hormone replacement therapy assessment today
Register now and complete your medical health questionnaire in just a few minutes to request a prescription for hormone replacement therapy online.
Hormone replacement therapy frequently asked questions
Is HRT safe?
Yes, especially if you start before the age of 60. While there are short- and long-term risks, these are unlikely, and are usually outweighed by the benefits.
Your doctor will advise whether HRT is right and safe for you.
How long should I stay on HRT?
There’s no fixed time limit. Some women use it for a few years while others continue it for decades under medical guidance.
You can stay on HRT as long as the benefits outweigh the risks and you feel better with it.
Does HRT cause weight gain?
There’s no evidence to suggest that HRT directly causes weight gain.
Hormonal changes during menopause can affect fat distribution and metabolism. But this happens whether or not you’re on HRT.
How soon will I feel better after starting HRT?
Many women notice an improvement in symptoms within a few weeks. But the full benefits can take up to 3 months.
HRT usually starts on a low dose. Your doctor may advise changes to your dose or type of HRT to bring you the best results.
Can I start HRT if I still have periods?
If you’re in the perimenopausal stage (experiencing symptoms of menopause and still have irregular periods) you can start HRT.
You’ll usually need a type that regulates the cycle, like sequential (cyclical) combined HRT.
What happens if I stop taking HRT suddenly?
You might find that your symptoms return quickly, often within days or weeks.
If you want to stop HRT, it’s better to taper off gradually under medical supervision.
Can I get HRT after a hysterectomy?
Yes, you can. Oestrogen replacement therapy is suitable for women who have had a full hysterectomy.
Do I still need contraception when taking HRT?
Yes, you do.
HRT isn’t contraception. So if you’re under 55 and still at risk of pregnancy, you’ll need to continue using contraception during sex.
Learn more about hormone replacement therapy
National Health Service (NHS)
Cleveland Clinic
The British Menopause Society
The Menopause Charity
Menopause Matters
