Types of hormone replacement therapy: Which is right for you?

Hormone replacement therapy (HRT) is an effective treatment for unpleasant menopause symptoms.

It’s generally safe for women under 60 years old who begin HRT within 10 years of menopause.

But while all types of HRT can relieve menopause symptoms, they have different effects on the body.

To minimise HRT side effects and risks, it’s important to get a tailored treatment that suits your symptoms and health profile.

Before prescribing HRT, a UK-licensed doctor at The Online Clinic will carry out a thorough evaluation of your medical history.

That way, we can prescribe the best HRT for your menopause symptoms while keeping you safe.

Register as a patient and start your free consultation to request an online HRT prescription.

Types of hormone replacement therapy explained

There are two main HRT options: oestrogen-only HRT and combined oestrogen and progesterone HRT.

In some cases, your doctor might also recommend testosterone replacement therapy.

The various types of HRT can contain different hormones, be administered in different ways or be taken at different times.

The best HRT for menopause depends on factors like:

• Your personal health profile
• Your stage of menopause
• Whether you’ve had your womb removed
• How you respond to treatment
• Your lifestyle preferences

During your free consultation, your doctor will ensure you’ve had HRT explained thoroughly and recommend a suitable HRT treatment for your needs.

Oestrogen-only HRT

Treatment using oestrogen alone is only available for women who’ve had a hysterectomy (surgical womb removal).

Oestrogen is a naturally occurring sex hormone that’s vital for many important bodily functions such as:

• Menstruation
• Fertility
• Bone Strength
• Brain function
• Protection against heart disease
• Protection of skin against the effects of aging
• Bladder control

But at high levels, oestrogen is also a carcinogen.

Excess oestrogen promotes too much growth in the endometrium (lining of the uterus). This increases the chance of genetic errors that can lead to endometrial (womb) cancer.

In most types of HRT, oestrogen is administered along with progesterone. That’s because progesterone – another naturally occurring sex hormone – prevents excessive uterine lining growth.

However, if you’ve had a hysterectomy, there’s no increased risk of womb cancer. So you can take oestrogen-only HRT without these concerns.

Combined HRT

Combined HRT involves taking both oestrogen and progesterone.

It’s recommended for women who still have their womb because it doesn’t increase the risk of womb cancer.

There are two types of combined HRT: sequential (cyclical) combined HRT and continuous combined HRT.

Sequential combined HRT

Your doctor will recommend sequential combined HRT if you have menopause symptoms but still have periods.

In sequential HRT, you take oestrogen every day. And you take 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

If you’re in postmenopause, your doctor will recommend continuous combined HRT.

Continuous HRT involves taking oestrogen and progesterone every day without pausing.

Testosterone replacement therapy

The NHS isn’t currently able to prescribe testosterone replacement therapy for menopause.

But as a specialist doctor, The Online Clinic can.

However, we’ll only prescribe it for patients in postmenopause who’ve been stable on HRT for 3 months or more but haven’t experienced improvement.

Become a patient of The Online Clinic to start your free consultation and find out whether testosterone therapy is right for you.

Comparing different types of HRT options

Please note that Testosterone is only prescribed at The Online Clinic if the patient is using regular HRT. Testosterone is not prescribed alone.

How is HRT administered?

HRT is usually administered in one of 5 forms: tablets, patches, gels, sprays or vaginal rings.

Tablets

For oestrogen-only and combined HRT

HRT tablets are usually taken orally once a day. So it’s very easy to make it part of your routine.

However, HRT tablets have been shown to slightly increase the risk of blood clots.

Unlike transdermal (taken through the skin) medications, tablets are processed by the liver. This reduces the amount of oestrogen your body can absorb.

To counteract this, tablet doses of oestrogen must be higher to have a full effect. The more oestrogen you take in, the higher your risk of blood clots.

This is the only form of HRT that increases risk. So doctors usually prescribe a different option where possible.

Skin patches

For oestrogen-only and combined HRT

HRT patches stick to the skin on your abdomen, hips or upper buttocks. Each one lasts for several days.

Patches gradually release hormones into your skin. This steady delivery means you experience fewer fluctuations, and so fewer side effects.

But patches might not stick well to moisturised skin. And they can cause redness or irritation, or leave a mark when removed.

It’s always best to apply HRT patches to dry, non-moisturised skin and peel off slowly to avoid marks.

Gels

For oestrogen-only and testosterone HRT

You gently soothe an HRT gel into your skin once a day. This discreet topical medication is then gradually absorbed over several minutes.

The biggest risk of HRT gels isn’t to you, but to other people.

It takes a few minutes for your skin to fully absorb HRT gel. That means it can be transferred to other people or pets if you touch them shortly after applying.

Gels are also easily sweated off during hot weather or physical activity. So they might not be suitable if you exercise regularly or have a very active lifestyle.

Sprays

For oestrogen-only and combined HRT

Simply apply one to 3 sprays on the inner arm or inner thigh and wait for your body to absorb it.

HRT sprays have a lower risk of skin irritation compared to patches.

But you must wait two minutes before dressing to give your skin time to absorb the hormones. You also need to wait at least an hour before bathing or showering.

When using the oestrogen sprays and gels, a progesterone capsule will be prescribed for patients who require combined HRT.

Vaginal rings

For oestrogen-only HRT

After placing the ring in your vagina, you leave it for 3 months. This makes it more convenient than other short-term HRT options.

Vaginal rings provide slow release of low-dose oestrogen. So they’re even safe if you still have your womb.

This treatment is effective for treating vaginal dryness, burning sensations and painful sex.

But it doesn’t provide enough oestrogen to treat other menopause symptoms like hot flushes, mood swings or night sweats.

Some women also find insertion uncomfortable.

Comparing HRT delivery methods

Please note that Oestrogen-only sprays and gels can be prescribed alongside progesterone capsules (either oral or vaginal) to achieve the combined HRT for patients who still have a womb.

How to choose the right HRT treatment for you

Factors to consider

• Age: While the risks of HRT are low, they increase greatly as you age. For women over 60 years old, the risks often outweigh the benefits. Your doctor might recommend non-hormonal treatments or additional medical supervision
• Symptoms: Hot flushes, night sweats, mood swings and other symptoms can be treated by replacing declining sex hormones. But if you mainly struggle with vaginal dryness, burning sensations and painful sex, a vaginal ring or cream might be more suitable. Getting the right treatment lets you target symptoms effectively without unnecessary risks
• Medical history: Certain types of HRT can increase risks such as breast cancer, blood clots and stroke. While the increase is low, it can be a significant risk for women with a history of these conditions or high-risk factors. Your doctor will evaluate your medical history to help you find a treatment that’s safe for you
• Lifestyle: Even during or after menopause, your levels of sex hormones are affected by your lifestyle. Similar to medical weight loss, HRT is most effective when combined with positive lifestyle changes. If you have risk factors like high blood pressure, your doctor might also need to withhold treatment until they’ve been brought down to normal levels

Stage of menopause

Menopause occurs in 3 stages:

• Perimenopause: Usually starts in your 40s, long before menopause. You may start to experience some menopause symptoms
• Menopause: The point where you no longer have periods. It’s usually diagnosed when you’ve gone 12 consecutive months with no menstrual period
• Postmenopause: The time after menopause. Most symptoms have gone away, but you might experience some mild ones for several years

These stages are characterised by different levels of hormones, the presence or absence of periods, and severity of symptoms.

Different HRT options are more suitable for each stage.

For example, in perimenopause the levels of sex hormones are higher than in postmenopause.

Using continuous HRT in postmenopause can create hormone imbalances. These can make some symptoms worse or increase risks, as well as cause vaginal bleeding.

In postmenopause, however, ovarian function has stopped. And both oestrogen and progesterone are consistently low.

This means continuous HRT is much safer and matches the body’s steady hormonal state.

Remember that women enter menopause at different ages. So a treatment that’s right for one woman might not be for another.

Register as a patient with The Online Clinic to find a treatment tailored to your age and stage of menopause.

Medical guidance and supervision

Requesting an HRT prescription from a trusted and licensed service like The Online Clinic lets you treat menopause symptoms with the fewest side effects and risks.

Understanding your symptoms, medical history, stage of menopause and other factors can help you find the best HRT for menopause. But there’s no way to know exactly how HRT will affect you personally.

That’s why it’s important to schedule regular check-ins and undergo HRT with medical supervision.

Your doctor can help you manage symptoms and side effects by adjusting the dose or type of HRT, or recommending non-hormonal lifestyle changes.

Or if they spot early warning signs of growing risks, they might discontinue your treatment to keep you safe.

HRT is common among those experiencing menopause. But it’s still a medical treatment that needs expert supervision.

With The Online Clinic, you can have confidence in your treatment with regular monitoring from a UK-licensed medical professional.

HRT duration and adjustments

When should I start HRT?

It’s best to start HRT during perimenopause or early menopause.

Starting early helps reduce menopause symptoms and even helps protect against osteoporosis (bone thinning) and heart disease.

After age 60, the risks of HRT increase significantly.

It’s still possible to take HRT over the age of 60 if symptoms are severe.

But since the risks of cancer, blood clots and stroke are higher, it’s only recommended in select cases.

How long should I take HRT for?

HRT is safest when taken at the lowest possible dose for the shortest possible time.

It’s usually recommended for two to 5 years. But longer-term use of 5-10 years is possible if symptoms are persistent.

Your doctor will advise whether the benefits of long-term HRT outweigh the risks.

Can I switch or stop HRT treatment?

If your symptoms change, side effects occur or health risks increase, your doctor might recommend changing your type of HRT or how it’s administered.

Switching is common and safe. And it can sometimes take a few tries before you find the right fit.

Your doctor might also advise stopping treatment if:

• You’ve been symptom free for one to two years
• You’re nearing or over the age of 60
• You’ve developed a health condition like breast cancer or blood clots

If the situation is severe, you can stop taking HRT abruptly with medical supervision.

But to reduce symptom recurrence and sudden hormone changes, it’s recommended to taper off slowly.

Find the right HRT options for you with The Online Clinic

HRT is an effective treatment for menopause symptoms.

But which type of HRT is right for you depends on your age, medical history and other important factors.

With a free consultation from The Online Clinic, you can find the best HRT for menopause with minimal side effects and risks.

Our service offers:

• UK-licensed doctors: Most online HRT clinics allow pharmacists to review prescription requests. But we ensure all requests are reviewed by qualified medical professionals to prescribe effective treatments that keep you safe
• Industry regulation: We’re regulated by the Care Quality Commission (CQC) to bring you a superior service. In our latest report, the CQC awarded us a rating of Good in all 5 assessed areas.
• Fast service: During normal working hours (7:00am to 10:00pm), your doctor will typically review your request within 30-60 minutes. And if you place an order before 3:30pm Monday to Friday (excluding public holidays) you can get next-day delivery
• Ongoing medical supervision: After ordering your online HRT prescription, you can schedule regular check-ins to discuss your treatment. Patients also have access to a database of information about their prescriptions to stay informed

We also have over 13,000 mainly 5-star patient reviews from satisfied patients throughout the UK.

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

Get your online HRT prescription today

Register as a patient and fill in a short medical health questionnaire to find out if you’re eligible for an online HRT prescription.

Make informed decisions about your HRT treatment

NHS

• Types of hormone replacement therapy (HRT)
• When to take hormone replacement therapy (HRT)
• Oestrogen tablets, patches, gel and spray
• Benefits and risks of hormone replacement therapy (HRT)
• Vaginal oestrogen

Cleveland Clinic

• Menopause: What is it, age, stages, signs and side effects
• Hormone replacement therapy (HRT) for menopause

Mayo Clinic

• Menopause hormone therapy: Is it right for you?

British Menopause Society

• BMS & WHC’s 2020 recommendations on hormone replacement therapy in menopausal women

The Menopause Charity

• Starting or continuing HRT many years after your menopause