HRT and menopause: The benefits, types and what to expect

Like a retirement plan or platinum health insurance, Hormone Replacement Therapy (HRT) feels like one of those intense, distant things we can't imagine ever needing… until we get there ourselves, and then we’re extremely grateful they exist. 

While HRT was once seen as a last resort for only extreme menopausal symptoms, this is no longer the case. Due to recent advancements in technology, HRT is now more accessible and convenient for  menopausal and perimenopausal women than ever before. And, for those who are navigating these transitional stages, the benefits of HRT can be nothing short of life-changing.

But, how does HRT actually work to relieve menopause symptoms, and who can use it? What is the difference between its various forms, from traditional medication to patches and pessaries? Plus, how do its benefits stack up against the costs and side effects? To help you make an informed decision about your own hormonal health, here’s the lowdown on HRT.

What is HRT?

Hormone replacement therapy (or HRT) is a treatment that addresses menopause symptoms by replacing estrogen and progesterone — female sex hormones that naturally decline during this phase [1]. In its various forms, HRT provides a reliable dosage of these hormones to help restore equilibrium in the body.

For decades, HRT was a privilege reserved only for the wealthy, due to the high price of the medication. While in some cases, it was possible to obtain HRT treatment at a reduced cost through insurance, this was typically only for women who experienced severe menopause symptoms. Stigma was another barrier, with many women sadly believing that taking HRT meant something was "wrong" with them.

Thankfully, this is all changing — with a growing number of women from all walks of life taking control of their health with HRT.

The main benefits of HRT for menopause

While the process of menopause and perimenopause (the 2 to 10 years leading up to your last period) is totally natural, that doesn’t mean it’s always a seamless transition. This can be especially confronting for women who experience menopause earlier than expected or have a more protracted lead-up to menopause.

Some HRT menopause benefits include:

Relieves menopause symptoms

The most well-known menopause symptoms are hot flushes — a sudden flare of heat, sometimes accompanied by sweating. And while yes, HRT does provide reliable relief from hot flashes, this is far from the only symptom.

Menopausal symptoms can encompass everything from sleep and mood to sex drive. This is because estrogen plays a protective role in many different systems in the body. So, when the body stops making enough estrogen, this can take a toll in a multitude of ways.

HRT is known to relieve the most common symptoms of menopause, including brain fog, low mood, irritability, headaches, low libido, night sweats, joint pains and more [4].

Maintain and improve fertility

It’s important to note that HRT can't restore fertility in women who have already undergone menopause (the 12-month mark since the final period). However, for women in perimenopause or in the earlier stages of the menopause transition, HRT has been found to maintain or improve fertility in some cases [5].

One way HRT can help increase the likelihood of falling pregnant is by regulating periods. For women who have patchy or irregular periods, it can be difficult to track the menstrual cycle, such as knowing when you’re ovulating. HRT helps to regulate this, as well as creating a more favourable environment for conception by thickening the womb lining.

Provides gender-affirming care

Many cisgender women report that when they go through perimenopause or menopause, they no longer feel like themselves. By treating menopause symptoms such as increased body and facial hair, HRT can help indirectly address the psychological impact of gender dysphoria.

Reduce osteoporosis risk

During and after menopause, the reduction in estrogen production can significantly reduce bone mineral density (BMD) [6]. At any given time, our bones are undergoing a remodelling process, where bone tissue breaks down (osteoclasts) and new bone tissue forms (osteoblasts). During menopause, bone loss can bone can outpace regeneration, which increases the risk of osteoporosis — both now, and in the future.

By restoring estrogen levels, HRT helps to prevent the premature death (apoptosis) of osteoblasts while restricting the lifespan of osteoclasts. It also helps to maintain the delicate, lattice-like internal structure of the trabecular bones, which are highly susceptible to density loss.

New research shows that HRT can increase bone mineral density by an average of 13% over five years, which goes a long way to improve mobility and prevent breaks and fractures [7].

Assist with weight loss and maintenance

Many women find that when they enter menopause, it becomes more challenging to maintain their weight. This is due to the strong biological connection between sex hormones, metabolism and appetite. In addressing the hormonal factors, many women find that they are more easily able to achieve their weight loss or body recomposition goals.

While HRT itself is not designed for weight loss, research shows that combining it with weight loss medications like Wegovy and Mounjaro can be highly effective for helping perimenopausal and menopausal women lose weight [8]. Programs like Juniper, which combine targeted medication with lifestyle intervention, are particularly helpful, as they focus on helping women maintain muscle mass for long-term success.

How HRT works in the body

In some ways, HRT works in a similar way to the contraceptive pill. Just as birth control pills provide synthetic doses of estrogen, progesterone, or both (depending on the type), HRT also deposits these hormones into the bloodstream — where they bind to the relevant receptors in the body [9].

The difference is, while The Pill provides high enough doses to prevent pregnancy, HRT uses a lower dose to simply top up the hormones depleted during menopause.

The different types of HRT

There are several different types of HRT, and finding the right balance of hormones can often be a process of trial and error.

Estrogen-only HRT

When HRT was first created in the 1930s, it consisted only of estrogen. However, after a link was found between HRT and endometrial cancer, the combined version with progesterone was rolled out (as this was found to lower the risk).

While for the last few decades, estrogen-only HRT has been mostly used by women without uteruses (such as those who have had hysterectomies), the increase of transdermal and cyclical options has put it back on the menu again.

Combined HRT

Combining estrogen with progesterone, this is the most common type of HRT. The estrogen helps to relieve menopausal symptoms, while the progesterone protects the uterine lining against cancer [10].

Cyclical vs continuous HRT

Continuous HRT involves taking the same dose nonstop without breaks. This dosing regime is generally recommended to women who do not have periods (post-menopausal), as it tends to provide more reliable relief.

For women who do still have periods, cyclical HRT is designed to mimic the natural rise and fall of estrogen and progesterone. Sometimes referred to as sequential HRT, this involves taking estrogen every day, while only taking progesterone for 10 to 14 days of each 28-day cycle [11]. This can help to maximise relief while reducing side effects — though withdrawal bleeding is common.

Body-identical and bioidentical HRT

While these terms may sound similar, there's an important distinction to be made. Body identical hormones are (you guessed it) identical to those produced by the body, derived from yams and soy. They're regulated, rigorously tested, and available on the NHS [12].

Meanwhile, while some bioidentical HRT may be body-identical technically, it's difficult to say because it's unregulated. Bioidentical hormones are custom-compounded in specialist pharmacies and available via private prescription.

How HRT is taken

Thanks to innovations in the medical industry, there are now several different ways to access menopausal hormone therapy, depending on personal needs and preferences.

HRT tablets

One of the most common forms of HRT is an oral tablet, taken once daily. While this can be a convenient way to take HRT, some believe it can be less effective than other types due to the tablet needing to pass through the digestive system first [13].  Its efficacy is also reliant on patients remembering to take the medication every day.

HRT patches

A newer form of Hormone Replacement Therapy, these are sticky, medicated patches worn on the body. Available in both estrogen-only and combined forms, they gradually release hormones through the skin (bypassing the digestive system). These transdermal patches are generally considered safe and highly effective, although some may find them uncomfortable to wear.

HRT gels and sprays

Another transdermal option, these are applied to the skin and absorbed into the bloodstream. By bypassing the liver, they provide reliable relief while reducing the risk of blood clots. For this reason, they are a highly popular modern option for HRT.

Vaginal HRT

For women who want relief from localised vaginal and urinary symptoms (such as vaginal dryness, itchiness and painful intercourse) but don't want to commit to full HRT, topical HRT is an option. Available in formats such as creams, pessaries, vaginal rings and DHEA inserts, these provide a low dose of estrogen only to the vaginal and bladder tissue. This, in turn, can improve tissue elasticity, pH balance, and natural lubrication and provide symptom relief [14].

Who can take HRT?

In the UK, anyone experiencing symptoms of perimenopause or menopause can take HRT. It's suitable for most individuals with a womb or who have had a hysterectomy. This means that even if you are going through premature or early menopause, you may still be able to access HRT.

Who shouldn't take HRT?

There are certain conditions that can make certain forms of HRT unsafe and unsuitable. Generally, it is not recommended for people with a history of breast cancer, active liver disease or blood clots [15].

However, just because traditional, continuous HRT isn't suitable, it doesn't mean you can't access menopausal symptom relief. It's important to speak to your healthcare provider and see what's possible.

Common side effects of HRT

All medications have their potential side effects, and HRT is no exception. Both oestrogen and progesterone have their own side effects — meaning, the potential adverse symptoms you’ll experience will depend on what type of HRT you’re taking [16].

If you're taking estrogen-only HRT, you may experience the following side effects:

• Breast pain or tenderness
• Headaches
• Digestive issues such as nausea or diarrhoea
• Unexplained vaginal bleeding or spotting
• Leg cramps
• Mood changes, such as a low mood, mood swings or depressive thoughts

For combined HRT (with progesterone), you may experience the above, plus these additional side effects:

• Feeling tired or dizzy
• Mild rash or itchy skin
• Acne
• Oilier hair and skin

Typically, these side effects are mild and subside within a few weeks of use. However, if you experience ongoing symptoms, it's important to talk to your GP.

The risks of HRT, explained

The health risks of taking HRT are real, but very rare. To put it in perspective, taking The Pill for 10-20 years generally has a higher risk profile than HRT. Still, it's important to know the facts.

Estrogen-only HRT has not been shown to increase breast cancer risk and may even slightly reduce it [17]. Meanwhile, combined HRT, which includes progesterone, is linked to a slightly increased risk of developing breast cancer — around two to eight extra cases per 1,000 women over five years [18]. On the flipside, estrogen-only HRT can increase the risk of uterine cancer if a woman still has a uterus, which is why progesterone is added to protect the uterine lining [19].

For many healthy women, particularly those using modern transdermal HRT, the overall risks of HRT remain low. However, doctors assess patients suitably based on risk factors by taking a detailed medical history.

How long can you stay on HRT?

There’s no hard and fast rule about how long you can stay on HRT. The answer most experts give is “for as long as the benefits outweigh the risks", which is going to look different for everyone. Many women choose to continue to take HRT for several years post-menopause, as it can take time for the hormones to recalibrate after that final period.

The important thing is that you’re seeing your doctor for regular check-ups and maintaining an ongoing conversation about whether HRT.

When to speak to your GP about starting HRT — and other options

One major misconception of HRT is that it’s only for women in the very late stages of menopause. In reality, research shows that it provides the most reliable relief for women who are 10 years out from their final period [20]. Now, obviously, this is difficult to predict without a crystal ball! However, it’s a good idea to be proactive if you're experiencing the symptoms and to seek help sooner rather than later.

It's also important to note that sex hormones aren't the only biological factor that impacts how we feel and look. Whether you're seeking a supplement to HRT or are simply seeking answers about your own body, Juniper offers support to women of all ages. Learn more about our unique, research-backed program here.

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