Types
Oestrogen comes as a patch, gel, spray or tablet. Estradiol, the same molecule your ovaries made, is the usual choice.
The progestogen is usually micronised progesterone, taken at night for either 12 days a month or every day. A hormonal intrauterine device is an alternative and also provides contraception.
If you have had a hysterectomy, you take oestrogen alone.
Benefits
Reduces hot flushes and night sweats by about 75 percent. Improves sleep, joint aches and vaginal symptoms. Prevents bone loss and cuts fracture risk. Can improve mood in perimenopause.
Breast cancer risk in numbers
Combined oestrogen and progestogen adds fewer than one extra case of breast cancer per 1,000 women per year of use. That is similar to the risk from drinking two glasses of wine a day or being overweight.
Oestrogen alone, after hysterectomy, did not raise breast cancer risk in the largest randomised trial.
Blood clots and stroke
Oestrogen tablets raise the risk of clots and stroke. Oestrogen through the skin at standard doses does not appear to raise clot risk. This makes patches, gels and sprays the preferred choice for many women.
Who should not take it
Women with current or past breast cancer, most women with a past blood clot or stroke, active liver disease, or unexplained vaginal bleeding. Each case is individual, and some women in these groups can use vaginal oestrogen.
How long
There is no fixed date to stop. Review the plan every year. Many women take it for five years or longer. Starting after 60 or more than ten years after menopause carries more risk.
See a practitioner if
- You want to discuss starting
- Bleeding is unexpected or continues beyond six months of starting
- You develop calf pain, chest pain or breathlessness, which need urgent care
Common questions
Is body identical hormone therapy different?
Estradiol and micronised progesterone are identical to your own hormones and are approved medicines. Custom compounded bioidentical products are not regulated and are not recommended.
Do I need blood tests to monitor it?
Usually not. Dose is adjusted to symptoms. Blood tests are used in specific cases, such as poor absorption of a gel.
Can I take it if my mother had breast cancer?
Often yes. A family history alone is not usually a reason to avoid it. Your practitioner will weigh your overall risk.
- The Menopause Society, 2022 Hormone Therapy Position Statement
- Women's Health Initiative randomised trials, long term follow up
- National Institute for Health and Care Excellence, NG23, updated 2024
This page is education, not medical advice. Talk to your doctor or menopause practitioner about your own care. In an emergency, call your local emergency number.