In short: HRT (hormone replacement therapy) replaces the oestrogen, and usually a progestogen, that your body makes less of during perimenopause. UK guidance from the NHS and NICE reports it is effective for many symptoms, that the type, dose and delivery are individual, and that it should be reviewed and adjusted over time. It is not a set-and-forget prescription, and the decision belongs to you and your doctor or a menopause specialist. This page explains the options in plain English so you can walk into that conversation informed. It is information, not medical advice.
What HRT is, and what it means in perimenopause
HRT replaces hormones, mainly oestrogen and a progestogen (a form of the hormone progesterone), that your body produces less consistently as you move through the transition (NHS, 2026). In perimenopause specifically, there is a wrinkle that matters: you are still cycling, at least some of the time.
Because of that, UK guidance describes two broad patterns. For women who still have periods, a sequential or cyclical regimen is often described, oestrogen every day with a progestogen added for part of each month. For women who have gone twelve months without a period, a continuous regimen is described instead, both hormones every day. Guidance notes that a woman who starts on a sequential regimen in perimenopause may later be moved to a continuous one after menopause (NHS, 2026). Even the basic shape of HRT changes as you move between stages. If you are not sure which stage you are in, the stages of perimenopause may help.
The main types, described plainly
The point of this section is vocabulary, not recommendation. These are the terms your doctor will use. HRT differs along two lines: which hormones it contains, and how you take it.
Which hormones it contains
| Type | What it is | Who the guidance describes it for |
|---|---|---|
| Combined HRT | Oestrogen plus a progestogen (a form of the hormone progesterone) | Women who still have their womb, where the progestogen protects the womb lining |
| Oestrogen-only HRT | Oestrogen on its own | Women who have had their womb removed (a hysterectomy) |
| Sequential (cyclical) combined | Oestrogen every day, with the progestogen added for part of each month | Often described for women who still have periods, so during perimenopause |
| Continuous combined | Oestrogen and the progestogen every day | Often described after menopause, once periods have stopped for a year |
Source: NHS, 2026; NICE, 2024.
How you take it
| Route | Examples | What the guidance notes |
|---|---|---|
| Through the skin | Patch, gel or spray | NICE and the NHS report this does not carry the small increase in blood-clot risk that tablets do, and NICE suggests clinicians consider it for women at higher risk of clots |
| Tablet | A daily tablet | Carries a small increased clot risk compared with the skin routes, though the overall risk is still small |
| Vaginal | Cream, pessary or ring | Used for local vaginal and urinary symptoms |
Source: NICE, 2024; NHS, 2026.
Which type and route suit you is a clinical decision made with your doctor, not something to self-select.
You may also see the phrase body-identical, meaning regulated hormones such as micronised progesterone and oestradiol that are structurally the same as the body's own and are available on the NHS. This is different from custom-compounded bioidentical products sold privately, which clinical guidance does not recommend because they are unregulated and unproven (UpToDate, 2026).
What the guidance says about benefits and risks
Here the rule is strict: what follows is what UK guidance and the evidence report, not a recommendation from anna.
On benefits, the NHS reports that HRT is effective at relieving many perimenopausal and menopausal symptoms, and that by raising oestrogen it helps protect against osteoporosis (NHS, 2026).
On risks, the picture is more nuanced, and the nuance is the honest part. NICE reports that combined HRT is associated with an increase in breast-cancer risk that rises with how long it is taken, is higher in current than past users, and falls after stopping though some increase can persist for years. The NHS frames the scale as roughly five extra cases per thousand women taking combined HRT for five years, and reports little or no increase with oestrogen-only HRT (NICE, 2024; NHS, 2026). The largest individual-participant meta-analysis to date reached the same broad conclusions: risk that increases with duration of use, is greater for combined than oestrogen-only preparations, and can persist for more than a decade after stopping (Collaborative Group on Hormonal Factors in Breast Cancer, 2019). On clots, guidance reports the small increased risk applies to tablets rather than to the transdermal, or through the skin, route (NICE, 2024).
The NHS's own summary is that for many women under 60 the benefits of HRT are likely to outweigh the risks, but it attaches its own condition: it depends on your age, your symptoms and your individual risk factors, which is exactly why it is a conversation with a doctor and not a decision to make from a web page (NHS, 2026).
If HRT isn't right for you
HRT is not the only route, and it is not right for everyone. Some women cannot take it, some choose not to, and some want to try other things first. The NHS notes that lifestyle measures and non-hormonal options exist, and that the right path depends on your health, your symptoms and your preferences, which is exactly the conversation to have with your doctor. At a general level, that can include everyday changes to sleep, movement and diet, and, for some symptoms, non-hormonal prescription options or talking therapies such as CBT that a clinician can talk you through. anna does not recommend any specific treatment, and none of this is advice, it is a prompt for the conversation. For the everyday-habits side, see perimenopause lifestyle.
HRT is not set and forget
This deserves its own section because it is the part most easily missed. HRT is not a prescription you collect once and never revisit.
UK guidance is explicit that care should be tailored to the individual and adapted if symptoms change over time, that the type, dose, route and duration are individual choices to be discussed, and that the lowest effective dose is the aim (NICE, 2024). It also sets a rhythm of review: NICE recommends reviewing treatment at around three months to check it is working and tolerated, and at least once a year after that, re-discussing the benefits and risks of continuing each time (NICE, 2024).
There are good biological reasons for this. Your perimenopause is not static, so the treatment that fits it should not be either. As your stage shifts, your symptoms settle or change, and your health and life circumstances move, the right regimen moves with them. Ongoing monitoring is not bureaucracy. It is how HRT is meant to be done.
How to talk to your doctor
You do not need to arrive with the answers, but a few things make the conversation more useful:
- A sense of your cycle and your symptoms over recent months. A record of what has changed, and when, is more useful than trying to remember on the spot.
- What you most want to change, and what you are worried about. Both belong in the conversation.
- Your relevant history, and any family history of breast cancer or blood clots, since guidance ties the options to exactly these factors.
- A question about follow-up: when will this be reviewed, and what should prompt an earlier visit. Guidance expects a three-month check and then annual reviews, so it is fair to ask.
If treatment is not helping, or side effects persist, guidance says you can ask to be referred to a clinician with menopause expertise (NICE, 2024).