What Is HRT? A Plain-English Guide

HRT — hormone replacement therapy, also called menopausal hormone therapy — is medication that replaces the hormones your body produces less of as you approach menopause, mainly estrogen. It is the most effective treatment for hot flashes and night sweats, and it also eases vaginal dryness and protects against the bone loss that speeds up after menopause, according to The Menopause Society and the U.S. Office on Women's Health. There are two main forms: estrogen-only, for women who have had a hysterectomy, and combined estrogen-plus-progestogen, for women who still have a uterus — the progestogen protects the womb lining. You can take it as tablets, skin patches, gels, sprays, or a hormone-releasing coil, and low-dose vaginal estrogen is a separate option for local symptoms. HRT carries some risks, including blood clots and, with combined types, a small increase in breast cancer risk. But The Menopause Society's 2022 position statement concludes that for most healthy women under 60 and within 10 years of their last period, the benefits outweigh the risks. This guide explains the terms in plain English so your next doctor's appointment makes more sense.

If you have started reading about menopause treatment, you have probably hit a wall of abbreviations and hormone names. HRT, estrogen, progestogen, transdermal, systemic, vaginal, cyclical, continuous. None of it is as complicated as it sounds once someone lays it out plainly. This guide walks through what HRT actually is, the forms it comes in, what it helps with, and what the major clinical bodies say about its risks — so you can have a clearer conversation with your own doctor.

What HRT stands for, and what it does

HRT stands for hormone replacement therapy. In the United States it is more often called menopausal hormone therapy or MHT, but the two terms describe the same thing: medication that tops up the hormones your ovaries make less of in the run-up to and after menopause.

The main hormone involved is estrogen. As estrogen production falls and fluctuates during perimenopause, many women develop hot flashes, night sweats, disrupted sleep, vaginal dryness, and mood changes. HRT works by restoring some of that estrogen, which is why it targets so many symptoms at once.

According to the U.S. Office on Women's Health, menopausal hormone therapy can relieve menopause symptoms such as hot flashes and vaginal dryness. The Menopause Society goes further, describing hormone therapy as the most effective treatment available for vasomotor symptoms — the medical term for hot flashes and night sweats — and for the genitourinary syndrome of menopause, which covers vaginal dryness and related discomfort.

The two main types: estrogen-only and combined

There are two broad categories of HRT, and which one you are offered depends on a single question: do you still have a uterus?

If you have had a hysterectomy, you can usually take estrogen-only HRT. The NHS notes that estrogen-only HRT is recommended for women who have had their womb removed.

If you still have your uterus, you will typically be offered combined HRT, which pairs estrogen with a progestogen (a synthetic or body-identical form of progesterone). The NHS explains that women who still have a womb need to take both, because the progestogen protects against the increased risk of womb cancer that estrogen alone can cause. NICE guideline NG23 reflects the same approach: combined HRT for people with a uterus, estrogen-only HRT for people who have had a total hysterectomy.

In short, the progestogen is not there to treat your symptoms — estrogen does most of that work. It is there to keep the lining of your uterus safe.

Cyclical versus continuous combined HRT

If you are prescribed combined HRT, you may hear it described as either cyclical (sometimes "sequential") or continuous.

Cyclical HRT is usually for women who are still having periods during perimenopause. The NHS describes a common pattern as taking estrogen every day and adding progestogen for the last 10 to 14 days of the cycle, which produces a monthly bleed.

Continuous combined HRT involves taking estrogen and progestogen every day without a break, and is generally used once you have reached menopause. This pattern is designed to be bleed-free over time.

The distinction matters for more than convenience. NICE NG23 notes that endometrial (womb-lining) cancer risk may slightly increase with sequential combined HRT, while it decreases with continuous combined HRT — one reason doctors often move women onto a continuous regimen after menopause.

How you take it: tablets, patches, gels, sprays, and coils

HRT is not one-size-fits-all when it comes to delivery, and the method can change the risk profile.

You can get your estrogen as:

• Tablets, taken once a day.
• Skin patches, changed every few days.
• Gel or spray, applied to the skin daily.

The progestogen part of combined HRT can come as a tablet, or from a hormone-releasing intrauterine system (IUS) such as the Mirena coil, which the NHS notes can stay in place for up to five years and also works as contraception.

The route matters because of blood clot risk. The NHS points out that estrogen taken as a patch, gel, or spray — known as transdermal HRT, meaning "through the skin" — does not raise the risk of blood clots, whereas tablets carry a small increase. NICE NG23 puts it directly: the risk of venous thromboembolism (a clot in a vein) is increased with oral HRT but not with transdermal HRT, and is greater with oral than transdermal. This is why a woman with clot risk factors may be steered toward a patch or gel rather than a pill.

Vaginal estrogen is a different category

One source of confusion is that low-dose vaginal estrogen — a cream, gel, tablet, pessary, or ring inserted into the vagina — is often grouped under "HRT" but behaves quite differently from the systemic types above.

Systemic HRT (tablets, patches, gels, sprays) sends hormones around the whole body. Local vaginal estrogen acts mainly where it is applied, treating vaginal dryness, burning, or discomfort during sex. The U.S. Office on Women's Health notes that topical vaginal estrogen relieves vaginal dryness but does not help with symptoms like hot flashes.

Crucially, the NHS states that vaginal estrogen does not carry the usual risks of HRT and does not increase your risk of breast cancer, and that you can use it without taking progestogen even if you still have a womb. For women whose main complaint is vaginal or urinary symptoms, this is an important and lower-risk option to know about.

What HRT helps with

The evidence for what HRT treats is consistent across clinical bodies:

• Hot flashes and night sweats. The U.S. Office on Women's Health describes systemic estrogen as the most effective treatment for these vasomotor symptoms, and NICE NG23 recommends offering HRT to people with vasomotor symptoms associated with menopause.
• Vaginal dryness and genitourinary symptoms. Both systemic and local estrogen relieve vaginal dryness, per the Office on Women's Health.
• Bone protection. Systemic estrogen protects against the bone loss that speeds up in early menopause. The Menopause Society's 2022 position statement states that hormone therapy has been shown to prevent bone loss and fracture.

HRT can also help with sleep and mood for some women, often indirectly — fewer night sweats can mean better sleep, which ripples into everything else.

What the risks are

HRT is a medical treatment with genuine trade-offs, and the honest answer is that the risks depend on the type, dose, route, your age, and your personal health history. Here is what the major bodies say.

• Blood clots. As above, oral HRT carries a small increased risk of venous thromboembolism; transdermal HRT does not, according to NICE NG23.
• Stroke and heart. The U.S. Office on Women's Health notes that hormone therapy can raise the risk of stroke and blood clots. Risk relates strongly to age and timing of starting.
• Breast cancer. NICE NG23 notes that combined HRT is associated with an increase in breast cancer risk that rises with longer duration of use, while estrogen-only HRT shows little or no increase in breast cancer risk.
• Womb (endometrial) cancer. Estrogen taken alone by a woman with a uterus raises endometrial cancer risk, which is precisely why progestogen is added in combined HRT.

The Menopause Society's 2022 hormone therapy position statement frames the overall picture this way: for most healthy, symptomatic women who are younger than 60 and within 10 years of their final period, the benefits of hormone therapy outweigh the risks. For women who start much later or are over 60, the balance shifts less favorably. This is sometimes called the "timing" of treatment, and it is one of the most important things to discuss with your doctor.

Who should talk to a doctor before starting

HRT is a personal decision made with a clinician, not something to start or rule out based on a single article. NICE NG23 stresses tailoring the conversation to the individual's age, circumstances, and risk factors, and reviewing benefits and risks over time. Women with a history of certain cancers, blood clots, liver disease, or some other conditions may need alternatives or extra caution.

The most useful thing you can bring to that appointment is a clear picture of your own symptoms: what you are experiencing, how often, how badly it affects your daily life, and how it has changed over time. That is where tracking earns its keep.

About Rythma

Rythma is a perimenopause tracking app for iPhone that learns your personal symptom patterns and predicts difficult days before they arrive. Built specifically for the unpredictability of perimenopause — rather than the fixed 28-day cycle most period apps assume — it helps you anticipate symptoms, plan your life around hard days, and bring a clear symptom report to appointments where treatment options like HRT come up.

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Rythma is a tracking and educational tool, not a medical device, and this article is for general information only — it is not medical advice. Perimenopause varies widely from person to person. Always consult a qualified healthcare professional about your symptoms, diagnosis, or treatment.