# HRT: a balanced look > Benefits, risks and what NICE and the NHS actually say Category: Perimenopause · 6 min read · Written by the Splash team · Sources checked October 2026 URL: https://splash.care/learn/perimenopause/hrt-basics ## Quick answer - HRT is the most effective treatment for most menopause symptoms. - Combined HRT slightly raises breast cancer risk (about 5 extra per 1,000 over 5 years, says the NHS). Oestrogen-only HRT has little or no rise. - Patches, gels and sprays do not raise clot risk; tablets slightly do. Vaginal oestrogen is very low risk. - HRT is not used to prevent heart disease or dementia. - Decide with a doctor based on your own history, and review at 3 months, then yearly. [HRT](https://splash.care/learn/glossary/hrt) has had a rollercoaster reputation. Here is a calm summary of what the NHS and NICE (guideline NG23, updated in 2024 and again in 2026) say, so you can have an informed chat with your [doctor](https://splash.care/learn/conditions/talk-to-your-doctor). This is general information, not advice for you personally. ## What it is HRT replaces [Oestrogen](https://splash.care/learn/glossary/oestrogen). If you still have a womb, you also take a [progestogen](https://splash.care/learn/glossary/progestogen) to protect the womb lining. [Oestrogen](https://splash.care/learn/cycle-basics/hormones-explained) alone raises the risk of womb cancer, which is why combined HRT is used if you have a womb. It comes as tablets, patches, gels or sprays. Vaginal oestrogen treats vaginal and urinary symptoms locally. The NHS says that for people under 60 with [menopause](https://splash.care/learn/glossary/menopause) symptoms, who are not at high risk of breast cancer or blood [clots](https://splash.care/learn/period-care/clots), the benefits of HRT are likely to outweigh the risks. The older view that made many people afraid of it is now seen as out of date, because it did not weigh the benefits as well as the risks. ## Benefits - It is effective at relieving most [perimenopause](https://splash.care/learn/glossary/perimenopause) and menopause symptoms: [hot flushes](https://splash.care/learn/perimenopause/hot-flushes), night sweats, sleep problems, vaginal dryness and [low mood](https://splash.care/learn/mind-mood/why-mood-shifts) or anxiety caused by menopause. Many people feel better within days to weeks. - Fracture risk is lower while you take HRT. NICE says the benefit lasts during treatment and fades once you stop. - It may help low mood that starts around the same time as other menopause symptoms. - The evidence on muscle strength is limited, so exercise remains key. ## Risks, in context - **Breast cancer:** combined HRT slightly raises the risk, and the rise grows the longer you take it. The NHS figure is around 5 extra cases in every 1,000 women who take combined HRT for 5 years. NICE says the risk can last at least 10 years after stopping, and that it is lower with sequential than continuous combined HRT, but still higher than without HRT. Oestrogen-only HRT (for people without a womb) has very little or no increase. Exact numbers depend on your own risk, so ask for NICE’s discussion aid. - **Blood clots:** HRT tablets can raise the risk, though it is still very low. NICE and the NHS say patches, gels and sprays ([Transdermal](https://splash.care/learn/glossary/transdermal)) do not. - **Stroke:** tablets slightly raise the risk, higher with higher doses, longer use and older age at starting. Transdermal HRT is unlikely to. The baseline risk under 60 is very low. - **Heart disease:** HRT does not increase the risk of coronary heart disease. But NICE says not to offer HRT to prevent heart disease or dementia, as it is not proven for that. - **Dementia:** NICE says the risk might rise if combined HRT is started at 65 or over. For oestrogen-only HRT it is unlikely to rise. - **Vaginal oestrogen** does not increase the risk of breast cancer or blood clots, and the NHS says it is safe to use long term. **5 in 1,000** Extra breast cancer cases with 5 years of combined HRT, say the NHS. Alcohol, weight and age also affect breast cancer risk. ## Starting, reviewing and stopping - NICE says to use the lowest effective dose and to talk about how long you might take it from the start. - Irregular bleeding or [spotting](https://splash.care/learn/glossary/spotting) is common for the first 6 months, or within 3 months of changing your dose. Tell a GP if it continues beyond that. - You should be reviewed after 3 months, then at least once a year. - There is no fixed time limit, but it is best to take HRT only for as long as the benefits outweigh the risks. The NHS says people usually take it for 2 to 5 years, sometimes longer. - When you stop, you can taper or stop straight away. Tapering may limit symptoms returning in the short term, but makes no difference in the long run. - HRT is not contraception, except a hormonal coil used as the progestogen. **Myth:** HRT is dangerous for everyone. **Fact:** For many people the benefits outweigh the risks. It is not suitable for everyone, for example some people with a history of breast cancer or blood clots, which is why a personal discussion matters. Specialist advice is available if you have a complex history. **Myth:** HRT makes you put on weight. **Fact:** The NHS says there is little evidence that most types of HRT cause weight gain. Some weight gain often happens around menopause with or without HRT. **Quick quiz:** Which type of HRT does not raise blood clot risk? 1. Tablets 2. Patches, gels and sprays 3. None of them Answer: Patches, gels and sprays. The NHS and NICE say tablets slightly raise the risk of blood clots, but patches, gels and sprays do not. > **Splash says:** it can take a few months to find the right type and dose. Side effects often settle within about 3 months, so keep talking to your doctor. ### When to see a doctor HRT needs a prescription and a chat about your personal and family history. Speak to a GP promptly about bleeding that carries on beyond 6 months on HRT or gets heavier, or any new breast lump. Call 999 for chest pain, sudden breathlessness, pain or swelling in one leg, or signs of a stroke. Keep up your breast screening if you take HRT. ## Sources 1. [NHS: Hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/) 2. [NHS: Benefits and risks of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/) 3. [NHS: When to take HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/) 4. [NICE NG23: Menopause: identification and management](https://www.nice.org.uk/guidance/ng23) This is general information, not medical advice. Splash can’t diagnose. If you’re worried, talk to a GP, pharmacist or sexual health clinic. In an emergency call 999 (UK) or 911 (US).