HRT options compared: patches, gels, tablets and more

HRT is not one medicine. It is a family of options, and the right one depends on whether you still have periods, whether you have a womb, your health history and what you prefer. This page explains the choices in plain words, so you can ask good questions. It is not a recommendation for you. A doctor or nurse will tailor it.

Step 1: which hormones?

• Oestrogen only: for people who have had a hysterectomy (womb removed). Taken every day.
• Oestrogen plus a progestogen (combined HRT): if you still have a womb. The progestogen protects the womb lining from thickening. You can take them as separate products or in one, and the progestogen can come from tablets, a patch, micronised progesterone capsules or a hormonal coil (IUS).
• Vaginal oestrogen: a low dose cream, gel, tablet, pessary or ring that treats vaginal and urinary symptoms. It works locally, so no progestogen is needed.

Step 2: how do you take it?

• Tablets: once a day and easy. But tablets carry a slightly higher risk of blood clots and stroke than skin options. The overall risk is still small.
• Patches: stuck on the lower body and changed every few days. They help if you forget tablets or have trouble swallowing. They do not raise clot risk. They can come off or irritate skin.
• Gel: smoothed on the skin daily. Does not raise clot risk. It takes a few minutes to dry.
• Spray: 1 to 3 sprays on the inner arm or thigh daily, and the NHS says to wait an hour before a bath or shower. Does not raise clot risk.

NICE says to consider skin (transdermal) HRT rather than tablets if you are at increased risk of blood clots, including with a BMI over 30.

Step 3: what pattern?

• [[sequential-hrt]]: usually advised if you still have periods. You take oestrogen daily and a progestogen for the last 10 to 14 days of each cycle, and you have a monthly bleed.
• Continuous combined: oestrogen and progestogen every day with no break, usually advised once you have had no period for a year. After a few months, many people have no bleeding.
• Spotting or irregular bleeding is common in the first 4 to 6 months of continuous HRT and usually settles.

Other options

• Tibolone: a daily tablet that acts like combined HRT with a hint of testosterone. Only suitable if your last period was over a year ago. The NHS says some studies suggest it may be less effective than combined HRT.
• Testosterone: a gel that a specialist may prescribe for low sex drive if HRT alone has not helped. It is not licensed for menopause in the UK. NICE says to consider it. Side effects can include acne and extra hair growth.
• Combined pill and HRT: you cannot take both. If you take the combined pill, a GP may suggest staying on it until about 50 and then switching, because it can hide the signs of menopause. If you take a progestogen-only pill, you can usually take HRT too.