HRT for perimenopause: what to know first

The essentials, before your appointment

1. 01

   What HRT actually is

   HRT replaces the hormones — mainly oestrogen, usually with a progestogen — that fall during the menopause transition. It's used to ease symptoms like hot flushes, night sweats, sleep and mood changes, and vaginal dryness, and it supports bone health.

2. 02

   The main types

   Oestrogen comes as patches, gels, sprays or tablets. If you still have a womb, a progestogen (or a combined product) is added to protect the womb lining. There's also low-dose vaginal oestrogen for local symptoms, which works differently from body-wide HRT.

3. 03

   What it helps — and what it doesn't

   HRT is very effective for vasomotor symptoms (hot flushes, night sweats) and genitourinary symptoms, and often helps sleep and mood tied to the transition. It isn't a treatment for every midlife symptom, so it helps to be clear about which symptoms bother you most.

4. 04

   How benefits and risks are weighed

   For most people starting around the time of menopause, benefits commonly outweigh risks — but the balance depends on your age, time since menopause, personal and family history, and the type and route of HRT. This is exactly the individualised judgement your clinician is there to make with you.

5. 05

   Non-hormonal options exist too

   If HRT isn't suitable or preferred, clinicians can discuss non-hormonal medicines, CBT for hot flushes and sleep, and lifestyle approaches. It's not all-or-nothing.

6. 06

   How to prepare for the conversation

   Bring a record: which symptoms you have, how severe and how often, how they affect daily life, your cycle pattern, and relevant medical and family history. A clear symptom log turns a rushed appointment into a productive one.

Common questions

Is HRT safe?

For many people HRT is a safe and effective option, but 'safe for me' depends on your individual history — which is why it's a clinician-led decision. Some conditions and histories change the balance or the recommended type. Don't start, stop or change HRT based on general information alone.

Will HRT make me gain weight?

HRT is not an established cause of weight gain. Weight changes are common in midlife for other reasons; some people find managing symptoms actually makes it easier to stay active. Raise any concerns with your clinician.

How long can I take HRT?

There's no fixed limit for everyone. Many people take it for several years, and the decision is reviewed periodically with a clinician based on symptoms, benefits and your own preferences.

Do I even need HRT?

Not everyone does — plenty of people manage the transition without it. It's most worth discussing if symptoms are affecting your quality of life, sleep, or work. Tracking your symptoms helps you and your clinician judge.

Keep reading

Menopause transition

Am I in perimenopause? 8 early signs

Mood & PMDD

PMDD vs PMS: how to tell the difference

Flow & bleeding

Is my period too heavy? When to see a doctor