Should you consider HRT for perimenopause?

Feb 243 min read

Perimenopause can be a challenging time, with symptoms ranging from hot flushes and mood swings to brain fog and sleep disturbances.

If you’re experiencing these changes, you might be wondering about hormone replacement therapy (HRT).

There is a lot of information (and misinformation) out there, so this guide is here to help you understand the basics of HRT and how it might support your health.

Should you consider HRT for perimenopause?

What is HRT?

Hormone replacement therapy (HRT) is a treatment that replaces the hormones oestrogen and sometimes progesterone, which naturally decline during perimenopause and menopause.

By restoring these hormone levels, HRT can help alleviate many of the symptoms.

HRT options available for perimenopause

There are different types of HRT available, and the best choice depends on individual health needs and preferences.

The main options include:

Combined HRT (oestrogen and progesterone): Suitable for women who still have their uterus, as progesterone helps protect the womb lining. (Oestrogen alone can stimulate the growth of the womb lining, leading to an overgrowth of cells. Without progesterone to counteract this effect, there is an increased risk of developing endometrial hyperplasia, which can increase the risk of cancer).
Oestrogen-only HRT: Recommended for women who have had a hysterectomy, as they do not need progesterone too.
Sequential (cyclic) HRT: Mimics a natural cycle and is often given to women who are still having periods.
Continuous combined HRT: Provides a steady dose of hormones and is usually prescribed for postmenopausal women.
Local HRT (vaginal oestrogen): Available as creams, pessaries and rings, it helps with vaginal dryness and discomfort without affecting the whole body.

HRT can be taken in different forms, including tablets, skin patches, gels and sprays. Your GP can help you decide which option suits you best.

Benefits of HRT for perimenopause

Many women find that HRT significantly improves their quality of life by:

Reducing hot flushes and night sweats
Improving sleep quality
Enhancing mood and reducing anxiety
Supporting brain function and memory
Helping to maintain bone density, reducing the risk of osteoporosis
Supporting vaginal health and reducing dryness or discomfort.

Is HRT for perimenopause safe?

There has been some confusion around the safety of HRT due to past studies that linked it to an increased risk of breast cancer and cardiovascular issues.

However, more recent research and NHS guidelines now confirm that for most women under 60, the benefits of HRT outweigh the risks.

The type of HRT, how it’s taken (e.g., patches, gels or tablets), and individual health factors all play a role in determining the best approach.

What does the NHS say about HRT for perimenopause?

In the UK, HRT is available on the NHS and is recommended as an effective treatment for perimenopausal and menopausal symptoms.

NICE (National Institute for Health and Care Excellence) guidelines support the use of HRT for symptom relief and encourage women to discuss their options with a GP.

Common concerns with HRT for perimenopause

Breast cancer risk: The risk is small and depends on the type of HRT used. For many women the benefits outweigh the risks, but it’s always best to discuss this with your GP.
Weight gain: HRT does not directly cause weight gain, but hormonal changes during perimenopause can affect metabolism. A balanced diet and regular exercise can help manage weight changes.
Who can take HRT? Most women can take HRT, but if you have certain medical conditions (such as a history of breast cancer or blood clots), your GP may recommend alternative treatments.