Hormone replacement therapy works by supplementing hormones that have declined or are no longer being produced at sufficient levels, most commonly estrogen during perimenopause, menopause, or after surgical removal of the ovaries. Estrogen plays a role in temperature regulation, vaginal and urinary tissue health, sleep, mood, bone density, skin, and sexual wellbeing. When estrogen levels fall, some people experience symptoms such as hot flashes, night sweats, vaginal dryness, sleep disruption, mood changes, reduced libido, and changes in bone health.
Estrogen replacement therapy provides estrogen through a prescribed formulation such as a tablet, patch, gel, spray, vaginal cream, vaginal tablet, or ring. Systemic estrogen, such as tablets, patches, gels, or sprays, circulates through the bloodstream and may be used for symptoms affecting the whole body, such as hot flashes and night sweats. Local vaginal estrogen is used at a lower dose and acts mainly on vaginal and urinary tissues, often for symptoms such as vaginal dryness, discomfort, or recurrent urinary symptoms.
For people who still have a uterus, estrogen is usually prescribed with a progestogen because estrogen alone can thicken the lining of the uterus and increase the risk of endometrial cancer. Adding a progestogen helps protect the uterine lining. People who have had a hysterectomy may be prescribed estrogen-only therapy, depending on their individual medical history and clinical needs. The NHS describes HRT as either combined HRT, which includes estrogen and progestogen, or estrogen-only HRT, with estrogen-only HRT generally recommended for people who have had a hysterectomy.
Treatment is usually individualized. A clinician considers the person's age, symptoms, medical history, uterus status, time since menopause, family history, cardiovascular risk, breast cancer risk, clotting risk, migraine history, fertility needs, medications, and personal preferences. Different routes may be chosen for different reasons. Transdermal estrogen, such as patches, gels, or sprays, may be considered where avoiding first-pass liver metabolism is preferred, while local vaginal estrogen may be used when symptoms are mainly genitourinary.
HRT may help relieve menopausal vasomotor symptoms such as hot flashes and night sweats, and may also support vaginal and urinary tissue health and bone protection in appropriate patients. ACOG notes that systemic estrogen therapy, with or without progestin, is the best treatment for hot flashes and night sweats, while local estrogen can be used for vaginal dryness symptoms.
HRT is not a one-size-fits-all treatment. Benefits and risks vary depending on the formulation, dose, route, duration of use, and the person's individual health profile. Modern guidance emphasizes shared decision-making, using the lowest effective dose for the appropriate treatment goal and reviewing treatment regularly with a qualified healthcare professional. NICE's menopause guidance covers individualized identification and management of menopause, including premature ovarian insufficiency, and was reviewed in April 2026.
Hormone replacement therapy is a regulated medical treatment. Lifestyle, nutrition, stress management, movement, sleep support, and complementary therapies may support general wellbeing during menopause or hormonal transition, but they do not replace medical assessment, prescribing, monitoring, or individualized risk review from a qualified healthcare provider.