Choosing hormone replacement therapy can feel confusing when the options include patches, gels, tablets and sprays. The names describe how treatment is delivered, but another decision matters just as much: which hormones you need and how regularly you take them. Understanding the main HRT types available in the UK makes a conversation with your GP much more useful.
First, understand which hormones you need
Most systemic HRT contains oestrogen, usually estradiol, to help relieve hot flushes, night sweats and other menopause symptoms. If you still have your womb, you normally also need a progestogen. It protects the womb lining from the effects of oestrogen and reduces the risk of endometrial cancer.
If you have had your womb removed, oestrogen-only HRT is usually suitable, although individual circumstances can change the advice. Combined HRT means taking both hormones, either in one product or separately. Your menopause stage, medical history and preferences help determine the best arrangement.
HRT patches in the UK
HRT patches stick to the skin and release hormones gradually. Depending on the product, you change them once or twice weekly. Oestrogen-only patches and patches combining oestrogen with a progestogen are available.
They suit people who prefer not to take a daily tablet and those who want to avoid the additional blood-clot risk associated with oral HRT. NHS and NICE guidance distinguish transdermal treatment, which delivers oestrogen through the skin, from tablets in this respect.
The practical drawback is adhesion. Patches may loosen with friction or irritate sensitive skin. Follow your specific brand’s placement instructions, apply to clean, dry skin and rotate application sites. If a patch repeatedly comes loose, ask your pharmacist rather than improvising with extra doses.
HRT gel in the UK
Oestrogen gel is applied to the skin, usually every day, where the hormone is absorbed into the bloodstream. It offers a transdermal alternative when patches irritate the skin or simply do not fit your routine.
Gel requires more daily attention. You must follow instructions on the amount, application area, drying time and contact with other people. Do not wash the treated area sooner than advised. If you have a womb, gel alone is not enough: your prescription must also include appropriate progestogen protection.
For example, someone who swims most mornings might prefer an evening gel routine, provided it follows the product instructions. Someone who dislikes daily applications might find a twice-weekly patch easier.
HRT tablets in the UK
Oral HRT tablets generally involve taking medicine every day. There are oestrogen-only and combined preparations, including products with different hormone schedules. Tablets may be straightforward if you already have a reliable daily medication habit.
However, oral HRT is linked with a higher risk of venous blood clots than transdermal oestrogen. This does not mean every tablet user will develop a clot, or that patches are risk-free in every respect. A GP may particularly favour a patch, gel or spray when clot risk is raised, including in people with obesity or certain medical histories.
Oestrogen sprays and vaginal treatments
Oestrogen spray is another systemic option applied to the skin each day. As with gel, a separate progestogen is generally required if you have a womb. Spray routines involve specific drying and washing instructions, so convenience depends on your daily habits.
Vaginal oestrogen is different. Low-dose creams, tablets, pessaries and rings treat local symptoms such as vaginal dryness, irritation or discomfort during sex. They do not adequately treat hot flushes or night sweats. Because very little hormone is absorbed throughout the body, low-dose vaginal oestrogen usually does not require added progestogen, even when you have a womb.
Some people use vaginal oestrogen alongside systemic HRT when local symptoms remain troublesome. A guide to managing vaginal dryness can help you identify symptoms worth discussing rather than assuming every menopause complaint needs a higher systemic dose.
Sequential versus continuous combined HRT
Delivery method is only half the picture. For people with a womb, the hormone schedule can affect bleeding patterns. Sequential, or cyclical, combined HRT typically provides oestrogen throughout the cycle and progestogen for part of it. It is often used during perimenopause, when periods are still occurring, and commonly produces a withdrawal bleed.
Continuous combined HRT provides both hormones without a planned break and is generally offered after menopause, commonly once periods have stopped for at least 12 months. Unexpected bleeding can occur initially, but persistent or new bleeding requires medical assessment.
Instead of a combined tablet or patch, some people take transdermal oestrogen with oral micronised progesterone. A suitable 52 mg levonorgestrel intrauterine system, such as Mirena, may also provide womb-lining protection and contraception. Your clinician should confirm the device and its replacement date for HRT use.
How to choose a type with your GP
The most useful question is not simply which form is strongest. It is which formulation offers symptom relief while fitting your health risks and the routine you can follow consistently. Before an appointment, note your main symptoms, last period, bleeding changes, medicines, migraines and any history of clots, breast cancer or liver disease.
Ask how the progestogen will be supplied if you have a womb, whether a transdermal route is preferable, and when to review the dose. HRT is not contraception, so discuss pregnancy prevention if relevant. Our guide to perimenopause symptoms and overview of menopause treatment options can help frame that conversation.
Relief may begin within weeks, but a treatment can take around three months to show its full effect. Side effects such as breast tenderness, headaches or irregular bleeding sometimes settle. Do not change the dose yourself; arrange a review if symptoms persist or side effects are difficult. Unexplained vaginal bleeding should be assessed, particularly if it continues or develops after treatment has settled.
Frequently asked questions
Are HRT patches safer than tablets?
For blood-clot risk, transdermal oestrogen is generally preferable to oral HRT. Overall suitability still depends on your age, medical history, hormone combination and individual risks, including breast cancer risk.
Can I use HRT gel without progesterone?
Usually only if you do not have a womb. People with a womb normally need progestogen alongside systemic oestrogen gel to protect the womb lining. Low-dose vaginal oestrogen is an important exception.
Which HRT type is best during perimenopause?
There is no single best delivery method. If you still have a womb and periods, sequential combined HRT may be suitable. Your GP can help match a tablet, patch, gel or spray with the necessary progestogen.
Can I switch HRT types if one does not suit me?
Yes. A clinician may adjust the dose, delivery route or progestogen if symptoms remain troublesome or side effects persist. Ask for a planned review rather than switching products independently.
Finding a workable treatment
The main hormone replacement therapy types differ in daily effort, hormone combinations and some safety considerations, not simply in packaging. Patches, gel and spray deliver systemic oestrogen through the skin; tablets are oral; low-dose vaginal treatments target local discomfort. The right choice is the one you and your clinician can justify medically and maintain comfortably, with appropriate follow-up.
