Approaches

Body-Identical HRT

Refers to HRT using hormones with a molecular structure identical to those produced by the human body — primarily 17β-estradiol and micronized progesterone. These are available as licensed products (patches, gels, Utrogestan) on the NHS and are distinct from unregulated 'compounded bioidentical HRT'. NICE and BMS endorse body-identical regulated HRT as the preferred approach.

Combined HRT

Preparations combining oestrogen and a progestogen in a single product, available in sequential (mimicking a cycle) or continuous combined (no bleed) formulations. Suitable for women with a uterus who need both oestrogen and progestogen.

Conjugated Estrogens

A mixture of oestrogen compounds derived from the urine of pregnant mares. One of the most widely studied oestrogen preparations, though largely replaced in the UK by body-identical options. Still prescribed in some cases, including for women post-hysterectomy.

DHEA

A precursor hormone produced naturally by the adrenal glands. Available as an oral supplement or vaginal pessary (Intrarosa, licensed for vaginal atrophy). Used to support oestrogen and testosterone levels, particularly in women with adrenal insufficiency or premature ovarian insufficiency.

Dydrogesterone

A synthetic progestogen used as the progestogen component in Femoston combined HRT. Structurally similar to natural progesterone and considered to have a more favourable side-effect profile than older synthetic progestogens. Does not have androgenic activity.

Estradiol Gel

Transdermal oestrogen in gel form, applied daily to the skin of the arm or thigh. Oestrogel is the most widely used brand in the UK. Dose can be adjusted by the number of pumps used.

Estradiol Patch

Transdermal oestrogen delivered via a patch applied to the skin, changed every 3–4 days. One of the most common HRT delivery methods in the UK.

Estradiol Tablets

Oral oestrogen tablets taken daily. Widely available and convenient but subject to first-pass liver metabolism, which can affect clotting factors and triglycerides more than transdermal routes.

Micronized Progesterone

Body-identical progesterone derived from plant sources and micronized for absorption. Used to protect the uterine lining in women taking oestrogen HRT. Can be taken orally or vaginally and is associated with better sleep and fewer side effects than synthetic progestogens.

Mirena IUS

A hormonal intrauterine system (coil) that releases a low dose of levonorgestrel locally into the uterus. In the context of HRT, it is used as the progestogen component to protect the uterine lining when combined with systemic oestrogen. Also functions as contraception.

Norethisterone

A synthetic progestogen used as the progestogen component in some combined HRT preparations and as a standalone treatment to delay menstruation or manage heavy periods. Has androgenic properties and is associated with more side effects than micronized progesterone in some women.

Testosterone Cream

Topical testosterone applied to the skin in small doses to address low libido and fatigue in women. In the UK, no testosterone product is licensed for women; use is off-label or via compounding pharmacies. Recommended by NICE and BMS as a treatment for hypoactive sexual desire disorder (HSDD) in menopausal women.

Tibolone

A synthetic steroid with oestrogenic, progestogenic, and weak androgenic activity. Used as a continuous combined HRT option in postmenopausal women. Typically causes no withdrawal bleed and may also benefit libido.

Vaginal Estrogen

Low-dose oestrogen applied directly to the vagina as a pessary, cream, or ring. Treats local symptoms of genitourinary syndrome of menopause (GSM) including vaginal dryness, discomfort, and recurrent UTIs. Does not significantly raise systemic oestrogen levels and is safe for most women, including many with a history of breast cancer.