A Beginner’s Guide To Starting HRT

Why consider HRT?

Menopause – and the years leading to up to it, known as perimenopause – has never been more openly discussed. But while conversations have increased, hormone replacement therapy (HRT) has had its fair share of controversy, with past studies linking it to an increased risk of breast cancer. Today, however, smarter, science-backed formulas are helping women take charge of their hormones and overall wellbeing. “HRT isn’t just about managing symptoms – it’s about future-proofing your health,” says Dr Deborah Lee of Dr Fox Online Pharmacy. “It’s estimated 80% of women experience some menopausal symptoms, with the menopausal transition lasting for around seven years. If you are between 40 and 60, and have noticed anything new or strange, chances are it’s down to hormonal fluctuations.” The main culprit? Declining levels of oestrogen. “Oestrogen is a master hormone that affects the bones, breasts, heart, blood vessels, pelvic muscles and brain,” she explains. “The female body wasn’t designed to function without it, and a deficiency can leave women more vulnerable to osteoporosis, cardiovascular disease and cognitive decline.”

What are the benefits?

For many women, HRT can be transformative. “It provides the body with what it needs to function at its best,” says Deborah. “Benefits include enhanced mood and mental clarity; stronger bones, reducing the risk of fractures and osteoporosis; heart health protection; improved sleep and energy levels; and increased libido and vaginal comfort, helping maintain a fulfilling sex life.” 

What are the different types of HRT?

Not all HRT is the same, and finding the right balance is key. “If you choose to start HRT, it typically includes one or more of the following hormones: oestrogen, progesterone and testosterone,” says Anna Miller, registered nurse and co-founder of Ardour Clinic. “Oestrogen tends to be the primary hormone in HRT, and can be administered in several forms, such as implants, skin patches, sprays and gels. Combined HRT – typically oestrogen and progesterone – can be delivered as a single tablet or patch containing both hormones or through separate oestrogen and progesterone tablets.” Deborah adds that, while oestrogen is the key hormone being replaced, those with a uterus will also need progesterone to protect the endometrial lining. Testosterone is sometimes included as well, particularly to help with libido and energy levels.

Can you explain the difference between body-identical and bio-identical HRT

This is one of the biggest sources of confusion in the HRT conversation, according to Deborah. “Body-identical HRT is regulated, thoroughly tested, and contains hormones structurally identical to those produced by the body,” she says. “This is what’s prescribed on the NHS and is the safest, most evidence-based option.” Bio-identical hormones, however, are often custom-mixed by private clinics, meaning they lack the same regulatory oversight. “The concern is that these formulas don’t undergo the same safety testing, so their effectiveness and long-term impact aren’t as well understood. It’s also worth noting bio-identical HRT isn’t recommended by the British Menopause Society,” she explains. 

What if you still need contraception?

For women experiencing heavy periods alongside menopausal symptoms who still require contraception, the Mirena coil can be a game-changer. “Once inserted, the coil releases a low dose of progesterone daily, thinning the womb lining,” says Deborah. “This can reduce periods by up to 90%, and for 20% of women, bleeding stops altogether. It lasts for five years and can be used alongside oestrogen therapy to manage menopausal symptoms, making it an excellent option during perimenopause.”

How do you find the right dosage?

HRT isn’t one size fits all, so fine-tuning your dosage is crucial. “Every woman’s hormonal needs are unique,” says Deborah. “Some will metabolise hormones more efficiently than others, meaning adjustments are necessary.” If your symptoms persist beyond three months, it may be time to refine the dosage or switch to a different delivery method. “Many women find patches work better than gels, or that they need a slightly higher or lower dose to feel their best.” 

What can you expect when starting HRT?

If you’re hoping for instant results, patience is key. “Some women feel an improvement within weeks, but for most, it takes a few months to really notice the benefits,” Deborah says. Common side effects in the early weeks include temporary bloating and fluid retention, mild headaches, breast tenderness, nausea and slight mood fluctuations. “These typically resolve within three months as your body adapts,” she says. “Hot flushes and night sweats often improve first. But symptoms like joint pain, mood swings and brain fog can take a few months to fully stabilise, so it’s important to give it time before deciding whether any tweaks are needed.”

Does HRT increase your risk of breast cancer?

This is one of the most common concerns surrounding HRT. “The reality is, for the vast majority of women, the benefits far outweigh the risks,” says Deborah. “The most recent research shows oestrogen-only HRT does not increase breast cancer risk, and for combined HRT, the added risk is minimal – lower than the risk associated with obesity or drinking alcohol.” To put it into perspective: for every 1,000 women taking combined HRT for five years, there may be four extra cases of breast cancer – a small increase compared to the significant protective benefits for heart, bone and brain health. Dr Louise Newson, a leading menopause specialist, is also passionate about debunking myths around HRT and cancer. “There is no statistically significant link between the two,” she says. “In fact, studies have found that taking oestrogen alone reduces the risk of breast cancer by 23% and death from breast cancer by 40%. It’s time we stop scaring women away from a treatment that could dramatically improve their quality of life.”

Can HRT help you stay healthier for longer?

Beyond symptom relief, HRT is increasingly being seen as a preventative measure. “We now know oestrogen has protective effects beyond menopause,” continues Deborah. HRT has been shown to lower the risk of osteoporosis and fractures; support brain health and reduce the risk of dementia; and improve muscle strength and metabolic health. “In many ways, HRT is about longevity and quality of life, not just symptom management,” she stresses. “We need to shift the conversation from ‘relief’ to ‘enhancement’.”

How long should you stay on HRT?

Gone are the days when women were told to stop HRT after five years. “For many women, staying on HRT long term is beneficial,” adds Louise. “There’s no reason to stop HRT as research has shown there are benefits of taking it forever, especially when it comes to reducing the risk of osteoporosis. Menopause marks a permanent shift in your body’s hormone levels – HRT simply replaces what’s missing and many women find their symptoms return after stopping.”

The bottom line?

Menopause isn’t something to just ‘get through’ – it’s a transition into the next stage of life, and HRT can help you feel your best. “HRT isn’t just about managing symptoms – it’s about thriving,” says Deborah. “Women today are rewriting the rules of midlife, and with the right hormonal support, there’s no reason why they can’t feel their absolute best while doing it.” Educate yourself, find the right practitioner, and don’t be afraid to explore whether HRT could be the missing piece in your midlife health journey.  

Visit DOCTORFOX.CO.UK, DRLOUISENEWSON.CO.UK & THEARDOURCLINIC.COM

DISCLAIMER: Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.