Getting HRT in the UK in 2026 should be straightforward. The evidence base is much clearer than it once was, NICE guidance explains when HRT should be discussed, and the range of preparations available means there are options to suit many women. Yet many women still struggle to access it, are given outdated information about risks, or are not offered it at all.
This complete guide explains what HRT is, how to get prescribed whether through the NHS or privately, what types are available, what it costs, what the current risk picture looks like, and what to do if you are not getting the help you need.
If you want specialist support, you can also search menopause clinics and HRT support services in The Menopause Directory.
What is HRT and how does it work?
Hormone replacement therapy replaces hormones, primarily oestrogen and sometimes progesterone, that decline during perimenopause and menopause. This hormonal change is linked with many symptoms women experience during this transition, including hot flushes, night sweats, brain fog, joint pain, low mood, poor sleep, vaginal dryness and urinary symptoms.
By restoring hormone levels, HRT can address the hormonal driver behind many symptoms rather than treating each symptom separately. For many women, the effect is significant. Symptoms that have affected quality of life, relationships and work can improve after starting the right preparation and dose, though response times vary.
HRT can also have important long-term health benefits for some women, particularly around bone density and osteoporosis risk. Cardiovascular risk depends on age, timing, route and individual health history, so this should be discussed with a knowledgeable clinician.
Who can take HRT?
Many women going through perimenopause or menopause are suitable candidates for HRT. The idea that HRT is only appropriate for women with very severe symptoms, or that it carries major risks for most women, is outdated and does not reflect current guidance.
NICE menopause guidance says clinicians should discuss the benefits and risks of HRT with people experiencing menopause symptoms. The British Menopause Society also provides evidence-based guidance for clinicians on HRT prescribing and risk assessment.
HRT is not appropriate for everyone. It may be unsuitable or require specialist input in women with a history of some hormone-sensitive cancers, undiagnosed vaginal bleeding, untreated endometrial cancer, active or recent blood clots, or certain other significant medical conditions. A good clinician will take a thorough personal and family history to assess whether HRT is appropriate for your individual circumstances.
Women with a history of breast cancer, blood clots, cardiovascular disease, or other significant health conditions should not be dismissed automatically. They may need specialist advice, and some options, such as vaginal oestrogen, may still be appropriate for some women.
How to get HRT prescribed in the UK
Through your GP on the NHS
Your GP is your first port of call for HRT on the NHS. Under NICE guidance, GPs should discuss HRT with women experiencing menopause symptoms, explain the benefits and risks, and offer it where it is appropriate.
To get the most from your GP appointment, come prepared. Write down all your symptoms and when they started. Note how they are affecting your daily life. Be specific about what you are looking for. If you want to discuss HRT, say so explicitly at the start of the appointment rather than waiting to see whether your GP raises it.
In women over 45 with typical menopause symptoms, NICE guidance is clear that diagnosis is usually based on symptoms and clinical history, not blood tests. You should not normally need to wait for hormone blood test results before HRT is considered.
If your GP is hesitant or dismissive, you can ask to see a different GP at your practice, request a longer appointment specifically to discuss menopause, or ask for a referral to an NHS menopause specialist.
Through a private menopause specialist
Private menopause clinics offer faster access to HRT, typically with longer consultation times and access to clinicians with specific menopause expertise. An initial private consultation typically costs between £99 and £350 depending on whether the service is nurse-led or doctor-led and whether it is in person or online.
Once private treatment is established, many clinicians can write to your NHS GP with a treatment plan. Your GP can then decide whether they are able to prescribe ongoing medication on the NHS, which can reduce the long-term cost of treatment.
Through an online menopause clinic
Online menopause clinics provide specialist consultations via video call and can prescribe HRT directly where clinically appropriate. They are available across the UK and are often one of the fastest routes to specialist care, particularly for women in areas where in-person private services are limited.
The same quality checks apply to online clinics as to in-person services. Look for Care Quality Commission registration where applicable, named clinicians, transparent pricing and recognised menopause training.
Types of HRT available in the UK
There is a wide range of HRT preparations available in the UK. Understanding the options helps you have a more informed conversation with your prescriber.
Oestrogen
Oestrogen is the primary component of HRT. It is available in several forms, and the delivery method matters clinically as well as practically.
Transdermal oestrogen, delivered through the skin via a patch, gel or spray, is often preferred for many women because it avoids first-pass metabolism through the liver and has a different risk profile from oral oestrogen. NICE guidance notes that transdermal HRT does not increase the risk of venous thromboembolism compared with baseline risk.
Patches are applied to the skin and changed according to the product instructions. Gels are applied daily to the skin, usually the arm or thigh. Sprays are applied to the forearm. Oral oestrogen tablets are also available and may be appropriate for some women.
Progesterone
Women who have a uterus need progesterone or a progestogen alongside oestrogen to protect the lining of the womb. Taking oestrogen without appropriate endometrial protection in women with a uterus increases the risk of endometrial cancer.
Micronised progesterone, sold as Utrogestan in the UK, is body-identical and is commonly used with transdermal oestrogen. Synthetic progestogens are present in some combined HRT preparations and may be appropriate for some women.
Women who have had a hysterectomy usually do not need progesterone and can often take oestrogen alone, unless there are specific clinical reasons otherwise.
Testosterone
Testosterone levels decline with age and may contribute to low libido in some women. Testosterone therapy for women is not licensed specifically for menopause in the UK, but it can be prescribed off-label by clinicians experienced in menopause care, particularly for low sexual desire when HRT has not fully helped.
Testosterone is not usually a first-line treatment and is typically considered alongside oestrogen-based HRT rather than used alone. Blood tests may be used to monitor levels and ensure dosing stays within a safe range.
Vaginal oestrogen
Vaginal oestrogen, available as a cream, pessary, tablet or ring, is used locally to treat vaginal dryness, urinary symptoms, discomfort during sex and genitourinary symptoms of menopause.
Unlike systemic HRT, vaginal oestrogen is absorbed mostly locally and is generally considered suitable for long-term use for many women. It may also be considered for some women who cannot take systemic HRT, depending on individual circumstances and specialist advice.
One vaginal oestrogen product, Gina, is available over the counter at pharmacies for postmenopausal women aged 50 and over, subject to pharmacist assessment.
What is body-identical HRT?
Body-identical HRT refers to hormones that have the same molecular structure as hormones produced naturally by the human body. Oestradiol gels, patches and sprays are body-identical, as is micronised progesterone.
Body-identical is not the same as unregulated compounded bioidentical HRT. Compounded bioidentical hormones are made by specialist pharmacies and are not licensed in the UK in the same way as regulated medicines. The British Menopause Society has warned against the routine use of compounded bioidentical hormone therapy because of concerns around quality control, safety, dosing and evidence.
Licensed body-identical HRT is available on both NHS and private prescription and is the appropriate route for most women who want regulated, evidence-based hormone therapy.
What does HRT cost in the UK?
On the NHS
Standard NHS prescription charges apply to HRT in England unless you are exempt. As of May 2026, the NHS prescription charge in England is £9.90 per item.
The HRT Prescription Prepayment Certificate covers eligible HRT items for £19.80 for 12 months. For many women who pay for prescriptions in England, this represents a significant saving.
Prescriptions are free in Wales, Scotland, and Northern Ireland.
Privately
Private HRT costs more but can provide faster access and greater choice of clinician. A realistic breakdown of private costs over the first year may include:
| Private HRT cost | Typical range |
|---|---|
| Initial consultation | £99 to £350 |
| Follow-up appointment | £75 to £150 |
| Oestrogen gel or patches | £8 to £30 per month |
| Micronised progesterone | £20 to £35 per month |
| Testosterone, if prescribed | £30 to £70 per month |
Once treatment is established, transferring ongoing prescribing to your NHS GP may be possible, reducing the ongoing cost substantially.
What are the real risks of HRT?
The risks of HRT were significantly amplified in public discussion after the Women’s Health Initiative study published in 2002. That study included older women and used specific hormone preparations that do not reflect all modern UK prescribing. Since then, the evidence has become more nuanced.
The current picture, reflected in NICE guidance and menopause specialist guidance, is that risks depend on the type of HRT, route of administration, age, timing, personal medical history and family history.
Breast cancer
Combined HRT using oestrogen and some progestogens is associated with a small increase in breast cancer risk with longer-term use. Oestrogen-only HRT has a different risk profile and is used only for women who do not need progesterone, usually because they have had a hysterectomy. Your clinician should explain your individual risk clearly and in context.
Blood clots
Transdermal oestrogen, delivered via patch, gel or spray, is not associated with an increased risk of blood clots compared with baseline risk according to NICE guidance. Oral oestrogen can carry a small increased risk. This is one reason transdermal oestrogen is often preferred, particularly for women with risk factors.
Stroke
Stroke risk depends on age, dose, route and individual risk factors. Transdermal routes are generally preferred for women with certain risk factors. Your clinician should assess your personal cardiovascular and stroke risk before prescribing.
Cardiovascular disease
HRT started before age 60 or within 10 years of menopause has a different risk profile from HRT started much later. For many healthy women in this window, HRT can be considered after an individual benefits-and-risks discussion. Starting HRT significantly later, particularly in women with established cardiovascular disease, requires more careful specialist assessment.
The key message is that HRT should be an individualised decision. For many women under 60 or within 10 years of menopause, benefits can outweigh risks, but that discussion should be based on your own health profile with a knowledgeable clinician.
What to do if your GP will not prescribe HRT
If your GP is reluctant to prescribe HRT or has declined without adequate explanation, you have several options.
- Ask to see a different GP at your practice, ideally one with an interest in women’s health or menopause.
- Ask your GP to explain why HRT is not appropriate for you, with reference to NICE guidance.
- Request a longer appointment specifically to discuss menopause and HRT.
- Request a referral to an NHS menopause specialist.
- Seek a private consultation with a menopause specialist, who can provide a detailed assessment and treatment plan.
- Contact the practice manager or local Integrated Care Board if you believe you are being denied care that should be available.
You are entitled to care that follows current clinical guidance. If you feel dismissed, it is reasonable to ask for a second opinion.
Finding HRT support near you
The Menopause Directory lists NHS and private menopause services across the UK, including online clinics, private specialists, and support services with a particular interest in menopause and HRT. Whether you are looking for your first HRT prescription or seeking a second opinion on your current treatment, the directory helps you find the right support more easily.
Helpful places to start include:
- NHS menopause support: what you are entitled to
- Private menopause consultations in the UK
- Online menopause clinics in the UK
- How to find a menopause specialist near you
- Menopause clinics in the UK
Frequently asked questions
How do I get HRT prescribed in the UK?
The most straightforward route is through your GP on the NHS. Under NICE guidance, your GP should discuss HRT with you and offer it if it is appropriate. You can also access HRT through a private menopause specialist, either in person or via an online clinic, without a GP referral. Private consultations are often available within one to two weeks.
Do I need a blood test to get HRT?
Not routinely. In women over 45 with typical menopause symptoms, NICE guidance says diagnosis should usually be based on symptoms and clinical history, not blood tests. Blood tests may be appropriate in women under 45 or where the diagnosis is uncertain, but they should not usually delay treatment in women over 45 with typical symptoms.
What is the HRT Prescription Prepayment Certificate and how much does it cost?
The HRT PPC is an NHS scheme that covers eligible HRT items for a fixed annual fee. As of May 2026, it costs £19.80 for 12 months in England. Prescriptions, including HRT, are free in Wales, Scotland, and Northern Ireland.
What type of HRT is best?
There is no single best type of HRT. The right preparation depends on your symptoms, medical history, preferences, and whether you still have a uterus. Transdermal oestrogen, delivered via patch, gel or spray, is often preferred for many women. Women with a uterus also need progesterone or a progestogen for womb protection.
Is body-identical HRT the same as bioidentical HRT?
No. Body-identical HRT refers to licensed, regulated hormones with the same molecular structure as those produced by the body. These include oestradiol patches, gels and sprays, and micronised progesterone. Bioidentical hormones often refers to unregulated compounded preparations that are not licensed in the UK in the same way and are not recommended by mainstream clinical guidance.
How long can I take HRT?
There is no fixed universal limit on how long HRT can be taken. The decision to continue should be made jointly between you and your clinician, based on regular review of your symptoms, your health, and the benefits and risks in your individual circumstances.
What are the risks of HRT?
The risks depend on the type of HRT, route, dose, age, timing and individual health profile. Transdermal oestrogen does not increase blood clot risk compared with baseline risk according to NICE guidance. Combined HRT can be associated with a small increased breast cancer risk with longer use. Your clinician should discuss the risks specific to your circumstances.
Can I get HRT if my GP refuses to prescribe it?
Yes. If your GP declines to prescribe HRT without adequate explanation, you can ask to see a different GP, request a referral to an NHS menopause specialist, or seek a private consultation. A single private appointment can provide a detailed treatment plan that your GP may then consider implementing on the NHS.
Where to get support next
If symptoms are affecting your sleep, work, relationships or day-to-day wellbeing, it is sensible to speak with your GP, pharmacist or a qualified menopause clinician. The Menopause Directory can also help you compare menopause symptoms hub relevant support providers Ask MenoAI.
This guide is general information only and is not a diagnosis or personalised medical advice. Seek urgent medical help if symptoms feel severe, sudden or worrying.
Useful UK references: NHS menopause information, NICE menopause guideline NG23 and British Menopause Society publications.
Author: The Menopause Directory
About this guide
This guide is published by The Menopause Directory editorial team to help UK readers understand menopause symptoms, support options and services. It is for general information only and should not replace advice from a GP, pharmacist or qualified menopause specialist.
Last reviewed by The Menopause Directory editorial team.