Understanding the types of HRT available in the UK is one of the most useful things you can do before your first menopause appointment. There are dozens of preparations to choose from, and while your clinician will guide you, walking in with a basic understanding of the options means you can have a more informed conversation and a treatment plan that genuinely suits your life.
This guide explains every type of HRT available in the UK: what it is, how it works, which brands are available, the clinical pros and cons of each, and how to think about which option might be right for you.
The building blocks of HRT: oestrogen, progesterone and testosterone
Before comparing delivery methods, it helps to understand the three hormones involved in HRT.
Oestrogen is the primary component of HRT and the hormone most responsible for menopause symptoms. Replacing oestrogen addresses hot flushes, night sweats, brain fog, mood changes, joint pain, poor sleep, and vaginal dryness. It also supports bone density and cardiovascular health.
Progesterone is needed by women who still have a uterus to protect the womb lining. Taking oestrogen alone without progesterone in women with a uterus increases the risk of endometrial cancer. Women who have had a hysterectomy do not need progesterone and can take oestrogen alone.
Testosterone declines during menopause and its deficiency contributes to low libido, fatigue, brain fog, and low mood in some women. It is not a standard first-line HRT component but is increasingly prescribed alongside oestrogen-based HRT when these specific symptoms are present.
Why the delivery method matters
The way HRT is delivered into the body is not just a matter of personal preference. It has genuine clinical implications, particularly regarding the risk of blood clots.
Transdermal HRT, which is delivered through the skin via patches, gels, or sprays, bypasses the liver entirely. This means it does not activate the clotting factors that oral oestrogen can stimulate. As a result, transdermal oestrogen does not increase the risk of blood clots, unlike oestrogen taken as tablets.
This is why NICE guidelines and the British Menopause Society recommend transdermal oestrogen as the first choice for most women, particularly those who are overweight, have cardiovascular risk factors, have a history of migraines, or are at higher risk of blood clots for any reason.
| HRT type | How it is used | Best suited to |
|---|---|---|
| Patches | Applied to skin and changed once or twice weekly | Women wanting steady dosing without daily application |
| Gels | Applied to skin daily | Women needing flexible oestrogen dosing |
| Sprays | Sprayed onto skin daily | Women who prefer a quick-drying transdermal option |
| Tablets | Taken by mouth daily | Some women without clotting or cardiovascular risk factors |
| Vaginal oestrogen | Used locally as pessary, cream, tablet, gel or ring | Vaginal and urinary menopause symptoms |
HRT patches
Patches are one of the most widely used forms of HRT in the UK and a first-choice option for many women and clinicians. They are applied to the skin, typically on the lower abdomen, buttock, or upper thigh, and deliver a steady, consistent dose of hormones through the skin into the bloodstream.
Patches are available as oestrogen-only or combined, containing both oestrogen and a progestogen in one patch. They are changed either twice a week or once a week depending on the specific preparation.
Oestrogen-only patches
These are used by women who have had a hysterectomy, or as part of a regimen where progesterone is taken separately as a tablet. UK brands include Evorel 25, 50, 75 and 100, Estradot 25, 37.5, 50, 75 and 100, and FemSeven 50, 75 and 100.
Combined patches
Combined patches contain both oestrogen and a progestogen in a single patch. Sequential combined patches include Evorel Sequi and FemSeven Sequi. Continuous combined patches include Evorel Conti and FemSeven Conti.
Pros and cons of patches
Patches are convenient, discreet, and require changing only every three to four days, which suits women who do not want to remember a daily routine. They provide a steady, consistent hormone level. The main disadvantages are that they can sometimes cause localised skin irritation and may not adhere well in hot conditions.
HRT gels
Oestrogen gels are applied directly to the skin, usually the inner arm, thigh, or lower abdomen, once daily, and absorbed through the skin. Gels allow for flexible dosing. UK brands include Oestrogel (pump dispenser) and Sandrena (individual dose sachets). Both contain oestradiol and are body-identical. Women who still have a uterus need to take a separate progesterone alongside the gel.
HRT sprays
Oestrogen sprays deliver oestradiol via a fine mist sprayed onto the skin of the forearm or inner thigh. The main UK brand is Lenzetto. Like gels, sprays provide oestrogen only, meaning a separate progesterone is needed for women with a uterus.
HRT tablets
Oral HRT tablets have been used for decades and remain appropriate for many women. They are taken daily and are available in a wide range of formulations. The main clinical disadvantage is that oral oestrogen passes through the liver, activating clotting factors and carrying a small increased blood clot risk compared to transdermal preparations.
Micronised progesterone
Micronised progesterone, sold as Utrogestan in the UK, has the same molecular structure as the progesterone produced naturally by the body. It is taken as a capsule, usually at bedtime as it can have a mildly sedative effect. Evidence indicates it does not increase the risk of blood clots and has not been shown to increase breast cancer risk for the first five years of use.
Mirena coil as progesterone in HRT
The Mirena intrauterine system releases a small amount of levonorgestrel locally into the uterus and can be used as the progesterone component of HRT for women who already have a Mirena in place, combined with transdermal oestrogen.
Vaginal oestrogen
Vaginal oestrogen is used locally to treat vaginal dryness, urinary symptoms, discomfort during sex, and recurrent urinary tract infections related to menopause. It is considered safe for almost all women and can be used long term. UK preparations include Vagifem and Vagirux pessaries, Ovestin cream, and Blissel gel. Gina vaginal oestrogen tablet is available over the counter for women aged 50 and over.
HRT implants
HRT implants are small pellets inserted under the skin to release hormones gradually over several months. They are not usually a first-line NHS option and are more commonly discussed in private specialist care. If implants are offered, ask how dose monitoring, side effects, and follow-up will be managed, because they cannot be adjusted as quickly as gels, patches, sprays, or tablets.
Sequential versus continuous HRT: which is right for you?
Sequential HRT is for women who are still having periods or who have recently stopped. Oestrogen is taken daily and progesterone is added for 12 to 14 days of each 28-day cycle. Continuous combined HRT delivers both oestrogen and progesterone daily without a break and is for post-menopausal women.
If you are unsure which type of HRT is right for you, you can also compare menopause clinics, online menopause clinics, and menopause specialists near you through The Menopause Directory.
Frequently Asked Questions
What are the main types of HRT available in the UK?
HRT in the UK is available as patches, gels, sprays, tablets, implants, and vaginal preparations. Patches, gels, and sprays are transdermal and do not increase blood clot risk. Tablets are absorbed orally and carry a small blood clot risk. Vaginal oestrogen is used locally for vaginal and urinary symptoms.
What is the difference between HRT patches and tablets?
The key clinical difference is how they are absorbed. Patches deliver oestrogen through the skin, bypassing the liver, which means they do not increase the risk of blood clots. Tablets are processed by the liver, which carries a small increased blood clot risk. For most women, particularly those with cardiovascular risk factors, patches or other transdermal options are the preferred choice.
Which type of HRT is best for most women?
NICE guidelines and the British Menopause Society recommend transdermal oestrogen, delivered via patch, gel, or spray, as the first choice for most women. Combined with micronised progesterone for women with a uterus, this is the approach most closely aligned with body-identical HRT and carries the most favourable risk profile.
What is body-identical HRT and which products qualify?
Body-identical HRT refers to preparations containing hormones with the same molecular structure as those produced naturally by the human body. Oestradiol patches, gels, and sprays are body-identical, as is micronised progesterone sold as Utrogestan. These are regulated, licensed products available on both NHS and private prescription.
What is micronised progesterone and why is it recommended?
Micronised progesterone (Utrogestan) is a body-identical progesterone with a more favourable risk profile than synthetic progestogens. Evidence indicates it is not associated with an increased breast cancer risk for the first five years of use and does not carry the increased blood clot risk seen with some synthetic progestogens.
What is the difference between sequential and continuous HRT?
Sequential HRT involves taking oestrogen daily and adding progesterone for part of each cycle, producing a monthly withdrawal bleed. It is suitable for women who are perimenopausal. Continuous combined HRT involves taking both hormones daily without a break and is suitable for women who are post-menopausal.
Can I use HRT gel instead of patches?
Yes. Both gels and patches deliver oestrogen transdermally with the same clinical advantages over tablets. The choice between them is largely one of personal preference. Gels offer more flexible dosing, patches are changed less frequently.
Is vaginal oestrogen safe to use long term?
Yes. Vaginal oestrogen is absorbed locally and does not raise systemic hormone levels to any clinically significant degree. It is considered safe for almost all women and can be used indefinitely without a time limit.
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.