If you’re thinking of starting HRT, it’s best to see a healthcare professional that is experienced in managing menopause and they can clearly explain the different options and types of HRT, as well as outlining the pros and cons of the medication regimes for you. They will also consider your personal history, lifestyle and preferences.

Body identical HRT is the ‘gold standard’ of menopause treatments and it is closely regulated and evidence based. There are 3 hormones that make up HRT and you may only need 1, 2 or all 3 depending on your symptoms and history.

These medications are absorbed into the bloodstream and circulate round the body, so are sometimes called systemic HRT. And then there is also local, vaginal oestrogen which is not the same as systemic HRT but is often needed to improve genital comfort and strength as well as urinary symptoms specifically.

• Oestrogen: this is the key hormone that causes many symptoms when no longer produced by the ovaries. You can take it through the skin as it is then absorbed into the bloodstream and travels round the body. It comes in the form of a skin patch, gel or spray and you will be recommended a certain number of pumps of gel or spray or a certain size patch as your dose. You use the gel or spray every day, or if patches are used, these are changed 2x a week. Oestrogen is available in tablet form, but this comes with a small risk of blood clot, so is less used these days.

• Progesterone: if you still have a womb (haven’t had a hysterectomy), you will need to take progesterone when you start taking oestrogen. This is because oestrogen will thicken the lining of your womb and can sometimes cause the cells to change in an unhealthy way. Progesterone keeps the lining of your womb thin and the cells healthy. The safest type of progesterone is micronised progesterone, (called Utrogestan in the UK) and it comes in capsule form that you swallow. Depending on if you’re still having periods or not, you will be advised when to take the capsules. It may be in a 2 weeks on / 2 weeks off pattern, if you’re still having periods occasionally, or it will be continuously if it has been more than a year since your last period. The other way to have progesterone is from a Mirena coil that is inserted into the uterus and stays there for 5 years. This option has the added benefit of being a contraceptive if you need that, and it can help lighten heavy periods significantly.

• Testosterone: this hormone is particularly helpful for low sex drive, fatigue and brain fog, low mood, sleep, joint pains and muscle aches. Using this hormone as part of HRT is still relatively new and in fact, there are no licensed testosterone medications designed for menopausal women in the UK. All testosterone given to women at peri/menopause needs to be prescribed ‘off-licence’, but there are plenty of doctors (NHS and private) willing to do this. It can either be given via a cream (designed for women and called Androfeme) that is only available privately, or there are gels (called Testogel or Testim) that are designed for men but can be given in much smaller doses to women and these are available on the NHS. You rub the cream or gel into the outer thigh or lower tummy area daily. It’s important to have a blood test after you start testosterone replacement to ensure your levels stay well within the female range.

• Vaginal oestrogen: this treatment is not absorbed into the bloodstream, and just stays in the vaginal and vulval area. It’s to help with symptoms of dryness, itch, soreness, painful sex, needing to wee a lot, having leaks of wee, or recurrent UTIs or thrush. It comes in the form of a tablet, pessary, gel or cream that is inserted into the vagina, usually at bedtime to stay in place overnight. There is also a soft silicon ring called Estring that is inserted high up into the vagina and releases a steady of oestrogen for 90 days and is then replaced. Vaginal oestrogens are a very safe and effective treatments and need to be taken long term to provide benefits. It can be used alongside HRT. (If you are only using this type of oestrogen, you do not usually need to take progesterone).