HRT: What’s changed, and what it could mean for you

UK guidance on hormone replacement therapy (HRT) has been updated in recent years, and there are now more treatment options for menopause symptoms than before. NICE, the body that sets clinical guidance in England, recommends HRT as the first-line treatment for hot flushes and night sweats. It also states that HRT is unlikely to affect life expectancy.

A non-hormonal tablet has now been approved for NHS use for people who cannot or prefer not to take HRT. This article explains what has changed and what it could mean for you, whether you are considering HRT, already taking it, or looking for an alternative.

What is HRT?

HRT is a treatment that replaces hormones that fall during the menopause, mainly oestrogen. It is used to relieve symptoms such as hot flushes, night sweats, sleep problems and vaginal dryness.

HRT comes in several forms, including tablets, patches, gels and sprays. Women who still have a womb are also prescribed a progestogen alongside oestrogen. This protects the womb lining, because taking oestrogen on its own can increase the risk of womb (endometrial) cancer. A progestogen is not usually needed after a hysterectomy.

What has changed in UK guidance on HRT?

NICE updated its menopause guideline in November 2024, the first major update since 2015. It reviewed new evidence on how HRT affects heart disease, stroke, breast cancer, dementia and life expectancy. The main changes are:

• HRT is confirmed as the first-line treatment for hot flushes and night sweats
• HRT is unlikely to affect life expectancy
• Menopause-specific CBT can be considered alongside HRT, or for people who cannot or prefer not to take it
• Updated advice covers managing vaginal and urinary symptoms of the menopause
• A new discussion aid helps clinicians and patients talk through risks and benefits together

Since then, there have been further developments. In March 2026, NICE recommended a non-hormonal tablet, fezolinetant, for NHS use. In April 2026, it updated its advice on unexpected bleeding while taking HRT.

Is HRT safe?

For many women, HRT is a safe and effective treatment, and the benefits are likely to outweigh the risks, particularly for women who start it under the age of 60. Like any medicine, it carries some risks, and these depend on your age, health, family history and the type of HRT you take.

Current UK guidance says:

• HRT helps reduce the risk of fractures caused by osteoporosis
• There is a small increase in breast cancer risk, which varies with the type of HRT and how long it is taken
• There may be a small increase in dementia risk for women who start HRT after the age of 65
• Oestrogen-only HRT is not suitable for women with a womb unless a progestogen is also taken

Your clinician will talk through your personal risks and benefits before recommending treatment.

Menopause can be a time of change. Understanding your options, including HRT, can help you make informed choices about your health and wellbeing.

Is there an alternative to HRT?

Yes. HRT is not suitable for everyone, for example people with a history of certain blood clots, and some people prefer not to take it. In these cases there are non-hormonal options.

• Fezolinetant (Veoza) is a once-daily tablet recommended by NICE in March 2026 for moderate to severe hot flushes and night sweats. It works on the part of the brain that controls body temperature, rather than on hormones. It is not recommended for people with current breast cancer, other oestrogen-dependent cancers or liver disease. Liver function tests are recommended before and during treatment.
• Elinzanetant (Lynkuet) works in a similar way and has been licensed in the UK since July 2025. It has not yet been assessed by NICE for NHS use.
• Menopause-specific CBT can help with hot flushes, night sweats, sleep problems and low mood, either on its own or alongside other treatment.
• Bleeding while taking HRT – Some irregular bleeding is common in the first few months of starting or changing HRT. In April 2026, NICE updated its guidance on when bleeding on HRT should be investigated further, bringing it in line with its guidance on suspected cancer.

Bleeding that is persistent, heavy or starts after the first few months of HRT should always be checked by a clinician.

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