Who HRT may suit, and who needs specialist advice

There's no single test that says "yes" or "no" to hormone therapy — it's a decision built from your symptoms, your timing relative to menopause, and your personal and family health history. NICE guideline NG23 gives a clear framework for working through it.

Where the benefit-risk balance tends to favor HRT

For people under 60, or within 10 years of menopause onset, without contraindications, both NICE and The Menopause Society (2022) describe a more favorable benefit-risk ratio. This is often called the "timing window" — starting later, or after age 60, shifts the balance because absolute risks of coronary heart disease, stroke, and blood clots rise with age regardless of HRT.

Situations that call for extra care or specialist input

NICE sets out specific guidance, rather than a blanket "no," for several groups:

• Type 2 diabetes: HRT can still be considered, after weighing comorbidities and seeking specialist advice if needed.
• Increased risk of blood clots (VTE): Transdermal (patch/gel) HRT is preferred over oral; people at high VTE risk should be referred to a haematologist for assessment before considering HRT. See HRT and blood clot risk.
• Personal history of coronary heart disease or stroke: HRT should be discussed and offered, if appropriate, specifically by a healthcare professional with menopause expertise.
• Personal history of, or high risk of, breast cancer: Requires information on all available options and referral to a menopause specialist — see our dedicated breast cancer survivors guide and HRT and breast cancer risk.
• Diagnosed with breast cancer while already on HRT: NICE recommends stopping systemic HRT, following its breast cancer guideline.

In every one of these situations, NICE's actual recommendation is referral to someone with menopause expertise, not an automatic rule-out — the right answer depends on the details of your case.

General contraindications worth raising directly

Beyond the specific groups above, actively unexplained vaginal bleeding, active liver disease, and a personal history of hormone-sensitive cancers are the kinds of things that need to be discussed and ruled out or addressed before starting HRT — raise these proactively rather than waiting to be asked.

Making the decision with your clinician

See types of HRT once you've worked through whether HRT is a reasonable option, or our Does It Work? evidence directory if you want to compare it against non-hormonal and lifestyle options first. Use our treatment conversation builder to organize your personal and family history before your appointment.