Types of HRT

"HRT" isn't one single product — it covers several different combinations of hormones, delivered in different ways. Here's how the main types break down, based on NICE guideline NG23.

Combined vs. estrogen-only: which type you're offered

• Combined HRT (estrogen + progestogen): Offered to people who still have a uterus. The progestogen protects the uterine lining from the effects of estrogen alone, which can otherwise raise the risk of endometrial (uterine lining) cancer.
• Estrogen-only HRT: Offered to people who have had a total hysterectomy, since there's no uterine lining left to protect.

This isn't a preference — it's based on whether you have a uterus, and it matters for safety, not just convenience.

Within combined HRT: sequential vs. continuous

If you're taking combined HRT, there's a second choice:

• Sequential combined HRT: Progestogen is included for only part of each cycle, which usually produces a regular, period-like bleed.
• Continuous combined HRT: Progestogen is included every day, aiming to avoid a regular bleed. This is typically used once you're further past menopause.

NICE recommends discussing both options as part of choosing combined HRT, and it's worth noting that sequential and continuous regimens also carry slightly different breast cancer risk profiles — see our HRT and breast cancer risk page.

The hormones themselves, and how you take them

Beyond the combined/estrogen-only split, there's variation in:

• Which estrogen and progestogen are used (different formulations exist, and NICE notes some comparisons, such as micronised progesterone vs. other progestogens, don't yet have enough evidence to show a clear risk difference)
• Route: pill, patch, gel, or spray — see our patch vs. pill comparison for how this affects safety, not just convenience
• Dose: NICE recommends using the lowest effective dose for anyone taking HRT

There's also a separate category — low-dose vaginal estrogen — which treats local symptoms only and isn't part of this systemic combined/estrogen-only decision at all.

Working out which combination fits you

The right combination depends on whether you have a uterus, your personal risk factors, and your preferences around bleeding and routine. See who HRT may suit, and who needs specialist advice for the bigger picture before narrowing down a specific type, our Does It Work? evidence directory if you want to compare non-hormonal options too, and organize your questions in our treatment conversation builder.