Hormone Replacement Therapy (HRT) will soon be available to women over the counter, with watchdogs set to propose a reclassification of the medication.

The proposal would be a marked difference to current rules which, up until now, have meant that women have only been able to access the treatment after a consultation with a GP or specialist.

Numerous studies have demonstrated that HRT is safe and effective, but lingering concerns from previous studies still remain.

One major report that looks set to tackle these anxieties was published in 2021 and found that previous research about a link between hormone replacement therapy (HRT) and dementia was unfounded.  

The BMJ study, which was the biggest of its kind to date, looked at GPs prescribing records and the HRT history of over 100,000 women, aged 55 and older, with dementia, compared with a control group of nearly 500,000 women with no history of dementia. The two groups were matched by age and GP surgery, with records used between 1998 and 2020. 

“Up until now we’ve had conflicting studies,” says Tom Dening, professor of dementia research at Nottingham University, who was one of the report authors. “The data was very confused, but this study suggests overall there isn’t an increased risk with HRT and I would hope that is reassuring.”

HRT is taken by millions of women worldwide to offset symptoms that can affect up to 75 per cent of menopausal women and can include hot flushes, sleep disturbance, mood swings, reduced libido, joint pains, brain fog and depression. 

HRT is also recommended on account of its long term health benefits, since numerous studies show that it can reduce a woman’s future risk of heart disease, type 2 diabetes and osteoporosis, provided they start within 10 years of menopause onset. 

Ahead of the move to make the treatment readily available in pharmacies without a prescription, we answer your questions based on the latest research.

How does HRT work?

Hormone Replacement Therapy does what it says on the tin – it replaces the hormones that are at a lower level in women as they approach menopause. 

The treatment mainly works to relieve some of the key symptoms of menopause, such as hot flushes, migraines, mood swings, tiredness and reduced sex drive. 

Until now, women have been able to book in for a consultation with a GP and then begin HRT as soon as they start experiencing menopausal symptoms, without the need to undergo any preliminary tests. 

But HRT treatment will soon be made available over the counter for the first time, The Telegraph understands, following a long campaign to improve access and reduce the cost for those who receive it on prescription.

When was HRT ‘invented’?

Hormone replacement therapy was first prescribed to women in 1965, and really took off during the 1990s. However, it fell in popularity in the early 2000s after a study linked its usage to other health concerns.

Numbers have since crept up again, however. In 2015, the National Institute of Health and Care Excellence (Nice) changed their guidance to encourage more doctors to prescribe HRT, claiming too many menopausal women had been suffering in silence. 

Who takes HRT?

Women who are going through the menopause can use HRT. However, the treatment is not suitable for those who have a history of blood clots or breast, ovarian or womb cancer; have high blood pressure or liver disease; or those who are pregnant. 

It’s still possible to get pregnant while on HRT, the NHS warns, so use contraception until two years after your last period if you’re under the age of 50, or one year after if you’re over 50. 

Types of HRT

For most women, HRT is a combination of oestrogen and progestogen – unless they have had a hysterectomy, in which case they can take oestrogen on its own. 

There is also a strand called bioidentical HRT (BHRT) or ‘natural HRT’ which mimics the hormones your body provides naturally. This treatment is often available at a cost, although some of the forms of HRT currently prescribed from your NHS GP are also from natural sources and identical to the hormones produced in your body. 

You can take HRT in a multitude of ways, including pills, skin patches, gels, creams and pessaries. Much like the contraceptive pill, you can either take it continuously or in cycles. 

Are there any risks we should consider when taking HRT? 

We know from the Women Health Initiative Randomised Trial (WHI), a series of studies starting in 1993, with a long-term follow up in 2016 and December 2019, that women who take synthetic oestrogen and progestogen may have a small increased risk of breast cancer, but overall the risk is minimal. 

“Even if you look at the worst numbers, the risk is lower than the risk a woman has if she drinks a couple of glasses of wine a night, or she doesn’t exercise or if she’s overweight,” says leading menopause expert Dr Louise Newson. 

If you are taking oestrogen-only HRT, after a hysterectomy, this has been shown to reduce your risk of breast cancer compared with women who do not take HRT, according to the Womens’ Health Initiative randomised clinical trials.

One key issue with these trials, however, is that they used older types of HRT, not the newer, low-risk versions we have in the UK today.