What are the current NICE guidelines for initiating Hormone Replacement Therapy (HRT) in perimenopausal women?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

For people with a uterus, NICE recommends offering combined HRT to manage menopausal symptoms, and for those who have had a total hysterectomy, oestrogen-only HRT should be offered.

When initiating HRT, use the lowest effective dose and discuss individual preferences, risks, and benefits with the patient.

HRT should be offered after discussing the potential short- and long-term benefits and risks, including the importance of individual choice of preparation.

Vaginal oestrogen can be offered for genitourinary symptoms, with regular review, and the treatment should be tailored to the patient's preferences and clinical response.

HRT can be started in women aged 40 or over, with treatment tailored to their symptoms, age, and health profile, and the lowest dose should be used for the shortest duration necessary.

Related Knowledge Topics

Educational content only. Always verify information and use clinical judgement.