There are two useful ways to sort the types of HRT: by the hormone it contains (estrogen, progestogen, or testosterone) and by how you take it (tablet, patch, gel, spray, vaginal product, or implant). Most people choosing hormone replacement therapy for menopause end up combining one hormone decision with one delivery decision, for example a daily estrogen gel plus a progesterone capsule, or an all-in-one combined patch. Which mix fits you depends on whether you still have a uterus, your stage of menopause, your clot risk, and plain personal preference.
This pillar maps every form of HRT, what each one does well, and where it falls short. If you want to go deeper on the most popular route, we have a full breakdown of how the estradiol patch works and which brands to consider, plus a hands-on comparison of the best HRT patches reviewed by brand.
The main types of HRT at a glance
Every HRT regimen answers three questions. Which hormones? Delivered how? On what routine? Here is the short version before we go through each one.
| Decision | Your options | What drives the choice |
|---|---|---|
| Hormones | Estrogen only, or estrogen plus a progestogen (combined). Testosterone is sometimes added. | Whether you still have a uterus |
| Delivery | Tablet, patch, gel, spray, vaginal cream/ring/tablet, IUS, injection, or implant | Clot risk, convenience, which symptoms you have |
| Routine | Sequential (cyclical) or continuous combined | How far through menopause you are |
That framework covers menopausal HRT, which is what most searches for "types of hormone replacement therapy" are about. The same hormones and delivery forms also appear in testosterone therapy for men and in gender-affirming care, though the doses and goals differ.
HRT by hormone: estrogen, progestogen, and testosterone
The first split is which hormone you are replacing. Menopause lowers estrogen and progesterone, and more gradually testosterone, so HRT tops up one or more of these.
Estrogen (estradiol)
Estrogen is the workhorse of HRT. It's what relieves hot flushes, night sweats, vaginal dryness, and the sleep and mood disruption that come with them, and it protects bone density. The form most modern prescriptions use is 17-beta estradiol, which is molecularly identical to the estrogen your ovaries made. Older conjugated estrogens (Premarin, derived from pregnant mares' urine) are still available but prescribed far less often now.
Estrogen alone is the right choice only if you've had a hysterectomy. Without a uterus to protect, there's no reason to add a second hormone.
Progestogen and progesterone
If you still have a uterus, estrogen on its own can thicken the womb lining and raise the risk of endometrial cancer. A progestogen prevents that buildup, which is why combined HRT pairs the two. "Progestogen" covers both natural micronised progesterone (Utrogestan in the UK, Prometrium in the US) and synthetic progestins like medroxyprogesterone, norethisterone, and dydrogesterone.
Micronised progesterone is the body-identical option and tends to cause fewer side effects such as bloating and mood dips. It can be taken as a capsule or, for some people who get drowsy or irritable on it, used vaginally.
Testosterone
Testosterone falls during menopause too, and some women find replacing it helps with low libido, energy, and concentration once estrogen is already optimised. It's usually a gel or cream applied to the skin. In most countries it isn't formally licensed for women, so it's prescribed off-label, typically by a menopause specialist. For men with diagnosed low testosterone it's a separate field, testosterone replacement therapy, delivered mostly by gel or injection.
Combined HRT vs estrogen-only HRT
This is the single biggest fork in the road, and it comes down to one fact about your anatomy.
- Estrogen-only HRT is for people who have had their uterus removed. One hormone, fewer moving parts.
- Combined HRT (estrogen plus a progestogen) is for everyone who still has a uterus. You can get the two hormones in one product, like a combined patch or tablet, or as separate items, for instance an estrogen gel alongside a progesterone capsule or a hormonal coil.
Mixing and matching is common and completely normal. A frequent setup is transdermal estrogen for the lower clot risk plus micronised progesterone for endometrial protection.
Forms of HRT: how you take it
Delivery is where most of the day-to-day difference lives. The biggest medical distinction is oral versus transdermal. Estrogen swallowed as a tablet passes through the liver first, which nudges up the risk of blood clots. Estrogen absorbed through the skin (patch, gel, or spray) skips that first pass, and at standard doses doesn't raise clot risk at all. One often-cited analysis found oral HRT users were about 58% more likely to have a clot within 90 days than non-users, while transdermal users showed no increase. That's why many clinicians now start with a skin-based route, especially for anyone with migraine, higher BMI, or a clotting history.
| Form | Hormone(s) | How often | Clot risk | Good fit if you | Example brands |
|---|---|---|---|---|---|
| Tablet | Estrogen, progestogen, or combined | Once daily | Slightly raised | Want the simplest routine | Premarin, Elleste, Provera, Utrogestan |
| Patch | Estrogen or combined | Changed 1-2x/week | Not raised | Forget pills or want it set-and-forget | Estradot, Evorel, Climara, Vivelle-Dot |
| Gel | Estrogen | Once daily | Not raised | Like flexible dosing | Oestrogel, Sandrena, Divigel |
| Spray | Estrogen | Once daily | Not raised | Want fast-drying skin application | Lenzetto, Evamist |
| Vaginal | Low-dose estrogen | Daily then 2x/week, or 3-monthly ring | Negligible | Mainly have dryness or painful sex | Vagifem, Imvexxy, Estring, Estrace |
| IUS (coil) | Progestogen | Every 5 years | Not raised | Want progestogen plus contraception | Mirena |
| Injection/implant | Estrogen or testosterone | Weekly to 6-monthly | Varies | Prefer infrequent dosing | Testosterone esters, estradiol pellets |
Tablets
Pills are the oldest and most familiar form, taken once a day. They come as estrogen-only, progestogen-only, or all-in-one combined tablets, which makes them simple. The trade-off is the liver first-pass effect and a higher chance of nausea or indigestion than skin routes. Anyone with liver problems is usually steered away from oral estrogen.
Patches
Skin patches stick to your lower abdomen, hip, or buttock and release hormone steadily, so you change them once or twice a week instead of dosing daily. Both estrogen-only and combined estrogen-plus-progestogen patches exist, which is why a single patch can sometimes cover everything. This transdermal hormone replacement avoids the clot bump of tablets and sidesteps stomach side effects. The catch is adhesion: heat, sweat, swimming, and moisturiser can loosen them, and the adhesive sometimes leaves a red mark.
Patches are also the most-searched route by far, which is why we keep two dedicated guides. If you're weighing types of hormone patches for menopause, start with the estradiol patch explainer for how the dosing works, then check the top-rated patch brands compared head to head.
Gels and sprays
Estrogen gel (Oestrogel, Sandrena, Divigel) is rubbed into the arm or thigh once a day and absorbs through the skin. It's popular because you can fine-tune the dose by pumps or sachets, and it carries the same low clot risk as patches. The annoyance is the wait: gel needs around five minutes to dry before you dress. Sprays (Lenzetto, Evamist) do the same job from a metered pump and dry faster, though you usually wait an hour before bathing. With both gels and sprays, keep the treated skin away from children and partners until it's absorbed, since hormone can transfer by direct contact.
Vaginal estrogen
Low-dose vaginal estrogen comes as a cream, a small tablet or pessary, or a soft ring. It targets dryness, burning, painful sex, and recurrent urinary infections, and that's all it does: it won't touch hot flushes or mood. Because the dose stays mostly local, it doesn't carry the systemic risks of other HRT, and you can use it without a progestogen even if you have a uterus. Rings like Estring are replaced every three months; tablets are daily for two weeks then twice weekly. In 2025 an FDA advisory committee recommended removing the decades-old boxed warning from low-dose vaginal estrogen, reflecting the much lower risk profile compared with systemic HRT. Note that Femring is a higher-dose ring that acts systemically and does need progestogen cover if you have a uterus.
IUS (the hormonal coil)
A levonorgestrel intrauterine system, most often the Mirena, sits in the uterus and slowly releases progestogen directly to the womb lining. It's a tidy way to get the progestogen half of combined HRT: you pair it with estrogen by patch, gel, or tablet, and the coil handles endometrial protection for up to five years while also working as contraception. Insertion can be uncomfortable, and some people get spotting or cramping in the early months.
Injections and implants
These are the least common menopausal HRT options but worth knowing. Estradiol pellets are implanted under the skin and release hormone over roughly six months, convenient but harder to reverse once placed. HRT shots, meaning injections, show up far more in testosterone therapy than in menopause care; testosterone esters are dosed every one to two weeks, with the upside of steady control and the downside of needles.
Systemic vs local HRT
Cutting across all of those forms is one more distinction. Systemic HRT puts hormone into your bloodstream so it reaches the whole body, which is what you need for hot flushes, night sweats, sleep, and bone protection. Tablets, patches, gels, and sprays are systemic. Local HRT means low-dose vaginal estrogen that stays mostly where you apply it, treating genital and urinary symptoms without raising whole-body hormone levels. Plenty of people use both at once, for example a patch for flushes plus a vaginal tablet for dryness.
Sequential vs continuous combined routines
If you take combined HRT, there are two ways to schedule the progestogen, and your stage of menopause decides which.
| Routine | Who it suits | How you take it | Bleeding |
|---|---|---|---|
| Sequential (cyclical) | Perimenopause, still having periods | Estrogen daily; progestogen 10-14 days each month | A monthly withdrawal bleed |
| Continuous combined | Postmenopause, no period for 12+ months | Estrogen and progestogen every day | Aim for no bleeding once settled |
Most people start sequential during perimenopause to keep a predictable bleed, then switch to continuous combined a year or so after their last natural period, when the goal becomes no bleeding at all. Unexpected bleeding on a continuous regimen is worth a check with your prescriber.
Body-identical and bioidentical HRT
You'll see "body-identical" and "bioidentical" used loosely, so it helps to separate them. Body-identical hormones are regulated, prescription products whose molecules match your own, the standard 17-beta estradiol and micronised progesterone most clinics now use. They're well studied and FDA or MHRA approved.
Compounded "bioidentical" hormones are a different thing: custom-mixed at a pharmacy, marketed as natural, but not standardised, not approved, and not backed by the same safety data. Major bodies including ACOG and The Menopause Society advise against compounded versions precisely because the dose and purity aren't guaranteed. If you want hormones identical to your body's own, you can get them as regulated body-identical products without going the compounded route.
How to choose the right type of HRT
There's no single best type, only the best fit for your situation. A few questions narrow it down fast:
- Do you have a uterus? No means estrogen-only is on the table. Yes means you need a progestogen, whether as a tablet, combined product, or coil.
- What's your clot risk? Migraine with aura, a clotting history, or higher BMI usually points to transdermal estrogen (patch, gel, spray) over tablets.
- Which symptoms dominate? Whole-body symptoms like flushes need systemic HRT. Dryness alone can often be handled with local vaginal estrogen.
- How do you want to dose? Daily habit suits pills, gels, and sprays; set-and-forget suits patches and the coil.
- Where are you in menopause? Still bleeding leans sequential; a year past your last period leans continuous combined.
Bring those answers to your appointment. Expect to trial and adjust, since finding the right form and dose often takes a couple of tries over three to six months, and switching routes is normal rather than a setback.
Frequently Asked Questions
What is the safest form of HRT?
For systemic treatment, transdermal estrogen (a patch, gel, or spray) plus micronised progesterone is generally considered the lowest-risk combination, because skin-absorbed estrogen doesn't raise clot risk the way oral estrogen can. The safest option overall still depends on your personal medical history.
What are the two main types of HRT?
By hormone, the two main types are estrogen-only HRT (for people without a uterus) and combined HRT, which adds a progestogen to protect the womb lining. By delivery, the broad split is systemic HRT for whole-body symptoms versus local vaginal estrogen for dryness.
Which type of HRT is best for weight and bloating?
No form reliably causes weight loss, but many people find micronised progesterone and transdermal estrogen sit better than older oral progestins, which more often trigger bloating. If a regimen makes you bloated, ask about switching the progestogen or the route.
Can you switch between types of HRT?
Yes. Moving between tablets, patches, gels, and sprays, or changing the progestogen, is routine and often needed to land on the right fit. Make changes with your prescriber rather than stopping abruptly, especially with the progestogen if you have a uterus.
Do all types of HRT need progesterone?
No. Estrogen-only HRT is used by people who've had a hysterectomy, and low-dose vaginal estrogen can be used without progestogen even with a uterus. Everyone else taking systemic estrogen with a uterus needs a progestogen.