The oestrogen used in most modern HRT. How it is delivered changes the risk profile more than most people realise.
Explained by a GMC-registered GP, not a leaflet
Honest about what we can and cannot prescribe remotely
Side effects given the same weight as benefits
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
Five-star Google reviews from the people we have looked after
Registered with the Care Quality Commission
Estradiol is body-identical oestrogen — chemically identical to the oestradiol your ovaries produce, derived from plant sources. It is the oestrogen used in most modern HRT in the UK.
It comes as a patch, a gel, a spray, a tablet, or a vaginal preparation. Which route you use matters clinically, not just practically, and that is the single most useful thing on this page.
Where the womb is still present, oestrogen must be given with a progestogen to protect the lining. Estradiol alone is only appropriate after hysterectomy.
Patches are changed once or twice weekly, applied below the waist — buttock or thigh, not the breast. Rotate sites.
Gel is applied daily to the arm or thigh over a wide area and left to dry for a few minutes before dressing. It should not be applied to the breasts.
Spray is applied daily to the inner forearm.
Tablets are taken once daily.
Give it three months before judging it. Symptoms often improve within weeks, but dose adjustment is normal and finding the right one takes time. Stopping at six weeks because it has not fully worked is the commonest reason people conclude HRT does not suit them.
Early and usually settling within three months: breast tenderness, nausea, headache, bloating, leg cramps and mood changes. These often mean the dose or route needs adjusting rather than that HRT is wrong for you.
Irregular bleeding is common in the first three to six months, particularly on continuous regimens.
The risk conversation deserves accuracy rather than either reassurance or alarm.
Report any unexpected or persistent bleeding, particularly after the first six months.
Several things people assume rule them out do not. Migraine with aura is not a contraindication to transdermal HRT, although it is to the combined pill. A family history of breast cancer is not an automatic bar. Both are worth a proper discussion rather than assumption.
Enzyme-inducing drugs — some anti-epileptics, rifampicin, St John's Wort — reduce oestrogen levels and may require higher doses or a transdermal route.
Oestrogen can increase levothyroxine requirements.
Monitoring: review at three months after starting, then annually. Blood pressure and weight at review.
Blood tests are usually not needed to diagnose menopause over 45 — it is a clinical diagnosis, and FSH fluctuates so wildly in perimenopause that a single normal result excludes nothing. Levels are sometimes checked to guide dosing in specific circumstances, particularly with gel or spray.
Yes. HRT is well suited to remote care — the diagnosis is clinical, the discussion is the substance of it, and twenty minutes is enough to have it properly.
What that involves: a full symptom and risk history, a discussion of route that actually explains why transdermal may suit you better, the right progestogen where the womb is present, and review at three months rather than a prescription issued and forgotten.
What we will also raise: local vaginal oestrogen for urinary and vaginal symptoms, which is separate from systemic HRT, carries none of the same risks, can be used alongside it, and is markedly under-prescribed. Many women on HRT still have unresolved local symptoms because nobody added it.
Where we will refer rather than prescribe: a history of breast cancer, complex clotting disorders, or anyone needing specialist menopause input.
Any bleeding after the menopause must be investigated before HRT is started, not treated as a reason to start it.
This page is information, not an offer to supply.
The most useful thing on this page is probably this: if you are in England and paying NHS prescription charges for HRT, get an HRT Prepayment Certificate.
It costs roughly the price of two single prescription charges — around £20 — and covers all your HRT prescriptions for twelve months. If you use patches, gel and progestogen separately, that is a substantial saving.
A great many women who are entitled to it have never heard of it, and no one at the pharmacy counter volunteers the information. Prescriptions are free in Wales, so it does not apply there.
Body-identical estradiol gel, patches and spray are not expensive drugs; on a private prescription you pay the pharmacy's cost plus their fee, which is usually modest.
There is no fixed time limit on HRT, and the idea that you must come off at five years is out of date. The decision is a periodic review of benefit against your individual risk, not a countdown.
Reducing gradually over a few months usually produces fewer returning symptoms than stopping abruptly, though stopping suddenly is not dangerous.
Symptoms returning after stopping is common and is not failure — it means the underlying hormonal change is still there. Restarting is a legitimate choice.
This is where most improvements come from, and it is under-used.
If you have a uterus, oestrogen must always be combined with adequate progestogen protection. Oestrogen alone thickens the womb lining and raises the risk of womb cancer.
Combined HRT is associated with a small increase in breast cancer risk, which rises with duration and falls after stopping. Oestrogen-only HRT, for women without a uterus, carries little or no increase.
For context, the effect is comparable in size to drinking a couple of units of alcohol a day or being significantly overweight — which is not a reason to dismiss it, but it is the scale of the thing.
Over 45, generally no. The diagnosis is made on symptoms and cycle pattern, and hormone levels fluctuate too much to be helpful.
Under 45, blood tests do have a role, and under 40 they are important.
No, and the words are deliberately confusing. Body-identical HRT is regulated, licensed and available on prescription — the same molecules your body makes.
Compounded "bioidentical" preparations from private clinics are unregulated and unlicensed, and are not recommended by the British Menopause Society.
For many women, yes. Transdermal oestrogen avoids the increased clot risk that oral oestrogen carries.
It is the preferred route with migraine, a raised BMI, or any clot risk factor, and it is still not offered as often as it should be.
Not directly. It can help indirectly by improving sleep, energy and mood, which makes everything else easier.
Anyone marketing HRT as a weight loss treatment is overselling it.
There is no arbitrary limit. It is reviewed periodically against your symptoms and risks.
The old five-year rule caused a great deal of unnecessary suffering and no longer reflects the guidance.
Yes — HRT is not contraception. Contraception is generally advised until two years after the last period if under 50, or one year if over 50.
This is a very common misunderstanding, and pregnancies do happen because of it.
Progestogen intolerance is real and common, causing low mood, bloating and irritability.
Switching to micronised progesterone or a hormonal coil usually solves it — it is a reason to change the preparation, not to abandon HRT.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
On this page
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
Patient reviews
