• Pills, patches, spays and gels: HRT comes in pill forms (either oestrogen-only or combined with progestogen), transdermal/skin patches (oestrogen only or combined), oestrogen gels, implants (which release oestrogen under the skin), and oestrogen sprays (containing estrodiol and known as Lenzetto), applied to the inner part of the arm between the wrist and the elbow. 
• IUS implants: Intra-uterine systems such as Mirena deliver progestogen directly into the womb for 3-5 years and function as a contraceptive too (you can still get pregnant when you are perimenopausal). 
• Synthetic oestrogen and progestogen: These are the older types of HRT made of synthetic chemicals, some of which are derived from horse urine. They are not regarded as being as safe as the newer body identical HRT (see below). Synthetic HRT comes in tablets or patches which combine both oestrogen and progestogen or contain only one. 

• Bioidentical oestrogens: This type of natural HRT is made from plant chemicals and is the safest form of HRT when delivered transdermally (aka through the skin). Bioidentical oestrogens don’t raise the risks of breast cancer or blood clots as it doesn’t go through the liver. It’s available as gels, (e.g., Oestrogel and Sandrena) a spray (Lenzetto) and tablets (containing estradiol, such as Elleste Solo). The safest type is the sort available on NHS prescription – more on that later – which has been regulated by the Medicines and Healthcare products Regulatory Agency (MHRA). 
• Bioidentical progestogen: Micronised progesterone (Utrogestan) tablets, are the only body identical form of progestogen currently available. It is chemically identical to human hormones and made from plant sources. It’s used in conjunction with body identical oestrogen for women who have an intact uterus. 
• Testosterone gel: Although testosterone is better known as being a male hormone, women make it too, and most of it is produced in the ovaries. Young women normally make approximately 100 to 400 mcg per day (3-4 times the amount of oestrogen produced by the ovaries).  

If you don’t have enough testosterone, symptoms can include low sex drive, sexual arousal and orgasm problems, plus memory and concentration issues, fatigue and loss of muscle strength. Testosterone gel is not available routinely on NHS prescription for women with menopausal symptoms, but it can be prescribed if other types of HRT don’t restore sexual function. The NICE Menopause Guideline says that testosterone gel can be prescribed if the prescriber is familiar with it and is willing to prescribe it ‘off licence.’ Some GPs prefer not to take this responsibility though, and will refer you to a menopause specialist for advice before prescribing. Other GPs will have prescribing restrictions which mean they are not able to offer it. It can also be prescribed privately. Possible side-effects include body hair growth and acne. 

• Local vaginal oestrogen: This can be delivered into the vagina via pessaries and vaginal rings, creams, and gel containing estradiol. Products include Vagifem, Vagirux and Estring. 

It’s a treatment used for urogenital atrophy – the medical name for thinning and shrinking of the tissues of the vulva, vagina, urethra and bladder – which is caused by oestrogen deficiency. This results in vaginal dryness, vaginal irritation, a frequent need to urinate and urinary tract infection. 

It can be used alongside other forms of HRT or on its own and can also be considered as a treatment option if standard HRT is contraindicated (in women who have had breast cancer for instance, or have a history of blood clots).