In short
Hormone replacement therapy replaces the oestrogen the ovaries stop producing, and is the most effective treatment there is for hot flushes and night sweats. A patch or gel through the skin is the usual first choice, because it avoids the raised clot and stroke risk that oral tablets carry. Women who still have a womb also need a progestogen, usually micronised progesterone, to protect the lining. For a healthy woman who starts within ten years of her last period, the absolute risks are small and the balance is favourable. It is a prescription treatment in the UAE.
Treatment Overview
What does hormone replacement therapy actually replace?
Hormone replacement therapy replaces oestradiol, the main oestrogen the ovaries produce, which falls away over the menopause transition. The primary purpose is to relieve hot flushes and night sweats. Sleep disturbance, low mood and anxiety, and in some women joint aches, also respond to oestrogen, according to the Endocrine Society clinical practice guideline.
What it is no longer used for: preventing heart disease, preventing dementia, or preventing osteoporosis on its own in a woman without symptoms. Those were once reasons to prescribe it and are not any more.
Which preparations are used?
The usual choice is 17-beta oestradiol through the skin, as a patch or a gel, because it is identical to the oestrogen the ovary makes and it avoids the first pass through the liver.
All routes relieve hot flushes equally well. The difference between them is safety, not effectiveness. The table sets out what each route means in practice.
| Route | What it means | Main consideration |
|---|---|---|
| Patch, twice weekly | Steady levels, skipped by the liver | No increase in clot risk in the studies so far, and low doses were not linked to more strokes |
| Gel, daily | Same principle as the patch, dose easier to adjust | Needs to dry before dressing, and skin contact with others should be avoided |
| Tablet, daily | Passes through the liver first | Raises the risk of clots, and raises stroke risk. Better effect on cholesterol, but raises triglycerides |
| Vaginal, low dose | Acts locally only | For dryness and discomfort, not for hot flushes. No progestogen needed |
The skin route is particularly important for women with raised triglycerides, active gallbladder disease, migraine, or a known clotting tendency such as factor V Leiden. For a healthy woman with none of those, a tablet is a reasonable choice if she prefers it, because her baseline risk is low.
Vaginal dryness and discomfort are treated locally, with a moisturiser first and low-dose vaginal oestrogen if that is not enough. Local treatment explained.
Why is progesterone part of the treatment?
Because oestrogen on its own thickens the lining of the womb, and that can progress to cancer. Any woman with a womb who takes systemic oestrogen needs a progestogen with it.
The problem can start early. Endometrial hyperplasia has been seen after as little as six months of unopposed oestrogen. This is not a precaution that can be skipped or negotiated.
The first choice is micronised progesterone, which is identical to the progesterone the body makes: 200 mg for 12 nights a month in a cyclical regimen, or 100 mg every night in a continuous one. It is taken at bedtime because it causes drowsiness. Unlike the older synthetic progestin medroxyprogesterone acetate used in the Women’s Health Initiative, it is neutral for cholesterol and does not appear to add breast cancer risk, although the data are more limited.
Women who have had a hysterectomy take oestrogen alone, and women using only low-dose vaginal oestrogen do not need a progestogen either.
What dose is used?
Treatment now starts low and goes up only if symptoms need it, rather than everyone starting on the same standard dose.
| Stage | Transdermal | Oral |
|---|---|---|
| Usual starting dose | 0.025 mg patch | 0.5 mg daily |
| Standard dose that relieves symptoms in most women | 0.05 mg patch | 1 mg daily |
| Severe symptoms, or after removal of both ovaries at a young age | 0.05 to 0.1 mg patch | 1 to 2 mg daily |
Hot flush relief usually appears in the first three to four weeks. If flushes persist after that, the dose goes up. Lower doses cause less bleeding and less breast tenderness, and are linked to fewer effects on clotting.
How well does it work?
Oestrogen at standard dose removes hot flushes completely in roughly 80 percent of women, and reduces frequency and severity in the rest. A meta-analysis of 24 trials in 3,329 postmenopausal women found about 18 fewer hot flushes per week than placebo, a reduction of around 75 percent.
Nothing else comes close. That is the reason the conversation is about whether hormone therapy is safe for you, rather than whether it works.
Where oestrogen is not an option, the tested alternatives are specific antidepressants, gabapentin and the newer neurokinin blockers, not supplements. The nonhormonal options.
What are the risks, in real numbers?
For women starting in their fifties, the Women’s Health Initiative figures work out to a few extra cases per 1,000 women over five years, and they differ depending on whether a progestogen is taken.
These numbers come from one regimen, conjugated equine oestrogen with medroxyprogesterone acetate, which is not the regimen used today. Transdermal oestradiol with micronised progesterone may well be safer. The figures are the best available and should be read as an outer estimate.
| Outcome | Oestrogen plus progestogen | Oestrogen alone |
|---|---|---|
| Invasive breast cancer | 3 more | 2.5 fewer |
| Coronary heart disease | 2.5 more | 5.5 fewer |
| Stroke | 2.5 more | 0.5 fewer |
| Pulmonary embolism | 3 more | 1.5 more |
| Hip fracture | 1.5 fewer | 1.5 more |
| Deaths from any cause | 5 fewer | 5.5 fewer |
Two things stand out. Oestrogen alone, for women who have had a hysterectomy, reduced breast cancer in the trial. And in both groups, deaths from any cause were lower, not higher. An 18-year follow-up of both Women’s Health Initiative trials found no increase in overall, cardiovascular or cancer mortality.
For scale: the breast cancer figure of three extra cases per 1,000 over five years is less than one per 1,000 per year, and is a similar order of magnitude to the risk carried by obesity or by being physically inactive.
Clot risk is the one that route changes most. In observational data, transdermal oestrogen showed no excess clot risk, including in women with a clotting tendency or a high BMI, while oral oestrogen did.
Why does it matter when you start?
Because the same treatment behaves differently at 52 and at 70. Starting within ten years of the last period, or before 60, is where the balance is favourable.
In the ELITE trial, 643 postmenopausal women were separated by time since menopause and given oral oestradiol or placebo for a median of five years. Progression of early artery wall thickening differed between the early and late groups. The KEEPS trial in women aged 45 to 54 found no difference in artery calcium or wall thickness between hormone therapy and placebo over four years.
At the other end, the American Geriatrics Society advises against starting hormone therapy at 65 or older, and treatment is avoided from 70. Between 60 and 69 it is an individual decision rather than a rule.
What side effects are common?
The common ones are breast tenderness and vaginal bleeding, both more likely at higher doses.
Breast soreness usually settles and often improves on a lower dose. Bleeding happens in almost all women on a cyclical regimen, by design, and is common in the first months of a continuous one. Skin irritation under a patch is usual rather than unusual and often improves by rotating the site.
Some bleeding is expected early on, and some bleeding needs investigating. Which is which.
How long do you stay on it?
The standard figure is three to five years, and usually not past 60, but that is a starting point for a conversation rather than a cut-off.
Hot flushes outlast it. Symptoms persist for a median of 7.4 years in total, and over 40 percent of women aged 60 to 65 still have them. Both the Menopause Society and the American College of Obstetricians and Gynecologists say treatment should be individualised and not stopped on age alone.
Treatment is reviewed once a year, and stopping is planned rather than abrupt. What the yearly review covers.
Women whose menopause came before 40 are a separate case: treatment continues at least to the average age of menopause, around 50 to 51, to protect bone, heart and brain.
Hormone replacement therapy in Dubai and the UAE
Is hormone replacement therapy available in Dubai?
Yes, on prescription from a licensed doctor and dispensed by a licensed pharmacy. Oestrogen and progesterone preparations sit in the regulated categories of the UAE medicine classification maintained by Dubai Health Authority Drug Control.
Which specific brands and pack sizes are stocked changes over time and between pharmacies, so the exact product is settled at the prescription stage rather than promised in advance. Whether a preparation is registered in the UAE, whether it is in stock, and whether it is covered by your insurance are three separate questions.
Compounded hormone mixtures and saliva testing are not used here, and the reason is not brand preference. What is wrong with compounded hormones.
Bringing hormone therapy into the UAE, and taking it out
Medicines in the controlled and semi-controlled categories need an approval from the Ministry of Health and Prevention before you travel, and the approval is free.
According to the ministry rules, the application needs a prescription issued within the last three months giving your name, the medicine, dose, form and prescriber, plus a medical report issued within the last year giving your diagnosis and treatment plan. Both need the clinic stamp, and the quantity may not exceed three months of your own treatment.
For women who move between countries, the more practical answer is usually to move the prescription to a doctor here, with the records, so that supply and reviews run locally.
Do patches and gels survive Dubai heat?
They are stored at room temperature, out of direct sun, and not left in a car. Heat and sweat also affect a patch while it is on the skin: patches can loosen in humidity or after swimming, and a patch that has fallen off part way through is not delivering its dose. Applying it to dry skin and pressing for the time the leaflet states matters more here than in a cooler climate. Gel needs to dry fully before dressing, which takes longer in humid air.
Each form in detail: HRT patches and oestrogen gel, HRT tablets and vaginal oestrogen. Without hormones: non-hormonal menopause treatment.
Who Is a Good Candidate?
- Women with moderate to severe hot flushes or night sweats affecting sleep, work or quality of life.
- Women within ten years of their last period, or under 60, with no contraindication.
- Women whose menopause came early or who had both ovaries removed, where treatment is about long term protection as well as symptoms.
- Women already on hormone therapy who want the preparation, the dose and the risk picture reviewed.
- A personal history of breast cancer: systemic oestrogen is not prescribed.
- Coronary heart disease, a previous clot or stroke, or active liver disease.
- Unexplained vaginal bleeding: this is investigated before any hormone is started.
- A womb still present and a request for oestrogen without a progestogen: not offered.
- Compounded hormone mixtures, pellets or dosing steered by saliva tests: not used here.
What Happens During the Consultation
-
1
Your symptoms and where you are in the transition
Which symptoms, how severe, what they are costing you in sleep and function, and your cycle pattern. Over 45 this is what makes the diagnosis, not a blood test.
-
2
Your personal risk
Breast cancer history in you and your family, clots, stroke, heart disease, liver disease, migraine, blood pressure, smoking, weight, and whether you still have a womb. This decides route as much as it decides yes or no.
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3
The numbers, before you decide
You are given the absolute figures for your age group, for the regimen being proposed, so the decision is yours on real information rather than on headlines.
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4
The prescription and the plan
Route, dose, progestogen if needed, what to expect in the first three months, what counts as a reason to call, and the date of the first review.
Program Structure & Follow-Up
What happens in the first three months?
The first three months are about getting the dose right and settling the bleeding pattern:
- Weeks 3 to 4: hot flush relief should be showing. If it is not, the dose is reviewed.
- Weeks 4 to 12: breast tenderness and irregular bleeding are common and usually settle.
- At three months: symptoms, blood pressure, bleeding pattern and tolerance are reviewed, and the dose adjusted.
Between appointments, patients can reach the practice through the membership programmes.
Is the dose set by blood levels?
No. The dose is set by whether your symptoms are controlled and whether you tolerate it, not by an oestradiol level. Routine hormone levels are not used to steer standard hormone therapy. Chasing a target number is the approach used by compounded hormone programmes, and it has no evidence behind it.
Over the age of 45 the diagnosis is made from your cycle pattern and your symptoms. A hormone blood test adds nothing and can mislead. Why blood tests are not used.
Benefits, Limits & Safety
What hormone therapy will not do
Hormone therapy is not prescribed to prevent heart disease, dementia or osteoporosis in a woman without symptoms, and it is not an anti-ageing treatment. It does improve bone density while it is taken, and fracture risk falls, but that is a benefit of treating symptoms rather than a reason to start.
When should you contact a doctor?
Contact a doctor on hormone therapy for signs of a clot, chest symptoms, or bleeding that does not fit the expected pattern:
- Sudden breathlessness or chest pain, which can signal a clot in the lung.
- Pain, swelling or redness in a calf, which can signal a clot in a leg vein.
- Sudden weakness on one side, or trouble speaking.
- New or worsening severe headache, or migraine with visual symptoms for the first time.
- Bleeding after a long spell of no bleeding, or heavy or persistent bleeding, which needs investigating.
- A new breast lump or nipple change.
In the UAE, call 998 for an ambulance in an emergency.
Do you still need mammograms?
Yes. Routine breast screening continues on hormone therapy, including short-term use. Abnormal mammograms were more common in the Women’s Health Initiative on hormone therapy, mostly as requests for additional views. Stopping treatment for a month or two before a mammogram does not reduce that and is not advised.
A history of breast cancer, coronary heart disease, a previous clot or stroke, or active liver disease changes the answer. Who is and is not a candidate.
What the evidence shows
Standard-dose oestrogen removes hot flushes completely in about 80 percent of women and reduces them in the rest, roughly 18 fewer per week than placebo across 24 trials. Sleep and mood usually improve with them.
How you are followed
Review at three months for dose, bleeding and blood pressure, then yearly. Dose is set by symptoms, not by hormone levels. Breast screening continues as usual.
When hormone therapy is not used
A personal history of breast cancer, coronary heart disease, a previous clot or stroke, active liver disease, or unexplained vaginal bleeding before it has been investigated.
Cost & Program Investment
What treatment costs depends on the preparation, whether a progestogen is needed and how much monitoring goes with it, so no single figure is given here. The consultation sets out the full cost before anything is prescribed. Ongoing care runs through the membership programmes.
Frequently Asked Questions
Combined oestrogen and progestogen was associated with about three extra cases of invasive breast cancer per 1,000 women over five years, in women starting between 50 and 59 in the Women's Health Initiative. That is under one per 1,000 per year. Oestrogen alone, in women who had a hysterectomy, was associated with fewer cases than placebo.
For a healthy woman starting within ten years of her last period, the evidence does not show harm and an 18-year follow-up of the Women's Health Initiative found no increase in cardiovascular deaths. It is not prescribed to protect the heart. Starting at 65 or older is advised against, and treatment is avoided from 70.
Oestrogen through the skin bypasses the liver. Oral oestrogen raises the risk of clots and of stroke. In observational data, transdermal oestrogen showed no excess clot risk, including in women with a clotting tendency or a high BMI. Both relieve hot flushes equally well.
If you still have a womb and you are taking systemic oestrogen, yes. Oestrogen alone thickens the womb lining and hyperplasia has been seen after as little as six months. Women who have had a hysterectomy do not need it, and neither do women using only low-dose vaginal oestrogen.
Hot flush relief usually appears within the first three to four weeks. If flushes are still there after that, the dose is reviewed. Sleep and mood often improve alongside the flushes.
Usually a low dose, such as a 0.025 mg patch or 0.5 mg oral oestradiol, increased if symptoms need it. Women with severe symptoms may start higher. Women who had both ovaries removed young often need more for the first two to three years.
The standard figure is three to five years and usually not past 60, but that is a starting point, not a rule. Symptoms last a median of 7.4 years, and both the Menopause Society and the American College of Obstetricians and Gynecologists say the decision should be individualised rather than based on age alone.
No. The dose is set by whether your symptoms are controlled and whether you tolerate the treatment. Routine oestradiol levels are not used to steer standard hormone therapy. Dosing steered by hormone levels, and by saliva tests in particular, belongs to compounded hormone programmes and has no evidence behind it.
Yes, on prescription from a licensed doctor and dispensed by a licensed pharmacy. Which brands and pack sizes are stocked varies, so the exact product is settled at the prescription stage. Registration in the UAE, availability and insurance cover are three separate questions.
Medicines in the controlled and semi-controlled categories need a free approval from the Ministry of Health and Prevention before you travel, with a prescription issued within three months, a medical report issued within a year, both stamped, and no more than three months of supply.
They do, but heat and humidity make them more likely to loosen, and a patch that has partly come off is not delivering its dose. Apply to clean dry skin, press for the time the leaflet states, and store the box at room temperature out of the sun rather than in a car.
Starting for the first time at 65 or older is advised against by the American Geriatrics Society, and from 70 hormone therapy is avoided. Between 60 and 69 it is an individual judgement rather than a rule. Continuing treatment that is already working is a different question from starting it fresh, and for troublesome symptoms at this age the nonhormonal options and local treatment for dryness are usually the route.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- The 2022 hormone therapy position statement of The North American Menopause Society
- Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women (Women's Health Initiative)
- Effects of conjugated equine estrogen in postmenopausal women with hysterectomy (Women's Health Initiative)
- Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials
- Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials
- Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol (ELITE)
- Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women (KEEPS)
- Duration of menopausal vasomotor symptoms over the menopause transition (SWAN)
- Drug Control
- How to bring prescription or controlled medicines into the UAE legally
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.