HRT in London 2026. What It Actually Involves, Who It Is For and What the Options Are
Hormone replacement therapy is the most effective treatment available for hot flushes, night sweats, sleep disruption and many of the other symptoms of perimenopause and menopause, and current national guidance supports it as a first-line option for most symptomatic women, particularly those under 60 or within 10 years of their last period. Despite that, prescribing remains inconsistent, many women are offered nothing beyond reassurance, and others are started on a single standard formulation without a conversation about the alternatives or their own risk profile. HRT is not 1 product but a category, oestrogen alone or combined with a progestogen depending on whether the womb is still present, delivered as a tablet, a patch, a gel or a spray, with the right choice depending on your history, your symptoms and your preference rather than on whatever happens to be the default at a given surgery. At The Wellness the decision is made properly, your individual risk factors are actually discussed rather than assumed, and the formulation is reviewed and adjusted until it works for you. Consultations from £150 by video and £220 in person. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated August 2026.
Start your HRT assessment on WhatsAppor email team@thewellnesslondon.com or call 020 3951 3429.
The Key Points
Who HRT is for HRT is appropriate for the great majority of women experiencing troublesome perimenopausal or menopausal symptoms, and current guidance is clear that for most women under 60 or within 10 years of their last period, the benefits outweigh the risks once individual factors have been discussed. It is not restricted to women with severe symptoms only, and waiting until symptoms become unbearable before considering it is a common and unnecessary source of prolonged disruption to sleep, mood and daily functioning.
Women with a personal history of certain cancers, unprovoked blood clots, or specific liver disease need an individualised discussion rather than a blanket rule, and in many of these situations a form of HRT can still be considered with the right specialist input, rather than HRT being ruled out automatically. Women under 40 with premature ovarian insufficiency are generally advised to take hormone replacement through to at least the average age of natural menopause, since the long-term protective effects on bone and cardiovascular health matter more in this group than in women starting HRT later.
What the options actually are
Systemic HRT treats the whole-body symptoms of menopause, hot flushes, night sweats, low mood, brain fog, joint aches and reduced libido, and is delivered as a tablet, a transdermal patch, a gel or a spray. Transdermal routes, patches, gel and spray, avoid the first pass through the liver that oral tablets undergo, which for many women carries a more favourable risk profile, particularly around blood clot risk, and is generally the preferred starting point for women with additional risk factors.
Women who still have a womb need a progestogen alongside oestrogen to protect the lining of the womb, given either continuously, for a period-free regimen, or cyclically, for a regular monthly bleed, depending on how close to the menopause you are and your preference. Women who have had a hysterectomy generally do not need a progestogen and can take oestrogen alone. The Mirena coil is a recognised and often convenient way of providing the progestogen component for women who already have one or would consider one, alongside contraceptive benefit during perimenopause where relevant.
Vaginal oestrogen, used locally rather than systemically, treats vaginal dryness, discomfort and recurrent urinary symptoms specifically, carries minimal systemic absorption, and can be used long-term, alongside systemic HRT or entirely on its own where systemic treatment is not wanted or not suitable. Testosterone is licensed and prescribed for some women with persistent low libido that has not responded to oestrogen alone, and is considered as an additional option where this specific symptom remains troublesome.
What the assessment involves
A detailed history covering your menstrual pattern, symptom severity and timeline, personal and family history of breast cancer, blood clots and cardiovascular disease, and any current medication, since some of these shift which formulation and route are most suitable rather than ruling HRT out altogether. Blood pressure and weight are checked as part of the baseline review before starting.
In women over 45 with typical symptoms, the diagnosis of perimenopause or menopause is usually made on history and age alone without blood tests, in line with national guidance, because hormone levels fluctuate too much through perimenopause to be reliably diagnostic. Under 45, and particularly under 40, blood tests including FSH are more useful, and premature ovarian insufficiency needs to be properly confirmed. Thyroid function is checked where symptoms overlap, since an underactive thyroid can closely mimic several menopausal symptoms. Bone density scanning is considered where osteoporosis risk factors are present, and a discussion of breast screening is included as standard.
How the review process works
The right formulation is rarely obvious on day 1, and adjustment over the first few months is a normal and expected part of getting HRT right rather than a sign that something has gone wrong. A review at around 3 months checks whether symptoms have improved, whether any side effects such as breast tenderness or irregular bleeding have settled, as they commonly do initially, and whether the dose, formulation or route needs adjusting.
Ongoing annual review continues once things are settled, covering symptom control, any new personal or family history that has emerged, blood pressure, and a discussion of how long you plan to continue, since there is no fixed stop date for HRT and the decision to continue, adjust or stop is reviewed with you rather than imposed at an arbitrary point.
What does treatment cost in London
Private menopause specialist appointments in the Harley Street district commonly run £250 to £450 for an initial consultation, with follow-up reviews charged separately at £150 to £300 each, and any bone density scanning or additional bloods billed on top. Comprehensive private menopause and hormone programmes at the top of the market exceed £32,000. Below all of it sits a tier defined by its conditions rather than its price, a prescription issued from a short questionnaire with no discussion of formulation, no baseline bloods where they matter, and no planned review to adjust the dose once it is clearly not right.
At The Wellness the assessment, the prescribing and the review are built into 1 ongoing service. All figures are from prices.
Extended 45-minute consultation for HRT initiation, including full history and formulation discussion, from £395. In-person consultation with examination in Marylebone, from £220. Same-day video consultation from £150. Comprehensive Blood Panel including thyroid function and relevant hormone markers, with consultation and interpretation, from £495. Follow-up review consultation for dose or formulation adjustment, from £220 in person or £150 by video. DEXA bone density scan arranged at a specialist centre with consultant reporting, from £250. HRT prescribing, ongoing review and specialist gynaecology referral to a named consultant arranged where indicated. Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street, in complete confidence.
Why choose The Wellness to start or review HRT
Because the conversation starts from the evidence, that for most symptomatic women under 60 or within 10 years of their last period the benefits of HRT outweigh the risks, rather than from a default caution that leaves women undertreated for years. Because your individual history, not a blanket rule, is what actually decides the formulation and route, and transdermal options are properly discussed for anyone where they carry an advantage.
Because getting the formulation right is treated as a process rather than a single decision, with a planned review built in from the outset rather than left to you to chase once the first prescription clearly is not working. And because testosterone, vaginal oestrogen and the Mirena coil are all part of the conversation where they are relevant, rather than treatments you have to already know to ask for.
Start your assessment on WhatsAppor call 020 3951 3429.
Frequently asked questions
Am I too old, or too young, to start HRT
There is no fixed cut-off. Most women under 60 or within 10 years of their last period are appropriate candidates, and current guidance supports starting HRT in this window as both safe and effective for most women. Women under 40 with premature ovarian insufficiency are generally advised to take hormone replacement through to at least the average age of natural menopause.
Is HRT safe for someone with a family history of breast cancer
It needs an individualised discussion rather than an automatic refusal. Depending on the specifics of the family history, certain forms of HRT can often still be considered, sometimes alongside specialist input, and this is exactly the kind of history that a proper consultation is for.
How long does it take to feel the benefit
Many women notice an improvement in flushes and sleep within a few weeks, though the full effect, and the point at which side effects such as breast tenderness or irregular bleeding settle, is usually clearer by the 3-month review, which is why an early review is built into the process rather than left open-ended.
What is the difference between tablets, patches, gel and spray
They all deliver oestrogen but by different routes. Transdermal options, patches, gel and spray, avoid the first pass through the liver that tablets undergo, which for many women, particularly those with additional risk factors, carries a more favourable safety profile, and is generally the preferred starting point.
Do I need a progestogen as well as oestrogen
If you still have a womb, yes, to protect the lining of the womb, given either continuously or cyclically depending on your preference and how close to the menopause you are. If you have had a hysterectomy, oestrogen alone is generally appropriate.
Can HRT help with low libido specifically
Systemic oestrogen helps many women, and vaginal oestrogen treats dryness and discomfort directly, but where low libido persists despite this, testosterone is a licensed and recognised additional option for some women and is discussed where relevant.
The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Blood analysis is performed by accredited laboratories and imaging is arranged at specialist centres with consultant reporting where indicated. This article is general information and not a substitute for individualised medical advice about your own history and risk factors.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. NICE guideline NG23, menopause diagnosis and management, including HRT prescribing recommendations. British Menopause Society guidance on HRT types, routes and individualised risk discussion. Royal College of Obstetricians and Gynaecologists guidance on premature ovarian insufficiency. Royal Osteoporosis Society guidance on menopause and bone health. Published 2026 London private menopause specialist pricing.
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