If your HRT has been ticking along untouched for a while, it may be time for a review. Here is how often you should be seen, why you can ask for a review whenever you need one, and the questions that will help you get the most from your appointment, including on dose, vaginal oestrogen and testosterone.
Getting a diagnosis and a first prescription can feel like a hard won victory. But once you are on HRT, it is easy to let it simply carry on, year after year, without ever revisiting whether it is still working as well as it could. A good review is your chance to fine tune things, and you are more entitled to one, and more in charge of it, than you might realise.
How often should HRT be reviewed?
Current UK guidance from NICE recommends a review three months after you start or change your HRT, and then once a year after that. The three month review checks how you are getting on with a new treatment or dose, and the annual review keeps everything on track over the longer term.
Importantly, this is a minimum, not a maximum. If your symptoms return, if you experience side effects, or if something simply does not feel right, you do not have to wait for your yearly appointment. You are entitled to ask for a review whenever you need one. You know your own body, and a good healthcare professional will want to hear from you.
Do I need a blood test to check my HRT?
For most women, no. Standard HRT is prescribed and adjusted based on your symptoms rather than your blood levels, because hormone levels fluctuate hour to hour and a single test tells you very little. Blood tests are mainly used to rule out other causes of your symptoms, such as an underactive thyroid, or as a safety check in specific situations, for example when taking testosterone. If you are told you cannot be treated or reviewed without a blood test, it is perfectly reasonable to ask, gently, why it is needed in your case.
Questions to empower you at your HRT review
The women who get the most from their appointments tend to be the ones who walk in prepared. Jotting down your questions beforehand turns a rushed ten minutes into something that genuinely moves things forward. Here are some worth considering.
Is my dose and type still right for me?
If symptoms have crept back, your dose may need adjusting, or a different form of HRT might suit you better. Patches, gels and sprays, which deliver oestrogen through the skin, do not carry the small clot risk linked with tablets, and are often preferred, particularly as we get older. If you are not feeling your best, say so clearly, you do not have to simply put up with it.
Would vaginal oestrogen help?
Vaginal dryness, discomfort, painful sex and recurring urinary symptoms are incredibly common, and often go unmentioned. Vaginal oestrogen, applied locally, can make a real difference, and it can be used alongside your usual HRT and safely for the long term. It is frequently overlooked, so it is well worth raising yourself if these symptoms affect you.
Could testosterone be an option?
Testosterone is a hormone women produce too, and levels fall with age. UK guidance supports considering it for menopausal women with low sexual desire when HRT alone has not helped enough. At present it is usually prescribed off label, using products licensed for men in carefully measured female doses, though a testosterone cream designed for women, AndroFeme, has now been licensed in the UK, with wider access expected during 2026. If low libido is troubling you despite good HRT, ask about a trial, or a referral to a menopause specialist.
How long can I stay on HRT?
There is no arbitrary time limit. You can continue for as long as the benefits outweigh the risks for you, which for many healthy women can be indefinitely. If anyone suggests you must stop simply because of your age or the number of years you have taken it, it is worth asking why, as this is an outdated idea.
What if I feel unheard?
Sadly, not every appointment goes smoothly, and some healthcare professionals are still cautious about HRT based on outdated information. If you feel dismissed, or are told you cannot have HRT with no clear medical reason, you are entitled to ask for a second opinion, to see a different clinician at your practice, or to be referred to a menopause specialist. Persistence is not being difficult, it is advocating for your own health.
Keeping your patch routine simple
If you use HRT patches, a little review of your everyday routine helps too. The sticky grey residue patches leave behind is a small but real daily irritation. Nudi Spray removes leftover patch adhesive in seconds, leaving clean, comfortable skin with no scrubbing. It is a simple way to make your routine that bit kinder to yourself. You can explore the full Nudi Spray range here.
Where to find trusted information
For balanced, reliable guidance to help you prepare, the NHS menopause pages, Balance by Dr Louise Newson, and the Women's Health Concern factsheets are all excellent starting points. Going in informed helps you feel confident and in control.
Frequently asked questions about HRT reviews
How often should I have an HRT review?
NICE guidance recommends a review three months after starting or changing HRT, then annually. You can also request a review at any time if your symptoms return, you have side effects, or something does not feel right. You do not have to wait for your yearly appointment.
Can I ask for an HRT review whenever I want?
Yes. While annual reviews are the standard once you are settled on treatment, you are entitled to ask for an earlier review if your symptoms change or your current HRT is not working well for you. Your experience of your own body matters.
Do I need a blood test to review my HRT?
Usually not. Standard HRT is guided by your symptoms, not blood levels, which fluctuate too much to be useful. Blood tests are mainly used to rule out other conditions or as a safety check with testosterone. If a test is insisted upon, it is fair to ask why it is needed in your case.
Can I use vaginal oestrogen as well as HRT?
Yes. Vaginal oestrogen works locally to ease vaginal and urinary symptoms, and it can be used alongside your usual systemic HRT, and safely for the long term. It is often overlooked, so it is worth asking about if you have these symptoms.
Can I get testosterone on the NHS for menopause?
Testosterone may be considered for low sexual desire when HRT alone has not helped enough. It is currently prescribed off label using male products in female doses, and availability varies. A female licensed cream, AndroFeme, has now been licensed in the UK with wider access expected in 2026. Ask your GP or request a referral to a menopause specialist.
This article is for general information and is not medical advice. Always discuss your individual treatment, including any changes to your HRT, with your GP or a qualified menopause specialist.