You’ve had the hot flushes for months, you’re sleeping badly, and you’ve finally decided to do something about it. Then comes the next question: do you wait for your GP, or pay to be seen privately? Many of my patients have already wrestled with NHS vs private HRT before they reach me. Some have left a short appointment with more questions than answers. Others have been told privately that they need tests or treatments they did not. Most simply want to know whether paying would make any real difference.
Here is my view: the medicine is the same. What changes is time, access and cost. Once you see that, the decision gets much simpler.
The HRT itself is the same on both routes
NHS and private doctors prescribe the same licensed medicines and follow the same NICE guidance, so private HRT is not clinically better. HRT replaces the oestrogen that falls during perimenopause and menopause. If you still have your womb, a progestogen is added to protect its lining. HRT helps with hot flushes, night sweats, poor sleep, low mood and vaginal dryness, and the British Menopause Society regards it as the most effective treatment for hot flushes and night sweats.
You would not be alone in using it. NHS figures show that 14.7 million HRT items were prescribed in England in 2024/25, an 11% rise on the year before, to an estimated 2.8 million women.
The body-identical HRT I prescribe where suitable, transdermal oestradiol with micronised progesterone, is licensed and available on the NHS too. Compounded “bioidentical” hormones, sold by some private clinics, are a different thing entirely. They are unregulated, NICE advises that their safety and effectiveness are unknown, and the British Menopause Society does not recommend them. I would steer you away from them, whichever route you choose.
HRT is not suitable for everyone, and not everyone wants it. If that is you, you still deserve a conversation about your symptoms and the other options open to you.
Whoever prescribes it should be honest about the risks
You should leave any appointment knowing the risks as clearly as the benefits. Combined HRT slightly raises the risk of breast cancer, by around 5 extra cases in every 1,000 women who take it for 5 years. Oestrogen-only HRT carries little or no extra risk. HRT tablets slightly raise the risk of blood clots and stroke, but patches, gels and sprays do not. That is one reason the type of HRT matters as much as the decision to take it.
Two more things are easy to miss. First, HRT is not contraception. You still need contraception for 2 years after your last period if you are under 50, or for 1 year if you are over 50. Second, if you have had breast cancer yourself, systemic HRT is usually not advised, but this is also very dependent on the type of breast cancer you’ve had, etc. so specialist advice matters even more, but you deserve a conversation as there are still a lot of options, including local HRT for your genitourinary symptoms.
The British Menopause Society advises that, for most healthy women starting before 60 or within ten years of the menopause, the benefits generally outweigh the risks. There is no fixed time limit, but treatment should be reviewed every year.
With NHS vs private HRT, you are really paying for time and access
On the NHS, you see your GP and describe your symptoms. If you are over 45 with typical symptoms, you will not usually need a hormonal blood test. If HRT is right for you, you collect it from your local pharmacy and have a review after about three months, then once a year. If treatment does not improve your symptoms, or side effects continue, you can be referred to a doctor with expertise in menopause.
Privately, you book directly with my clinic, no referral needed. There is time to go through your symptoms, your medical and family history, and your bone and heart health, not just the symptom that brought you in. Tests are arranged if they are clinically needed, and with your consent a summary goes to your NHS GP so your records stay complete. There is also time to discuss options such as testosterone for low sexual desire that persists despite HRT. Testosterone is not licensed for women in the UK, so it is prescribed off-label, but both NICE and the British Menopause Society support it in specific circumstances.
Cost is where the two routes differ most. On the NHS, the appointment is free. In England, prescriptions cost £9.90 per item in 2026/27, but an HRT prescription prepayment certificate costs £19.80 and covers as many qualifying HRT medicines as you need for 12 months. It does not cover every HRT medicine (testosterone, for example), so check before you buy. Prescriptions are free in Scotland, Wales and Northern Ireland. Privately, you pay for each consultation, any tests, and your medicine at the pharmacy’s retail price. Ask for a clear breakdown, and think about the cost of the whole first year, not just the first appointment.
Some situations need more than a quick fix
A specialist opinion, NHS or private, matters most when the picture is less straightforward:
- Premature ovarian insufficiency (menopause before 40) or early menopause (before 45)
- A personal or family history of breast cancer, blood clots, stroke, migraine with aura or liver disease
- Symptoms that continue despite trying more than one HRT preparation
- Unexpected bleeding on HRT
- Surgical menopause after removal of the ovaries
A large share of the women I see are already taking HRT that has simply never been optimised. The dose was never adjusted, the type of HRT was never reconsidered, or a progestogen that did not suit them was never changed. That is frustrating when you have been putting up with it for months (I know this can be hard!), but it is very fixable. My article on how long HRT takes to work explains what to expect and when to ask for a review.
Go in with three things written down
Whichever route you choose, the most useful thing you can do takes five minutes. Before your appointment, write down:
- Your top three symptoms and how they affect your day, for example “waking at 3am every night” or “hot flushes in meetings”
- Anything you have already tried, with the name, the dose and how long you took it
- Any personal or family history of breast cancer, blood clots or stroke
It makes the conversation better, whether you have a short slot with your GP or a private menopause consultation. I promise those five minutes are worth it. A good appointment should leave you clear on four things: why this treatment, what the benefits and risks are for you, how it will be reviewed, and when to seek advice sooner.
Many women use both routes: a private assessment to confirm the diagnosis and find the right treatment, then a letter to their NHS GP proposing ongoing prescribing. Your GP is not obliged to take over a private recommendation, and no private doctor can promise that they will. A licensed medicine and a clear letter explaining the reasoning make it easier. Whatever you do, stay registered with your NHS GP, because screening, vaccinations and urgent care all run through that registration.
The medicine is the same, so choose the route that gets it right for you
If you can be seen promptly, your symptoms are typical and your GP is confident managing menopause, start with the NHS. Paying will not buy you better HRT. If you are facing a long wait, more than one preparation has not worked, or your history is complicated, private care can give you the time to sort it out. Either way, what matters is not who writes your prescription. What matters is that someone has looked at you properly, explained your risks, and keeps reviewing your treatment until it works.
In one unhurried 45-minute consultation at 10 Harley Street, Dr Katy Kasraie will look at your health history, your goals and every suitable option, including approaches that do not involve medication. No referral needed, and most major insurers are accepted. Click here to book your appointment.