England April 2016 to June 2026
Published 12 November 2026
Changes to this publication
We have updated the Integrated Care Board structure used to the 2026 organisational structure. We have also updated the English indices of deprivation used to the 2025 version.
The HRT PPC drug list used in this publication has had more drug presentations added since the previous release.
Details can be found in section 4.1: Changes to this publication.
When methodology changes between releases, historical data from previous narrative reports and tables can also change. You should always use the latest release of our publications.
We are interested in any feedback about the publication, which you can send by using our Official Statistics feedback survey.Key findings
In England in 2025/26:
17 million HRT items were prescribed to an estimated 3.1 million identified patients.
The number of identified patients prescribed HRT was higher in less deprived areas.
The most common age group to be prescribed HRT was patients aged 50 to 54.
17 million Hormone Replacement Therapy (HRT) items were prescribed, 12% more than in 2024/25.
the estimated number of identified patients rose to 3.1 million in 2025/26 from 2.8 million in 2024/25, an increase of 9.1%.
the British National Formulary (BNF) presentation with the highest number of items prescribed was Progesterone micronised 100mg capsules at 2 million items, an increase of 57% since 2024/25.
the least deprived areas in England had more than twice as many identified patients receiving HRT prescribing compared to the most deprived areas.
an HRT Prescription Prepayment Certificate (HRT PPC) was used for 23% of HRT items, an increase from 21% of HRT items in 2024/25.
1. Things you should know
1.1. Introduction
This publication describes the prescribing of drugs that appear on the HRT Prescription Prepayment Certificate (HRT PPC) drug list, referred to as HRT items. These medications are subsequently dispensed in the community in England, Scotland, Wales, Isle of Man, or the Channel Islands.
Dispensing can be done by a pharmacy, appliance contractor, dispensing doctor, or have been personally administered by a GP practice. This publication does not include data on medicines used in secondary care, prisons, or issued by a private prescriber. The statistics do not include prescriptions that were issued but not presented for dispensing or where there has been an unmet demand for treatment.
1.2. Scope
These statistics detail:
- the total number of prescription items issued for drugs that appear on the HRT Prescription Prepayment Certificate (HRT PPC) drug list
- the number of identified patients that have received prescribing for these drugs
- demographic breakdowns of prescribing by age group
- demographic breakdowns by a measure of deprivation.
The costs associated with the provision of these medicines are not discussed in this summary. However, they are available within the supporting summary tables that accompany this release.
There is no single definition of HRT medications. Many other products may be used in the treatment of the menopause that are not included in these statistics. This publication uses ‘HRT’ as a catch-all term to refer to all drugs that appear on the HRT PPC drug list. Some medications included on the list may not meet other definitions of HRT when prescribed alone instead of in combination with another medication.
The release is limited to all drugs that are covered by the HRT PPC, which is intended to cover all drugs licensed to treat menopause in the UK. You can find the most up to date list of drugs included in the HRT PPC on the NHSBSA website.
These statistics use the therapeutic classifications defined in the BNF, using the classification system prior to BNF edition 70. Each January the NHSBSA updates the classification of drugs within the BNF hierarchy, and this may involve some drugs changing classification between years of data.
Medicines are classified by their primary therapeutic indication. However, sometimes a medicine may be prescribed for a reason other than the primary therapeutic indication. For example, the treatment of gender dysphoria. The clinical indication of a prescription is not captured by NHSBSA during processing, and therefore we cannot determine the reason that a prescription was issued.
Data in this publication does not distinguish between patients of different genders and includes all age groups, not just those typically associated with menopause.
1.3. Comparability with other outputs
The NHSBSA Data Science team have published an interactive HRT inequalities report to provide insights into HRT prescribing in menopause to women aged 40 years and over. The report includes a focus on patients living in Core20 areas, defined as the most deprived 20% of areas in England (Index of Multiple Deprivation (IMD) deciles 1 and 2), and compares these with patients living in non-Core20 areas (IMD deciles 3 to 10). The interactive report is not an official statistic.
Figures in this publication are not directly comparable with those published in the interactive HRT inequalities report because the two outputs use different methodologies and coverage.
Key differences include:
- the inequalities report uses a different HRT medicine list and is not based on the HRT PPC drug list
- it is restricted to female patients aged 40 years and over, whereas this publication includes all patients receiving medicines on the HRT PPC drug list
- the inequalities report only includes records where a valid NHS number can be identified, while this publication also includes data on items where the NHS number was not identified
- ICB is assigned in the report using the patient’s postcode, whereas ICB in this publication is based on the prescribing organisation
- the report includes additional clinical selection criteria, including requiring patients to have received at least one oestrogen HRT item.
Both publications exclude medicines issued and dispensed in prisons, secondary care settings and private prescriptions.
1.4. Background
Hormone Replacement Therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level during the perimenopause, menopause, and postmenopause.
Menopause is when periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.
Many women experience some symptoms, such as vaginal dryness, low mood, anxiety, hot flushes and difficulty sleeping. Some of these symptoms can be severe and have a negative impact on everyday life.
1.5. Definitions
Item
A single unit of medication listed separately on a prescription form. In this publication, an example of an item would be Estradiol 2mg tablets x84.
Patient
A unique NHS number captured from a prescription form or electronic prescription service (EPS) message.
NIC
The Net Ingredient Cost (NIC) is the basic price of the medication and the quantity prescribed. It does not include other fees incurred by dispensing contractors, such as controlled drug fees or the single activity fee. The basic price is determined by the Drug Tariff or by the manufacturer, wholesaler, or supplier of the product.
Total quantity
The total quantity of a drug or appliance that was prescribed. This is calculated by multiplying Quantity by Items. For example, if 2 items of Estradiol 2mg tablets with a quantity of 84 were prescribed, the total quantity will be 168.
Age
Where patients are identified, their age is calculated on 30 September of the given financial year to assign them to a single age band. For patients where date of birth has not been captured, they have been included in a category of unknown.
1.6. Time periods
This publication presents data from April 2016 to June 2026, the most recent available. Data is available in the supporting summary tables at both a monthly and a financial year level. Financial year 2025/26 covers April 2025 to March 2026. The most recent financial year, 2026/27, shows a year to date (YTD) view of the figures from April 2026 to June 2026.
1.7. Patient identification
When the NHSBSA processes prescriptions, the NHS number of the patient is identified for most, but not all, prescriptions. The proportion of items for which a patient could be identified is shown in Table 1. This means that data relating to patient counts represents most, but not all, patients.
These statistics do not contain any personally identifiable data. More information about how the NHSBSA protects personal information can be found in the statement on confidentiality and access.
Table 1: The proportion of items for which an NHS number was recorded for listed BNF paragraphs
| BNF paragraph name | 2022/2023 | 2023/2024 | 2024/2025 | 2025/2026 | 2026/27 YTD June 2026 |
|---|---|---|---|---|---|
| Female sex hormones and their modulators | 99.2% | 99.3% | 99.4% | 99.5% | 99.5% |
| Preparations for vaginal and vulval changes | 99.0% | 99.1% | 99.2% | 99.4% | 99.3% |
| Progestogen-only contraceptives | 94.5% | 94.8% | 95.0% | 95.8% | 95.9% |
| Anabolic steroids | 97.5% | 98.4% | 98.8% | 99.0% | 98.6% |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
2. Results and commentary
Number of prescribed items and estimated identified patients by financial year
Chart
Figure 1: The number of items prescribed and identified patients have both increased most years since 2016/17
Table
Table 2: The number of items prescribed and identified patients have both increased most years since 2016/17
| Financial year | Prescribed items | Identified patients |
|---|---|---|
| 2016/2017 | 3,518,127 | 1,138,221 |
| 2017/2018 | 4,019,647 | 1,251,672 |
| 2018/2019 | 4,509,788 | 1,347,390 |
| 2019/2020 | 5,299,717 | 1,455,855 |
| 2020/2021 | 5,421,088 | 1,384,542 |
| 2021/2022 | 7,440,756 | 1,813,233 |
| 2022/2023 | 10,933,505 | 2,344,683 |
| 2023/2024 | 13,285,183 | 2,634,977 |
| 2024/2025 | 14,725,140 | 2,804,440 |
| 2025/2026 | 16,525,240 | 3,059,192 |
| 2026/2027 (YTD June 2026) |
4,503,365 | 2,288,934 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
17 million HRT items prescribed in 2025/26.
3.1 million identified patients received an HRT item in 2025/26.
Items and patients have both continued to trend upwards.
In 2025/26, HRT drug items prescribed increased by 12% from the 15 million items prescribed in 2024/25.
There was a 9.1% increase in estimated identified patients in 2025/26, compared to 2.8 million patients in the previous year.
Between April 2026 and June 2026 there were 4.5 million HRT drug items prescribed. This was a 16% increase from 3.9 million items in the same time period in the previous year.
Number of prescribed items and estimated identified patients by month
Chart
Figure 2: The number of items and identified patients is generally increasing over time but varies by month
Table
Table 3: The number of items and identified patients is generally increasing over time but varies by month
| Year month | Prescribed items | Identified patients |
|---|---|---|
| 202407 | 1,269,235 | 930,105 |
| 202408 | 1,215,168 | 899,763 |
| 202409 | 1,203,911 | 892,699 |
| 202410 | 1,278,938 | 941,664 |
| 202411 | 1,226,368 | 910,456 |
| 202412 | 1,233,113 | 911,651 |
| 202501 | 1,289,155 | 949,782 |
| 202502 | 1,167,388 | 874,691 |
| 202503 | 1,254,953 | 929,920 |
| 202504 | 1,247,143 | 924,623 |
| 202505 | 1,334,773 | 981,292 |
| 202506 | 1,306,606 | 963,969 |
| 202507 | 1,410,625 | 1,029,287 |
| 202508 | 1,292,863 | 958,315 |
| 202509 | 1,376,724 | 1,011,623 |
| 202510 | 1,437,564 | 1,048,936 |
| 202511 | 1,354,011 | 1,000,312 |
| 202512 | 1,465,565 | 1,066,179 |
| 202601 | 1,450,244 | 1,061,080 |
| 202602 | 1,351,629 | 1,000,348 |
| 202603 | 1,497,493 | 1,089,834 |
| 202604 | 1,471,140 | 1,074,555 |
| 202605 | 1,476,652 | 1,077,345 |
| 202606 | 1,555,573 | 1,125,681 |
Source: Hormone Replacement Therapy summary tables - monthly (Excel: 1.9MB)
1.6 million HRT items prescribed in June 2026, a 5.3% increase from May 2026.
1.1 million identified patients received an HRT item in June 2026.
Between June 2025 and June 2026 there was a 19% increase in HRT items prescribed, up from 1.3 million items in June 2025.
The estimated identified patients who were prescribed at least one HRT drug item in June 2026 increased by 4.5% from the previous month.
Number of prescribed items and estimated identified patients by financial year and selected drug groups
In 2025/26, 99% of all HRT items were from 2 drug groups. These drug groups were BNF paragraph 6.4.1 female sex hormones and their modulators, and BNF paragraph 7.2.1 preparations for vaginal and vulval changes.
The charts in figure 3 show a rolling five-year time series, along with the year to date for 2026/27. The data is limited to items in these BNF paragraphs that are also included in the HRT PPC drug list.Chart
Figure 3: Items and identified patients in the 2 largest drug groups have increased over time
Table
Table 4: Items and identified patients in the 2 largest drug groups have increased over time
| Financial year | BNF paragraph | Prescribed items | Identified patients |
|---|---|---|---|
| 2020/2021 | 060401 | 3,627,557 | 815,228 |
| 2020/2021 | 070201 | 1,705,547 | 558,807 |
| 2021/2022 | 060401 | 5,259,502 | 1,153,414 |
| 2021/2022 | 070201 | 2,053,709 | 684,739 |
| 2022/2023 | 060401 | 8,254,828 | 1,612,624 |
| 2022/2023 | 070201 | 2,536,024 | 832,778 |
| 2023/2024 | 060401 | 10,235,493 | 1,844,037 |
| 2023/2024 | 070201 | 2,902,877 | 941,295 |
| 2024/2025 | 060401 | 11,277,126 | 1,957,341 |
| 2024/2025 | 070201 | 3,309,524 | 1,047,337 |
| 2025/2026 | 060401 | 12,458,334 | 2,119,952 |
| 2025/2026 | 070201 | 3,921,632 | 1,217,135 |
| 2026/2027 (YTD June 2026) |
060401 | 3,374,629 | 1,703,494 |
| 2026/2027 (YTD June 2026) |
070201 | 1,088,008 | 769,248 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
12 million female sex hormones and their modulators items prescribed in 2025/26.
3.9 million preparations for vaginal and vulval changes items prescribed in 2025/26.
In 2025/26, there was a 10% increase in female sex hormones and their modulators items prescribed, from 11 million items in the previous year.
There were an estimated 2.1 million identified patients who were prescribed at least one female sex hormones and their modulators item in 2025/26. This was an 8.3% increase compared to the 2.0 million identified patients in 2024/25.
In 2025/26, there was an 18% increase preparations for vaginal and vulval changes items prescribed, from 3.3 million items in the previous year.
An estimated 1.2 million identified patients were prescribed at least one preparations for vaginal and vulval changes item in 2025/26. This was a 16% increase from 1.0 million identified patients in 2024/25.
Estimated number of identified patients by financial year for selected BNF chemical substances
Chemical substance
A chemical substance is the name of the main active ingredient in a drug. The chemical substances featured in figure 4 and figure 5 are the top 5 most prescribed chemical substances for HRT prescribing. Although chemical substance is a grouping within the BNF, when a drug is available in different presentations with disparate uses it may be listed in multiple sections or paragraphs. In this case the drug will be assigned multiple chemical substances codes, one for each section it is in.
This is the case for Estradiol, which has a code for female sex hormones and their modulators, and another code for preparations for vaginal and vulval changes. The chemical substance code is included in the figures and commentary to distinguish between the prescribing for each drug group.Chart
Figure 4: Estradiol (0604011G0) was the HRT chemical substance with the most identified patients in 2025/26
Table
Table 5: Estradiol (0604011G0) was the HRT chemical substance with the most identified patients in 2025/26
| Financial year | BNF chemical substance | Identified patients |
|---|---|---|
| 2016/2017 | Estradiol - 0604011G0 | 207,604 |
| 2016/2017 | Estradiol with progestogen - 0604011L0 | 268,166 |
| 2016/2017 | Progesterone - 0604012S0 | 9,392 |
| 2016/2017 | Estriol - 0702010F0 | 206,672 |
| 2016/2017 | Estradiol - 0702010G0 | 287,960 |
| 2017/2018 | Estradiol - 0604011G0 | 233,098 |
| 2017/2018 | Estradiol with progestogen - 0604011L0 | 338,434 |
| 2017/2018 | Progesterone - 0604012S0 | 14,686 |
| 2017/2018 | Estriol - 0702010F0 | 216,076 |
| 2017/2018 | Estradiol - 0702010G0 | 312,662 |
| 2018/2019 | Estradiol - 0604011G0 | 266,046 |
| 2018/2019 | Estradiol with progestogen - 0604011L0 | 382,683 |
| 2018/2019 | Progesterone - 0604012S0 | 25,760 |
| 2018/2019 | Estriol - 0702010F0 | 230,847 |
| 2018/2019 | Estradiol - 0702010G0 | 341,707 |
| 2019/2020 | Estradiol - 0604011G0 | 345,684 |
| 2019/2020 | Estradiol with progestogen - 0604011L0 | 402,259 |
| 2019/2020 | Progesterone - 0604012S0 | 79,239 |
| 2019/2020 | Estriol - 0702010F0 | 247,725 |
| 2019/2020 | Estradiol - 0702010G0 | 369,283 |
| 2020/2021 | Estradiol - 0604011G0 | 363,497 |
| 2020/2021 | Estradiol with progestogen - 0604011L0 | 367,730 |
| 2020/2021 | Progesterone - 0604012S0 | 111,282 |
| 2020/2021 | Estriol - 0702010F0 | 235,338 |
| 2020/2021 | Estradiol - 0702010G0 | 348,267 |
| 2021/2022 | Estradiol - 0604011G0 | 592,795 |
| 2021/2022 | Estradiol with progestogen - 0604011L0 | 519,789 |
| 2021/2022 | Progesterone - 0604012S0 | 258,148 |
| 2021/2022 | Estriol - 0702010F0 | 300,731 |
| 2021/2022 | Estradiol - 0702010G0 | 421,514 |
| 2022/2023 | Estradiol - 0604011G0 | 954,923 |
| 2022/2023 | Estradiol with progestogen - 0604011L0 | 680,013 |
| 2022/2023 | Progesterone - 0604012S0 | 505,319 |
| 2022/2023 | Estriol - 0702010F0 | 371,130 |
| 2022/2023 | Estradiol - 0702010G0 | 513,684 |
| 2023/2024 | Estradiol - 0604011G0 | 1,181,842 |
| 2023/2024 | Estradiol with progestogen - 0604011L0 | 704,539 |
| 2023/2024 | Progesterone - 0604012S0 | 648,493 |
| 2023/2024 | Estriol - 0702010F0 | 431,623 |
| 2023/2024 | Estradiol - 0702010G0 | 569,506 |
| 2024/2025 | Estradiol - 0604011G0 | 1,321,159 |
| 2024/2025 | Estradiol with progestogen - 0604011L0 | 668,451 |
| 2024/2025 | Progesterone - 0604012S0 | 746,850 |
| 2024/2025 | Estriol - 0702010F0 | 497,228 |
| 2024/2025 | Estradiol - 0702010G0 | 618,988 |
| 2025/2026 | Estradiol - 0604011G0 | 1,494,385 |
| 2025/2026 | Estradiol with progestogen - 0604011L0 | 676,879 |
| 2025/2026 | Progesterone - 0604012S0 | 858,010 |
| 2025/2026 | Estriol - 0702010F0 | 611,967 |
| 2025/2026 | Estradiol - 0702010G0 | 688,432 |
| 2026/2027 (YTD June 2026) |
Estradiol - 0604011G0 | 1,173,757 |
| 2026/2027 (YTD June 2026) |
Estradiol with progestogen - 0604011L0 | 454,657 |
| 2026/2027 (YTD June 2026) |
Progesterone - 0604012S0 | 644,269 |
| 2026/2027 (YTD June 2026) |
Estriol - 0702010F0 | 361,423 |
| 2026/2027 (YTD June 2026) |
Estradiol - 0702010G0 | 432,340 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
In 2025/26, Estradiol (0604011G0) remained the chemical substance with the largest total number of identified patients.
1.5 million identified patients were prescribed at least one Estradiol (0604011G0) item in 2025/26.
Estradiol (0604011G0) was the chemical substance with the largest total increase in estimated identified patients between 2024/25 and 2025/26. The number of identified patients prescribed at least one Estradiol (0604011G0) item in 2025/26 increased by 173,000 patients, or 13%, up from 1.3 million in 2024/25.
Progesterone (0604012S0) was the chemical substance with the second highest estimated number of identified patients in 2025/26, with 858,000.
Between 2024/25 and 2025/26, the number of estimated identified patients for Estriol (0702010F0) increased by 23%, to 612,000 patients. Of the top 5 most prescribed chemical substances, Estriol (0702010F0) was the chemical substance with the largest percentage increase in estimated identified patients since 2024/25.
Number of prescribed items by financial year for selected BNF chemical substances
Chart
Figure 5: Estradiol (0604011G0) was the most prescribed HRT chemical substance by items in 2025/26
Table
Table 6: Estradiol (0604011G0) was the most prescribed HRT chemical substance by items in 2025/26
| Financial year | BNF chemical substance | Total items |
|---|---|---|
| 2016/2017 | Estradiol - 0604011G0 | 813,258 |
| 2016/2017 | Estradiol - 0702010G0 | 749,144 |
| 2016/2017 | Estradiol with progestogen - 0604011L0 | 783,616 |
| 2016/2017 | Estriol - 0702010F0 | 492,827 |
| 2016/2017 | Progesterone - 0604012S0 | 31,396 |
| 2017/2018 | Estradiol - 0604011G0 | 922,880 |
| 2017/2018 | Estradiol - 0702010G0 | 829,574 |
| 2017/2018 | Estradiol with progestogen - 0604011L0 | 1,026,219 |
| 2017/2018 | Estriol - 0702010F0 | 529,980 |
| 2017/2018 | Progesterone - 0604012S0 | 47,732 |
| 2018/2019 | Estradiol - 0604011G0 | 1,068,454 |
| 2018/2019 | Estradiol - 0702010G0 | 930,147 |
| 2018/2019 | Estradiol with progestogen - 0604011L0 | 1,202,478 |
| 2018/2019 | Estriol - 0702010F0 | 586,081 |
| 2018/2019 | Progesterone - 0604012S0 | 82,869 |
| 2019/2020 | Estradiol - 0604011G0 | 1,354,548 |
| 2019/2020 | Estradiol - 0702010G0 | 1,053,492 |
| 2019/2020 | Estradiol with progestogen - 0604011L0 | 1,292,198 |
| 2019/2020 | Estriol - 0702010F0 | 661,910 |
| 2019/2020 | Progesterone - 0604012S0 | 224,155 |
| 2020/2021 | Estradiol - 0604011G0 | 1,517,555 |
| 2020/2021 | Estradiol - 0702010G0 | 1,044,356 |
| 2020/2021 | Estradiol with progestogen - 0604011L0 | 1,186,842 |
| 2020/2021 | Estriol - 0702010F0 | 661,191 |
| 2020/2021 | Progesterone - 0604012S0 | 377,687 |
| 2021/2022 | Estradiol - 0604011G0 | 2,303,883 |
| 2021/2022 | Estradiol - 0702010G0 | 1,229,740 |
| 2021/2022 | Estradiol with progestogen - 0604011L0 | 1,639,532 |
| 2021/2022 | Estriol - 0702010F0 | 823,969 |
| 2021/2022 | Progesterone - 0604012S0 | 795,620 |
| 2022/2023 | Estradiol - 0604011G0 | 3,920,916 |
| 2022/2023 | Estradiol - 0702010G0 | 1,497,164 |
| 2022/2023 | Estradiol with progestogen - 0604011L0 | 2,186,503 |
| 2022/2023 | Estriol - 0702010F0 | 1,038,860 |
| 2022/2023 | Progesterone - 0604012S0 | 1,630,061 |
| 2023/2024 | Estradiol - 0604011G0 | 4,998,153 |
| 2023/2024 | Estradiol - 0702010G0 | 1,676,322 |
| 2023/2024 | Estradiol with progestogen - 0604011L0 | 2,396,227 |
| 2023/2024 | Estriol - 0702010F0 | 1,226,555 |
| 2023/2024 | Progesterone - 0604012S0 | 2,329,858 |
| 2024/2025 | Estradiol - 0604011G0 | 5,671,958 |
| 2024/2025 | Estradiol - 0702010G0 | 1,846,579 |
| 2024/2025 | Estradiol with progestogen - 0604011L0 | 2,346,801 |
| 2024/2025 | Estriol - 0702010F0 | 1,462,945 |
| 2024/2025 | Progesterone - 0604012S0 | 2,798,049 |
| 2025/2026 | Estradiol - 0604011G0 | 6,425,515 |
| 2025/2026 | Estradiol - 0702010G0 | 2,079,645 |
| 2025/2026 | Estradiol with progestogen - 0604011L0 | 2,373,392 |
| 2025/2026 | Estriol - 0702010F0 | 1,841,987 |
| 2025/2026 | Progesterone - 0604012S0 | 3,255,315 |
| 2026/2027 (YTD June 2026) |
Estradiol - 0604011G0 | 1,755,210 |
| 2026/2027 (YTD June 2026) |
Estradiol - 0702010G0 | 555,427 |
| 2026/2027 (YTD June 2026) |
Estradiol with progestogen - 0604011L0 | 616,020 |
| 2026/2027 (YTD June 2026) |
Estriol - 0702010F0 | 532,581 |
| 2026/2027 (YTD June 2026) |
Progesterone - 0604012S0 | 906,319 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
In 2025/26, Estradiol (0604011G0) remained the chemical substance with the largest number of items prescribed.
6.4 million Estradiol (0604011G0) items were prescribed in 2025/26.
Between 2024/25 and 2025/26, Estradiol (0604011G0) was the chemical substance with the largest increase in total items prescribed.
In 2025/26, there were 754,000 more Estradiol (0604011G0) items than the 5.7 million items in the previous year, a 13% increase. This was a similar percentage change to the 13% increase in estimated identified patients for Estradiol (0604011G0).
Top 10 presentations by prescribed items in 2025/2026
Presentations
Pharmaceutical presentations can come in many forms including tablets, capsules, patches, gels, creams and more. Please see the definitions of items and quantity given in section 1.5 to help interpret table 7.
The chemical substance listed in figures 4 and 5 can be made up of more than one of the presentations in table 7. For example, both Vagifem 10 microgram vaginal tablets and Estradiol 10 microgram pessaries have the chemical substance of Estradiol.Table 7 includes the BNF presentation that appeared on the prescription form. It is possible that products that are different brands, or generic equivalents, of the same product may appear separately in these tables.
For example, Oestrogel Pump-Pack 0.06% gel is the branded equivalent of Estradiol 0.06% gel (750 microgram per actuation) and Vagifem 10 microgram vaginal tablets is the branded equivalent of Estradiol 10 microgram pessaries.
In addition, BNF presentation names may change between yearly reports. For example, the presentation ‘Estriol 1mg/g vaginal cream with applicator’ in the 2025/26 report was named ‘Estriol 0.1% cream’ in the 2023/24 report.
Table 7: Top 10 presentations by prescribed items in 2025/2026
| BNF Presentation Name | Unit of Measure | Chemical Substance | Total Items | Total Quantity |
|---|---|---|---|---|
| Progesterone micronised 100mg capsules | capsule | Progesterone | 2,030,000 | 156,000,000 |
| Estradiol 0.06% gel (750microgram per actuation) | gram | Estradiol | 1,510,000 | 267,000,000 |
| Estriol 1mg/g vaginal cream with applicator | gram | Estriol | 1,340,000 | 26,900,000 |
| Estradiol 10microgram pessaries | pessary | Estradiol | 1,330,000 | 34,000,000 |
| Oestrogel Pump-Pack 0.06% gel | gram | Estradiol | 1,250,000 | 233,000,000 |
| Evorel Conti patches | patch | Estradiol with progestogen | 1,050,000 | 22,200,000 |
| Utrogestan 100mg capsules | capsule | Progesterone | 1,010,000 | 78,200,000 |
| Evorel 50 patches | patch | Estradiol | 750,000 | 15,100,000 |
| Evorel Sequi patches | patch | Estradiol with progestogen | 620,000 | 12,900,000 |
| Evorel 75 patches | patch | Estradiol | 502,000 | 10,100,000 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
Progesterone micronised 100mg capsules had the largest number of items prescribed in 2025/26, with 2.0 million items. This was an increase of 57% from 1.3 million items for this presentation in 2024/25.
Estimated number of identified patients per 1,000 population by Integrated Care Board (ICB) in 2025/2026
ICB population estimates
The ICBs in this publication have been updated to reflect the new ICB structure introduced in April 2026.
Office for National Statistics (ONS) mid-year population estimates have been used to calculate the estimated identified patients per 1,000 population.
The national average estimated identified patients per 1,000 population reported for England uses the latest 2025 mid-year population estimate. Mid-year population estimates for 2025 were not available for the new ICB structure at time of publication. Therefore, mid-year population estimates for 2024 have been mapped up from Lower Super Output Area (LSOA) level to the new ICB structure. Comparisons of ICB figures to the national average should be made with caution, as the national average and ICB figures use population estimates from different years.Patient map
Figure 6 (map): The number of identified patients prescribed HRT items per 1,000 population varied by ICB
Chart
Figure 6 (chart): The number of identified patients prescribed HRT items per 1,000 population varied by ICB
Table
Table 8: The number of identified patients prescribed HRT items per 1,000 population varied by ICB
| Financial year | ICB name | ICB code | Patients per 1,000 population |
|---|---|---|---|
| 2025/2026 | NHS CORNWALL AND THE ISLES OF SCILLY INTEGRATED CARE BOARD | QT6 | 76.8 |
| 2025/2026 | NHS GLOUCESTERSHIRE INTEGRATED CARE BOARD | QR1 | 74.6 |
| 2025/2026 | NHS DEVON INTEGRATED CARE BOARD | QJK | 72.7 |
| 2025/2026 | NHS SURREY AND SUSSEX INTEGRATED CARE BOARD | S9B9J | 72.4 |
| 2025/2026 | NHS DORSET INTEGRATED CARE BOARD | QVV | 71.1 |
| 2025/2026 | NHS HEREFORDSHIRE AND WORCESTERSHIRE INTEGRATED CARE BOARD | QGH | 70.3 |
| 2025/2026 | NHS SOMERSET INTEGRATED CARE BOARD | QSL | 69.8 |
| 2025/2026 | NHS BATH AND NORTH EAST SOMERSET, SWINDON AND WILTSHIRE INTEGRATED CARE BOARD | QOX | 69.1 |
| 2025/2026 | NHS NORFOLK AND SUFFOLK INTEGRATED CARE BOARD | T6Y0W | 66.3 |
| 2025/2026 | NHS HAMPSHIRE AND ISLE OF WIGHT INTEGRATED CARE BOARD | QRL | 64.9 |
| 2025/2026 | NHS THAMES VALLEY INTEGRATED CARE BOARD | S0E4D | 59.8 |
| 2025/2026 | NHS SHROPSHIRE, TELFORD AND WREKIN INTEGRATED CARE BOARD | QOC | 59.5 |
| 2025/2026 | NHS DERBY AND DERBYSHIRE INTEGRATED CARE BOARD | QJ2 | 59.3 |
| 2025/2026 | NHS HUMBER AND NORTH YORKSHIRE INTEGRATED CARE BOARD | QOQ | 59.3 |
| 2025/2026 | NHS BRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE INTEGRATED CARE BOARD | QUY | 59.0 |
| 2025/2026 | NHS CHESHIRE AND MERSEYSIDE INTEGRATED CARE BOARD | QYG | 57.7 |
| 2025/2026 | NHS KENT AND MEDWAY INTEGRATED CARE BOARD | QKS | 53.9 |
| 2025/2026 | NHS LINCOLNSHIRE INTEGRATED CARE BOARD | QJM | 53.9 |
| 2025/2026 | NHS NOTTINGHAM AND NOTTINGHAMSHIRE INTEGRATED CARE BOARD | QT1 | 53.2 |
| 2025/2026 | NHS CENTRAL EAST INTEGRATED CARE BOARD | S1Y5D | 51.6 |
| 2025/2026 | NHS ESSEX INTEGRATED CARE BOARD | D7T5G | 51.5 |
| 2025/2026 | NHS LANCASHIRE AND SOUTH CUMBRIA INTEGRATED CARE BOARD | QE1 | 51.4 |
| 2025/2026 | NHS NORTHAMPTONSHIRE INTEGRATED CARE BOARD | QPM | 51.4 |
| 2025/2026 | NHS NORTH EAST AND NORTH CUMBRIA INTEGRATED CARE BOARD | QHM | 51.3 |
| 2025/2026 | NHS COVENTRY AND WARWICKSHIRE INTEGRATED CARE BOARD | QWU | 51.2 |
| 2025/2026 | NHS WEST YORKSHIRE INTEGRATED CARE BOARD | QWO | 49.2 |
| 2025/2026 | NHS STAFFORDSHIRE AND STOKE-ON-TRENT INTEGRATED CARE BOARD | QNC | 48.3 |
| 2025/2026 | NHS SOUTH WEST LONDON INTEGRATED CARE BOARD | QWE | 46.7 |
| 2025/2026 | NHS SOUTH YORKSHIRE INTEGRATED CARE BOARD | QF7 | 46.1 |
| 2025/2026 | NHS LEICESTER, LEICESTERSHIRE AND RUTLAND INTEGRATED CARE BOARD | QK1 | 45.4 |
| 2025/2026 | NHS GREATER MANCHESTER INTEGRATED CARE BOARD | QOP | 43.1 |
| 2025/2026 | NHS SOUTH EAST LONDON INTEGRATED CARE BOARD | QKK | 39.2 |
| 2025/2026 | NHS BIRMINGHAM AND SOLIHULL INTEGRATED CARE BOARD | QHL | 36.8 |
| 2025/2026 | NHS WEST AND NORTH LONDON INTEGRATED CARE BOARD | Z9B2Z | 34.9 |
| 2025/2026 | NHS BLACK COUNTRY INTEGRATED CARE BOARD | QUA | 30.3 |
| 2025/2026 | NHS NORTH EAST LONDON INTEGRATED CARE BOARD | QMF | 23.5 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB) | Office for National Statistics - Mid-2024 ICB Mid-year population estimates (from LSOA level)
In 2025/26, NHS North East London ICB had the lowest estimated number of identified patients who received at least one HRT item per 1,000 residents. It had an estimated 23 patients per 1,000 population.
In 2025/26, NHS Cornwall and the Isles of Scilly ICB had the highest estimated number of identified patients who received at least one HRT item per 1,000 residents. It had an estimated 77 patients per 1,000 population.
In England in 2025/26, the estimated number of identified patients who received at least one HRT item per 1,000 population was 52.
Estimated number of identified patients by age band in 2025/2026
Chart
Figure 7: Patients aged 50 to 54 were the largest prescribing group for HRT in 2025/26
Table
Table 9: Patients aged 50 to 54 were the largest prescribing group for HRT in 2025/26
| Financial year | Age band | Identified patients |
|---|---|---|
| 2025/2026 | 00-04 | 249 |
| 2025/2026 | 05-09 | 170 |
| 2025/2026 | 10-14 | 865 |
| 2025/2026 | 15-19 | 6,062 |
| 2025/2026 | 20-24 | 15,588 |
| 2025/2026 | 25-29 | 21,577 |
| 2025/2026 | 30-34 | 28,718 |
| 2025/2026 | 35-39 | 50,058 |
| 2025/2026 | 40-44 | 170,789 |
| 2025/2026 | 45-49 | 447,744 |
| 2025/2026 | 50-54 | 663,858 |
| 2025/2026 | 55-59 | 603,235 |
| 2025/2026 | 60-64 | 378,607 |
| 2025/2026 | 65-69 | 217,370 |
| 2025/2026 | 70-74 | 157,431 |
| 2025/2026 | 75-79 | 144,405 |
| 2025/2026 | 80-84 | 87,054 |
| 2025/2026 | 85-89 | 42,830 |
| 2025/2026 | 90+ | 17,701 |
| 2025/2026 | Unknown | 11,119 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB)
In 2025/26, patients aged 50 to 54 remained the largest group of identified patients.
664,000 identified patients were aged 50 to 54, over a fifth of all identified patients in 2025/26.
Out of all identified patients who received an HRT item in 2025/26, 22% were patients aged 50 to 54.
Patients aged 55 to 59 were the second most common group with 603,000 patients, 20% of all identified patients who received an HRT item in 2025/26.
Estimated number of identified patients by IMD quintile in 2025/2026
Chart
Figure 8: More people were prescribed HRT in less deprived areas in 2025/26
Table
Table 10: More people were prescribed HRT in less deprived areas in 2025/26
| Financial year | IMD quintile | Identified patients |
|---|---|---|
| 2025/2026 | 1 - most deprived | 372,169 |
| 2025/2026 | 2 | 522,272 |
| 2025/2026 | 3 | 652,710 |
| 2025/2026 | 4 | 746,667 |
| 2025/2026 | 5 - least deprived | 828,615 |
Source: Hormone Replacement Therapy summary tables - annual IMD (Excel: 224KB)
829,000 patients prescribed HRT items in the least deprived areas in England in 2025/26.
372,000 patients prescribed HRT items in the most deprived areas in England in 2025/26.
The number of estimated identified patients in the least deprived areas was more than double the estimated identified patients in the most deprived areas. In general, more people were prescribed HRT in less deprived areas in 2025/26, a pattern which has been consistent since 2015/16.
The English Indices of Deprivation have been used to provide a measure of patient deprivation. The deprivation quintiles reported are usually those of the patient’s registered address. More information on this measure can be found in section 4 of this summary.
Proportion of chargeable items by financial year
Prescription charges
In England, a charge applies to NHS prescriptions unless a valid exemption is held. Items dispensed to non-exempt patients are counted as chargeable. Certain groups are exempt from paying for their NHS prescriptions, for example those over the age of 60. Some prescribed items are always free, such as contraceptives.
If a patient regularly pays prescription charges, a Prescription Prepayment certificate (PPC) could save them money by paying one upfront cost annually or for a 3-month period.
An annual HRT PPC was introduced in April 2023 that covers medicines licensed to treat the menopause in the UK.
Prescriptions covered by either a PPC or HRT PPC are classed as exempt in the data, because the patient does not pay when collecting the medication. PPC has been included in the ‘Other exemptions’ category.
Patients aged under 16 or 60 and over are eligible to claim free prescriptions. Patients do not need to provide proof of age when claiming prescriptions under the age exemption if their date of birth is printed electronically on the prescription. Therefore support with prescription costs, such as exemptions or PPCs, is generally only applicable to patients aged between 16 and 59.
More information on exemptions can be found in section 3 of this summary. You can find more information on HRT PPC data in the NHS Help with Help Costs England publication.Chart
Figure 9: The proportion of HRT items exempt from prescription charges has increased since 2022/23
Table
Table 11: The proportion of HRT items exempt from prescription charges has increased since 2022/23
| Financial year | Charge status | Total items | Proportion of items (%) |
|---|---|---|---|
| 2016/2017 | Age exempt | 1,404,298 | 39.90 |
| 2016/2017 | Charged | 849,654 | 24.20 |
| 2016/2017 | Other exemptions | 1,263,957 | 35.90 |
| 2017/2018 | Age exempt | 1,552,294 | 38.60 |
| 2017/2018 | Charged | 1,019,699 | 25.40 |
| 2017/2018 | Other exemptions | 1,447,401 | 36.00 |
| 2018/2019 | Age exempt | 1,715,960 | 38.10 |
| 2018/2019 | Charged | 1,172,306 | 26.00 |
| 2018/2019 | Other exemptions | 1,621,280 | 36.00 |
| 2019/2020 | Age exempt | 1,949,193 | 36.80 |
| 2019/2020 | Charged | 1,396,771 | 26.40 |
| 2019/2020 | Other exemptions | 1,953,455 | 36.90 |
| 2020/2021 | Age exempt | 1,997,584 | 36.90 |
| 2020/2021 | Charged | 1,385,399 | 25.60 |
| 2020/2021 | Other exemptions | 2,037,864 | 37.60 |
| 2021/2022 | Age exempt | 2,333,771 | 31.40 |
| 2021/2022 | Charged | 2,138,995 | 28.70 |
| 2021/2022 | Other exemptions | 2,967,845 | 39.90 |
| 2022/2023 | Age exempt | 2,984,795 | 27.30 |
| 2022/2023 | Charged | 3,279,008 | 30.00 |
| 2022/2023 | Other exemptions | 4,668,854 | 42.70 |
| 2022/2023 | Used HRT PPC | 665 | 0.01 |
| 2023/2024 | Age exempt | 3,507,445 | 26.40 |
| 2023/2024 | Charged | 1,902,774 | 14.30 |
| 2023/2024 | Other exemptions | 5,944,753 | 44.70 |
| 2023/2024 | Used HRT PPC | 1,930,184 | 14.50 |
| 2024/2025 | Age exempt | 4,077,603 | 27.70 |
| 2024/2025 | Charged | 1,438,431 | 9.77 |
| 2024/2025 | Other exemptions | 6,050,988 | 41.10 |
| 2024/2025 | Used HRT PPC | 3,158,009 | 21.40 |
| 2025/2026 | Age exempt | 4,816,951 | 29.10 |
| 2025/2026 | Charged | 1,403,773 | 8.49 |
| 2025/2026 | Other exemptions | 6,541,241 | 39.60 |
| 2025/2026 | Used HRT PPC | 3,763,144 | 22.80 |
| 2026/2027 (YTD June 2026) |
Age exempt | 1,334,960 | 29.60 |
| 2026/2027 (YTD June 2026) |
Charged | 360,646 | 8.01 |
| 2026/2027 (YTD June 2026) |
Other exemptions | 1,748,640 | 38.80 |
| 2026/2027 (YTD June 2026) |
Used HRT PPC | 1,059,091 | 23.50 |
Source: Hormone Replacement Therapy summary tables - annual (Excel: 230KB) | Hormone Replacement Therapy tables - exemption category management information (Excel: 219KB)
In 2025/26, 91.5% of HRT items were exempt from prescription charges at the point of dispensing. This was an increase from 90.2% in 2024/25. The first financial quarter of 2025/26, covering April to June 2026, has also continued this trend, increasing to 92.0%.
In 2025/26, an HRT PPC was used for 23% of HRT items, up from 21% in 2024/25. This was the third full financial year where the HRT PPC was available. In the first financial quarter of 2025/26 this increased to 24% of HRT items.
Proportion of chargeable items by month April 2025 to June 2026
Chart
Figure 10: The proportion of HRT items exempt from prescription charges has increased in most months since April 2025
Table
Table 12: The proportion of HRT items exempt from prescription charges has increased in most months since April 2025
| Year month | Charge status | Total items | Proportion of items (%) |
|---|---|---|---|
| 202504 | Age exempt | 356,220 | 28.60 |
| 202504 | Charged | 108,024 | 8.66 |
| 202504 | Other exemptions | 501,953 | 40.20 |
| 202504 | Used HRT PPC | 280,937 | 22.50 |
| 202505 | Age exempt | 379,534 | 28.40 |
| 202505 | Charged | 117,957 | 8.84 |
| 202505 | Other exemptions | 531,448 | 39.80 |
| 202505 | Used HRT PPC | 305,821 | 22.90 |
| 202506 | Age exempt | 370,566 | 28.40 |
| 202506 | Charged | 114,736 | 8.78 |
| 202506 | Other exemptions | 525,070 | 40.20 |
| 202506 | Used HRT PPC | 296,223 | 22.70 |
| 202507 | Age exempt | 405,793 | 28.80 |
| 202507 | Charged | 120,841 | 8.57 |
| 202507 | Other exemptions | 563,758 | 40.00 |
| 202507 | Used HRT PPC | 320,227 | 22.70 |
| 202508 | Age exempt | 382,737 | 29.60 |
| 202508 | Charged | 108,692 | 8.41 |
| 202508 | Other exemptions | 513,897 | 39.70 |
| 202508 | Used HRT PPC | 287,517 | 22.20 |
| 202509 | Age exempt | 401,170 | 29.10 |
| 202509 | Charged | 117,740 | 8.55 |
| 202509 | Other exemptions | 548,149 | 39.80 |
| 202509 | Used HRT PPC | 309,655 | 22.50 |
| 202510 | Age exempt | 422,093 | 29.40 |
| 202510 | Charged | 122,736 | 8.54 |
| 202510 | Other exemptions | 567,047 | 39.40 |
| 202510 | Used HRT PPC | 325,677 | 22.70 |
| 202511 | Age exempt | 398,040 | 29.40 |
| 202511 | Charged | 116,550 | 8.61 |
| 202511 | Other exemptions | 531,502 | 39.30 |
| 202511 | Used HRT PPC | 307,906 | 22.70 |
| 202512 | Age exempt | 434,595 | 29.70 |
| 202512 | Charged | 121,116 | 8.26 |
| 202512 | Other exemptions | 576,332 | 39.30 |
| 202512 | Used HRT PPC | 333,515 | 22.80 |
| 202601 | Age exempt | 427,524 | 29.50 |
| 202601 | Charged | 119,878 | 8.27 |
| 202601 | Other exemptions | 568,232 | 39.20 |
| 202601 | Used HRT PPC | 334,603 | 23.10 |
| 202602 | Age exempt | 395,653 | 29.30 |
| 202602 | Charged | 112,651 | 8.33 |
| 202602 | Other exemptions | 529,810 | 39.20 |
| 202602 | Used HRT PPC | 313,495 | 23.20 |
| 202603 | Age exempt | 443,026 | 29.60 |
| 202603 | Charged | 122,852 | 8.20 |
| 202603 | Other exemptions | 584,043 | 39.00 |
| 202603 | Used HRT PPC | 347,568 | 23.20 |
| 202604 | Age exempt | 439,542 | 29.90 |
| 202604 | Charged | 117,657 | 8.00 |
| 202604 | Other exemptions | 571,003 | 38.80 |
| 202604 | Used HRT PPC | 342,933 | 23.30 |
| 202605 | Age exempt | 436,095 | 29.50 |
| 202605 | Charged | 118,885 | 8.05 |
| 202605 | Other exemptions | 572,417 | 38.80 |
| 202605 | Used HRT PPC | 349,243 | 23.70 |
| 202606 | Age exempt | 459,323 | 29.50 |
| 202606 | Charged | 124,104 | 7.98 |
| 202606 | Other exemptions | 605,220 | 38.90 |
| 202606 | Used HRT PPC | 366,915 | 23.60 |
Source: Hormone Replacement Therapy summary tables - monthly (Excel: 1.9MB) | Hormone Replacement Therapy tables - exemption category management information (Excel: 219KB)
There was an increase in the overall proportion of HRT prescribing that is exempt from prescription charges in almost every month between April 2025 to June 2026. In June 2026, 92% of HRT prescribing was exempt from prescription charges at the point of dispensing, compared to 91% in June 2025.
HRT PPCs were introduced in April 2023 and the proportion of HRT prescribing for which an HRT PPC was used has continued to increase since then. However, the increases in 2025/26 were smaller than in previous years.
In most months between June 2025 and June 2026, the use of an HRT PPC increased slightly compared to the previous month, though there were small decreases in August 2025 and June 2026. In June 2026, 24% of HRT prescribing was exempt from prescription charges due to use of an HRT PPC, compared to 23% in June 2025.
In all months from April 2025 to June 2026, the proportion of HRT items exempt from prescription charges through use of an HRT PPC was higher than the proportion of HRT items that were charged.
3. Background
The menopause is a biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life. This is not usually abrupt, but a gradual process during which women experience perimenopause before reaching postmenopause. Usually the menopause is defined as having occurred when a woman has not had a period for 12 consecutive months (for women reaching menopause naturally).
As well as a change in their menstrual cycle women may experience a variety of symptoms associated with menopause such as hot flushes and sweats, low mood, vaginal dryness, low sexual desire, and others.
Most women will experience some symptoms. Symptoms can last for months or years, and can change with time. Prolonged lack of the hormone oestrogen affects the bones and cardiovascular system, and postmenopausal women are at increased risk of a number of long-term conditions, such as osteoporosis.
HRT, which replaces the hormones that are at low levels, is the main medicine treatment for menopause and perimenopause symptoms. More information on the menopause is available on the NHS website.
3.1. Included drugs
This publication includes all drugs that have been covered by an HRT PPC. The HRT PPC exempts patients from charges for drugs licensed to treat menopause in the UK. You can find the most up to date list of drugs included in the HRT PPC on the NHSBSA website.
A list of all drugs that are included in this release, including any that are no longer listed due to classification changes or discontinuation can be found in Appendix A (Excel: 15KB).
3.1.1. Female sex hormones and their modulators
Oestrogen-only HRT is usually only recommended for women who have had their womb removed during a hysterectomy. For women with a uterus, oestrogen plus progestogen HRT is recommended. A progestogen item should be prescribed to reduce the risk of cystic hyperplasia of the endometrium, a thickening of the endometrium, and possible transformation to cancer.
HRT comes in several different forms such as tablets and skin patches. The treatment routine for HRT depends on whether the patient is in the early stages of the menopause or has had menopausal symptoms for some time. More information on the types and routines of HRT treatment can be found on the NHS website.
The 2 types of routines are cyclical (or sequential) HRT and continuous combined HRT.
Continuous combined preparations are not suitable for use in the perimenopause or within 12 months of the last menstrual period. Women who use such preparations may bleed irregularly in the early stages of treatment.
You can find out more information on sex hormones and the menopause on the NICE website.
3.1.2. Preparations for vaginal and vulval changes
Preparations for vaginal and vulval changes are used to treat the symptoms of vaginal atrophy related to oestrogen deficiencies related to the menopause.
There are non-hormonal vaginal moisturisers available. Menopausal women with vaginal dryness can use vaginal moisturisers and lubricants alone or in addition to vaginal oestrogen.
You can find out more information on vaginal and vulval conditions on the NICE website.
3.1.3. Anabolic steroids
Prasterone
Prasterone is biochemically and biologically identical to endogenous dehydroepiandrosterone (DHEA), and is converted to oestrogens and androgens. It is used to treat vulvar and vaginal atrophy in postmenopausal women.
You can find out more information on prasterone on the NICE website.
3.1.4. Progesterone only contraception
Intrauterine system (IUS), or Mirena coil
For patients who have a womb and are taking or using oestrogen tablets, patches, gel or spray, the Mirena coil, an intrauterine system (IUS), may be a suitable way to deliver the progestogen they need.
The Mirena coil is inserted into the womb and it gradually releases a form of progestogen (levonorgestrel) into the body.
You can find out more information on levonorgestrel on the NICE website.
3.2. Gina 10 microgram vaginal tablets
Pharmacists in the UK can now dispense the HRT drug Gina 10 microgram vaginal tablets without a prescription.
Gina 10 microgram vaginal tablets are a locally acting oestrogen HRT and the only treatment available without a prescription. It has been clinically proven to target and treat the cause of vaginal atrophy and its associated symptoms after the menopause.
Gina 10 microgram vaginal tablets are a proprietary equivalent of Estradiol 10 microgram pessaries. The NHSBSA does not collect information about medicines that are sold over the counter. These statistics therefore may not be representative of the whole population taking HRT.
3.3. Exemption categories
Exemption category data for most exemptions is not included in these statistics due to a number of known data quality issues. Exemption category data is released alongside this publication to complement the HRT statistics, but is management information only. Users should exercise caution when using the exemption category data provided alongside these statistics.
It is possible for a patient to have multiple valid exemptions, including holding multiple exemption certificates. However, within NHS prescription data processed by the NHSBSA, only a single exemption category is identified against any individual form/item.
In a large number of cases the NHSBSA does not record a specific exemption category. A common reason for our records stating ‘No Declaration/Declaration Not Specific’ is the increasing use of the Real Time Exemption Checking service (RTEC). This service confirms to the dispenser that a person was exempt from the charge, but no record of the reason found by RTEC is passed on to NHSBSA prescription processing systems.
For paper prescriptions, the mark(s) on the rear of the form intended to indicate one, or more, exemption reason(s) is not clear and can be misinterpreted by the NHSBSA scanners.
NHSBSA performs no validation or verification of which exemption category has been marked or recorded during scanning.
The reported exemption category will represent the data as submitted by dispensing accounts and processed by NHSBSA to inform reimbursement.
3.3.1 Charge status
The charge status categories included in this narrative are:
- age exempt
- used HRT PPC
- other exemptions
- charged
NHS prescriptions are free to all patients aged under 16 or 60 or over. Although these may be claimed as separate exemption categories, they have been combined for reporting purposes within this article. Patients aged under 16 or over 59 do not need to provide proof of age when claiming prescriptions under the age exemption if their date of birth is printed electronically on the prescription. Students aged 16-18 in full time education are also eligible for free prescriptions but must provide proof, and have been included in the ‘other exemptions’ charge status category instead.
An HRT PPC can be purchased by patients to cover all their NHS prescriptions for applicable medicines licensed to treat menopause in the UK. The HRT PPC was introduced in April 2023. Certificates are valid for a period of 12-months and are purchased via a single up-front payment. Although this category is separate to ‘Charge Paid’, it should be noted that patients with these certificates are not receiving NHS prescribing free of charge. Instead, patients pay for a certificate to help with health costs rather than paying for prescriptions at the point of dispensing.
All other prescription charge exemptions, once age-related exemptions and HRT PPC have been removed, have been combined as a single other exemptions reporting group. This group includes prescriptions claimed using a regular PPC, where the patient buys a 3 or 12-month certificate to cover all their NHS prescriptions.
Patients without any valid payment exemption will pay a prescription charge for each prescription item they receive. This prescription charge is paid at the point of dispensing. The charged category covers items which were paid for at the point of dispensing and will not include items for patients who have purchased a PPC or HRT PPC.
4. About these statistics
These statistics are an official statistics in development publication by the NHSBSA. To learn more about how this publication compares to our other publications, you can view the Official Statistics guidance table on our statistical collections page.
Further information on the methodology used in this publication and further background information is available in our Background Information and Methodology supporting document.
4.1. Changes to these statistics
We have made the following changes to the methodology used in these statistics. A full time series has been rerun using the latest methodology, to allow comparisons over time. You should always use the latest release of our publications.
HRT PPC drug list
This release includes all drugs that are covered by the HRT PPC, introduced in April 2023. The HRT PPC provides exemption from prescription charges for drugs licensed to treat menopause in the UK.
The list of drugs is subject to change and the following changes have happened since the previous release of this publication:
- Angeliq - Estradiol 1mg / Drospirenone 2mg tablets were added to the list from February 2026
- Estradot Conti 40/130 transdermal patches were added to the list from November 2025
- Estradot Conti 30/95 transdermal patches were added to the list from November 2025
- Nalvee - Dydrogesterone 10mg tablets were added to the list from September 2025
- Ovesse 1mg/g vaginal cream with applicator was added to the list from October 2025
As a result of these changes, some data for historical years may have changed from the previous release in this publication series. The drugs added to the HRT PPC drug list are included for all years in the supporting summary tables, even for years before their inclusion on the list. This is to allow users to make comparisons over time.
ICB structure
The ICB structure used for this publication has been updated to the ICB structure introduced in April 2026.
Index of Multiple Deprivation
The IMD quintiles used in this release have been taken from English Indices of Deprivation 2025. Previous releases used IMD quintiles from the 2019 English Indices of Deprivation.
4.2. Patient counts
The patient counts shown in these statistics should only be analysed at the level at which they are presented. Adding together any patient counts is likely to result in an overestimate of the number of patients. A patient will be included, or counted, in each category or time period in which they received relevant prescriptions.
For example, if a patient received a prescription item for HRT in January 2026, and another in February 2026, then adding together those totals would count that patient twice. For the same reason, data on patient counts for different BNF levels, such as chemical substance or presentation, should not be added together.
4.3. Patient age
The age of patients used in these statistics is derived from data provided by the NHS Personal Demographics Service (PDS) for NHS numbers that have been successfully verified by them. A patient’s age, used to assign them to an age group, has been calculated on 30 September for the given financial year. It is possible that a patient’s PDS information may change over the course of the year. In these cases patients may be subject to multiple counting in these analyses.
4.4. Averages
Where this document refers to ‘average’, this is the mean unless otherwise stated. This is calculated by adding the number of items/patients/months together and dividing this by the number of items/patients/months.
4.5. Index of deprivation
The English Indices of Deprivation 2025 have been used to provide a measure of patient deprivation. The English Indices of Deprivation are an official national measure of deprivation that follows an established methodological framework to capture a wide range of individuals’ living conditions.
The reported Index of Multiple Deprivation (IMD) quintile, where 1 is the most deprived and 5 the least deprived, is derived from the lower-layer super output areas (LSOA) of the registered address of the patient who received the medication. The LSOA is taken from mapping the postcode to the National Statistics Postcode Lookup (NSPL) August 2026 version. If patient postcode is unknown but the practice postcode is known, this is used for mapping instead.
The IMD quintile has been recorded as ‘Unknown’ where the items are attributed to an unidentified patient, or where we have been unable to match the patient or practice postcode to a postcode in the NSPL.
IMD quintiles are calculated by ranking the 2021 census LSOAs from most deprived to least deprived and dividing them into 5 equal groups. These range from the most deprived 20% (quintile 1) of small areas nationally to the least deprived 20% (quintile 5) of small areas nationally. We have aggregated these into quintiles for use alongside the NHS Core20PLUS5 approach.
5. Accessibility
If you need information on this website in a different format such as accessible PDF, large print, easy read, audio recording or braille, you can contact us by:
Email: accessibility@nhsbsa.nhs.uk
Phone: 0191 203 5318
We’ll consider your request and get back to you in 5 working days.
These contact details are only for accessibility queries. This inbox is not for technical queries or IT problems. If you have a query that is not about accessibility, go to the ‘Contact us’ section of this page.
View our Accessibility statement for Official Statistics Narratives.
6. Feedback and contact us
Feedback is important to us; we welcome any questions and comments relating to these statistics.
You can complete a short survey about this publication to help us improve the Official Statistics that we produce. All responses will remain anonymous and individuals will not be identifiable in any report that we produce.
You can view our privacy policy on our website to see how your data is used and stored.
You can contact us by:
Email: statistics@nhsbsa.nhs.uk
You can also write to us at:
NHSBSA - Statistics
NHS Business Services Authority
Stella House
Goldcrest Way
Newburn Riverside
Newcastle upon Tyne
NE15 8NY
Responsible statistician: Grace Libby