Why are patients embracing HRT but not hormonal contraception?

It has been said repeatedly in the media recently that menopause is having a moment. Public awareness has never been greater, conversations are becoming more open and the use of hormone replacement therapy (HRT) continues to rise. At the same time, a different trend is emerging among women in their reproductive years: increasing reluctance to use hormonal contraception.

‘Hormone hesitancy’ describes the fear or reluctance to use hormonal medicines despite robust, scientific evidence supporting their safety and effectiveness. While hormone hesitancy could apply to many treatments, it appears to be disproportionately affecting contraceptive hormones, with seemingly little effect on HRT. This paradox raises questions about how women perceive hormones, and how healthcare professionals communicate their benefits and risks.

Prescribing rates

In the UK, HRT prescribing has increased dramatically over recent years, reflecting improved awareness of menopause and greater recognition of the benefits of treatment. Data published by the NHS Business Services Authority (NHSBSA) in October 2025 revealed that 14.7 million HRT items were prescribed to an estimated 2.8 million patients during 2024/2025^​1​. The data also show that HRT prescriptions increased by 11% since 2023/2024, while the number of patients increased by 6.4%^​1​.

By contrast, prescriptions for hormonal contraception — particularly combined oral contraceptives and long-acting reversible contraception (LARC) — have declined. A 2025 report from the Office for Health Improvement and Disparities showed that the overall rate of prescribing for LARCs in 2023 decreased to a rate of 43.5 per 1,000 population, compared with 44.1 per 1,000 in 2022, and remains below pre-pandemic levels. Although the prescribing rate in sexual health services for short-acting contraceptives increased from 8.1 to 9.1 per 1,000, there has been a larger decrease in the prescribing rate for short-acting contraceptives in primary care, from 116.9 per 1,000 in 2022 to 106.7 per 1,000 in 2023. Overall — and given that LARCs last for several years — this may indicate a continued shift in prescribing in favour of LARCs.

Many factors contribute to changing reproductive trends, and a declining uptake of effective contraception is concerning. Decreased LARC and short-acting combined oral contraception prescription rates have been linked to a rise in abortions and unintended pregnancy^​2–4​.

Differing perceptions

One explanation for why women are reacting differently to hormones lies in how women perceive these treatments. HRT is commonly understood to be replacing hormones that are naturally lost during menopause. Increasingly, body identical hormones are being used, reinforcing the perception that HRT restores the body’s normal physiology. The benefits are often immediate and tangible: vasomotor symptoms improve, sleep returns, mood stabilises and quality of life is restored.

Hormonal contraception is perceived differently. Rather than replacing hormones, contraceptive hormones prevent ovulation or alter the reproductive environment to prevent pregnancy. For many women, this is understood as adding synthetic hormones to an otherwise healthy body. The benefit is preventative — avoiding an unintended pregnancy that may never occur, while potential side effects are experienced in the present. It is therefore unsurprising that many women weigh up the risks and benefits differently.

Acceptance of HRT

The current acceptance of HRT did not happen overnight. Following publication of the Women’s Health Initiative study in 2002, HRT prescribing fell dramatically amid widespread fears about breast cancer and cardiovascular disease^​5​. Over the subsequent two decades, re-analysis of the evidence improved understanding of menopausal health and updated national guidance, while advocacy from clinicians and patient groups have transformed public perception. Menopause has become a national priority, which has been reflected in the ‘Renewed women’s health strategy for England‘, published in April 2026, annual HRT prescription prepayment certificates, improved access to specialist menopause services and greater inclusion of menopause in routine healthcare discussions.

Celebrity advocacy has played an influential role. High-profile figures — including Davina McCall, Halle Berry and many others — have openly shared their experiences, helping to normalise conversations around menopause and encouraging women to seek help^​6,7​. HRT is now recognised as neither a panacea nor a treatment suitable for everyone, but when appropriately prescribed and individualised, it can be life changing.

Concerns around hormonal contraception

Hormonal contraception has not experienced the same cultural shift. Despite being one of the greatest public health advances of the 20th century, more women express concerns about hormonal methods. This is particularly worrying, given that hormonal contraception provides benefits far beyond pregnancy prevention.

Combined oral contraceptives and progestogen-only methods are used to treat heavy menstrual bleeding, dysmenorrhoea, endometriosis, premenstrual syndrome, premenstrual dysphoric disorder, acne and polyendocrine metabolic ovarian syndrome. The levonorgestrel-releasing intrauterine system has transformed the management of heavy menstrual bleeding and endometrial hyperplasia, dramatically reducing the need for hysterectomy and surgery^​8​. Yet hormone hesitancy increasingly influences women’s willingness to use these treatments, even when prescribed primarily for medical indications.

Evidence suggests that expectations may influence women’s experiences of medications, including hormonal contraception. The results of a 2025 UK study, which explored medicine-related beliefs among oral contraceptive users, revealed that women with greater concerns about medicines, higher perceived sensitivity to medication and stronger expectations of adverse effects reported more symptoms as side effects attributed to oral contraceptives^​9​. This highlights the potential contribution of the ‘nocebo effect’, whereby negative expectations increase the likelihood of experiencing symptoms. While hormonal contraceptives, like all medicines, have recognised adverse effects, understanding the influence of expectations may help to explain why some women discontinue treatment despite the absence of clinically significant side effects.

Online influence

At the same time, contraceptive care is increasingly moving online. Digital platforms have undoubtedly improved convenience and access, but they often replace nuanced, person-centred consultations with transactional questionnaires. While women should remain central to contraceptive decision-making, reduced interaction with healthcare professionals may inadvertently reinforce reliance on social media and other unregulated sources of information.

Social media has undoubtedly contributed to this changing landscape. While it has played an important role in raising awareness of menopause, it has become a major source of misinformation about contraception. Personal experiences, often emotionally compelling but scientifically unverified, are frequently presented alongside evidence-based information, making it difficult for women to distinguish anecdote from fact^​10​.

How pharmacists can change the narrative

Healthcare professionals have a crucial role in addressing hormone hesitancy. The UK has excellent evidence-based resources, including guidelines from the College of Sexual and Reproductive Healthcare and the UK Medical Eligibility Criteria for Contraceptive Use, to support informed contraceptive counselling. In addition, GPs, nurses, and sexual and reproductive health clinicians receive training in contraceptive care. More recently, pharmacists have joined this workforce through the NHS Pharmacy Contraception Service.

Pharmacists are well placed to help bridge the gap between evidence and public perception. As probably the most accessible healthcare professionals, they can explore women’s concerns in a familiar, non-judgemental environment, correct misconceptions, explain differences between hormonal therapies and support truly shared decision-making.

Community pharmacies offer longer opening hours, including over the weekends, convenient access and reduced stigma. This makes them an ideal setting for conversations about contraception. Pharmacists are trusted professionals in the community, often seeing some women regularly, and play an important role in translating complex evidence into meaningful, balanced information. Explaining the differences between hormonal therapies, including dose, route of administration and mechanism of action, can help women appreciate that not all hormonal medicines carry the same benefits or risks.

As pharmacists take on an increasingly important role in initiating and supplying contraception, they can counter misinformation before it becomes a barrier to effective care. The success of a 2025 LARC pilot in Liverpool validates the role of pharmacists in providing contraception to women^​11​.

The menopause movement has demonstrated that attitudes towards hormones can change through education, advocacy and trusted communication. Perhaps it is time to apply the same principles to contraception. Hormone hesitancy should not be dismissed or criticised — rather, it should prompt meaningful conversations that enable women to make informed choices based on evidence rather than fear.

If we can achieve for contraception what has been achieved for menopause, we may not only improve contraceptive uptake but also ensure that women continue to benefit from the many therapeutic advantages that hormonal treatments offer throughout their reproductive lives.