How to Start HRT in Spain: Getting Your First Prescription
HRT is prescription-only in Spain. Any licensed doctor can prescribe it. Our doctors consult by video in English and email prescriptions if appropriate.
Dr. Daniel Cuenca Leal
Colegiado nº 284627651 · Ilustre Colegio Oficial de Médicos de Madrid
How Can You Start HRT in Spain?
Quick answer: HRT is prescription-only in Spain: in the Spanish medicines agency's CIMA database, every HRT product on sale is a 'Medicamento Sujeto A Prescripción Médica', a prescription-only medicine. Spanish law lets any licensed doctor (médico) prescribe prescription-only medicines, and it requires no particular specialty. You can consult a licensed doctor online who evaluates your symptoms and medical history, issuing a private electronic prescription as a PDF by email when medically appropriate.
You can start HRT with an online consultation through UrgentDoc by booking a video appointment with one of our licensed doctors at a time that suits you. Doctors send offers, and the consultation fee is shown on the doctor's offer before you pay. During the video visit, the doctor reviews your symptoms and takes a complete personal and family medical history. If the doctor decides HRT is appropriate, you receive a private electronic prescription as a PDF by email, issued through a private e-prescription platform such as REMPe. Show the PDF at a pharmacy; the pharmacist checks it before dispensing it, and the medicine is paid for directly at the pharmacy.
Medical disclaimer: This article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions regarding a medical condition or treatment plan.
| Route | Wait | What you pay | Language | Prescription |
|---|---|---|---|---|
| Public health system (SNS) | Varies | Public-system terms | Varies | Public (SNS) prescription |
| Private clinic | Varies | Clinic fee | Varies | Private prescription |
| UrgentDoc video consultation | You choose a time from doctors' offers | Fee shown on the doctor's offer before you pay; medicine paid at the pharmacy | English | Private electronic prescription (PDF by email) if the doctor decides it is appropriate |
Do You Need a Prescription for HRT in Spain?
Yes, you need a prescription. HRT is prescription-only in Spain: in the Spanish medicines agency's CIMA database, every HRT product on sale is a 'Medicamento Sujeto A Prescripción Médica', a prescription-only medicine, as listed in the AEMPS CIMA database. It cannot be purchased over the counter.
Under Real Decreto Legislativo 1/2015 Art. 79.1, Spanish law lets any licensed doctor (médico) prescribe prescription-only medicines, and it requires no particular specialty. This means any registered medical doctor can assess your need for hormone replacement therapy and write a legal prescription.
Prescriptions in Spain are governed by national regulations. According to Real Decreto 1718/2010, a Spanish prescription is legally valid throughout Spain. The pharmacist checks it and will not dispense it if there are reasonable doubts about its authenticity or validity.
If you use the public healthcare system, Real Decreto 1030/2006 establishes that in Spain's public health system, menopause care is one of the primary-care services. On the private route you pay two things: the consultation fee, shown on the doctor's offer before you pay, and the pharmacy's price for the medicine. If you already take treatment and simply need to continue an existing HRT prescription in Spain, our doctors can review your current regimen.
HRT for Perimenopause and Menopause: When to Begin HRT?
Women often wonder about the right time to start hormone replacement therapy. According to the Asociación Española para el Estudio de la Menopausia (AEEM), the average age of menopause in Spain is around 51 to 52, with the transition between 45 and 55 considered normal. AEEM notes that perimenopause typically lasts four to eight years, starting when cycles become irregular and ending twelve months after the final menstrual period. Menopause itself can only be confirmed in retrospect, once twelve consecutive months have passed without a period.
AEEM describes menopausal hormone therapy as the most effective treatment for hot flushes and night sweats. According to Spanish product information for an HRT gel, Spanish product information says HRT for menopause symptoms should only be started when the symptoms negatively affect your quality of life, and that the benefits and risks should be weighed carefully at least once a year.
Timing is an important consideration when deciding when to begin HRT. According to AEEM, for healthy women who start HRT before 60 or within ten years of their last period, the balance of benefits and risks is favourable.
Hormone replacement therapy is not an all-or-nothing choice. According to AEEM, vaginal dryness, burning, pain during sex and urinary discomfort have their own local treatment at very low doses. If you are experiencing changes but are unsure whether systemic therapy is right for you, you can book an online menopause consultation to review your symptoms and explore your clinical options.
Do I Need a Blood Test Before Starting HRT?
Many patients assume that starting hormone replacement therapy requires extensive blood work. However, this is usually unnecessary for women of typical menopause age.
If you are 45 or over, otherwise healthy and have menopause symptoms, NICE guideline NG23, from the UK's guideline body, says perimenopause and menopause are identified from your symptoms and your periods, without laboratory tests. Under the NICE recommendations:
- Perimenopause is identified if you have vasomotor symptoms (such as hot flushes or night sweats) that have recently started along with changes in your menstrual cycle.
- Menopause is identified after 12 months without a period for someone not using hormonal contraception, or based on symptoms alone if you have had a hysterectomy.
Blood testing can even be misleading during the perimenopause transition. AEEM, Spain's menopause society, says hormone levels fluctuate unpredictably in perimenopause, so a normal blood test does not rule it out. NICE notes that follicle-stimulating hormone (FSH) blood tests should only be considered to confirm menopause in people aged 40 to 45 with symptoms, or in individuals under 40 where premature menopause is suspected.
It is also vital to keep in mind that HRT is not a contraceptive. As AEEM notes, pregnancy is still possible during perimenopause, so you still need contraception - ask the doctor when you can stop.
What Is the Best Hormone Replacement Therapy?
Patients frequently search for what is the best hormone replacement therapy, but medical guidelines emphasize that treatment must be personalized.
The structure of your therapy depends primarily on your surgical history:
- If you have a uterus: NICE recommends combined HRT, estrogen with a progestogen, for people who still have a uterus. AEEM says that if you still have your uterus, a progestogen is always added to protect the lining of the womb.
- If you have had a hysterectomy: NICE recommends estrogen-only HRT for people who have had a total hysterectomy.
The method of administration also matters. HRT can be taken by mouth (oral tablets) or through the skin (transdermal preparations like patches, gels, or sprays). According to both AEEM and NICE guidelines:
- Estrogen through the skin, as a patch or gel, does not increase the risk of blood clots, unlike estrogen taken by mouth.
- NICE notes that blood clot risk is increased with oral HRT, and recommends considering transdermal rather than oral HRT for individuals at increased risk of blood clots, including those with a body mass index (BMI) over 30 kg/m².
- NICE also notes that stroke risk is unlikely to increase with transdermal HRT, whereas stroke risk increases with oral HRT containing estrogen.
Regarding dosing, NICE says the lowest effective dose should be used. The prescribing doctor evaluates your health background to select the appropriate combination, route, and dose for your circumstances.
Can I Start HRT at 60 or Post-Menopausal?
If you are post-menopausal or considering therapy later in life, your doctor will evaluate your individual cardiovascular and general health profile.
According to AEEM, for healthy women who start HRT before 60 or within ten years of their last period, the balance of benefits and risks is favourable.
Starting therapy later involves specific considerations regarding the route of delivery. NICE says the increase in stroke risk with HRT taken by mouth is greater the older you are when you first start it - for estrogen-only HRT, if you start after 60 - while stroke risk is unlikely to increase with HRT through the skin.
The doctor weighs your age and the time since your last period together with your medical history. Through an online consultation, our doctors review your cardiovascular health, the time elapsed since your last menstrual period, and your primary symptoms before determining whether initiating therapy is safe and appropriate.
What to Expect in an Online HRT Consultation and What to Prepare
Before issuing an online prescription, a doctor must carry out a careful clinical review. Before starting HRT, Spanish product information requires a full personal and family medical history, and says the physical examination, including of the breasts and pelvis, should take account of that history and of the contraindications and warnings, as detailed in Spanish product information for an HRT gel. Our doctors take that history during the video consultation and, if you need an in-person examination first, refer you for one.
To help your online HRT consultation run smoothly, have the following medical information and documentation ready:
| Information / Item | Why the doctor asks |
|---|---|
| Passport, DNI, or NIE number | Required under Real Decreto 1718/2010 Art. 3.2 to issue a legally valid private medical prescription in Spain. |
| Date of last period & surgical history | Identifies whether you have a uterus (requiring combined HRT with a progestogen) or have had a total hysterectomy (requiring estrogen-only HRT). |
| Recent blood pressure and weight | Assesses cardiovascular baseline and helps determine the safest route (such as transdermal options if BMI is over 30 kg/m²). |
| Current medications and allergies | Checks for drug interactions and ensures contraindications are identified before prescribing. |
| Personal & family medical history | Screens for contraindications outlined in Spanish product information, such as clotting issues, arterial disease, or liver conditions. |
| Breast and cervical screening history | Ensures routine health screenings are up to date and identifies any warning signs requiring in-person assessment. |
A prescription is never guaranteed: it is always the doctor's clinical decision based on your health background and symptoms. If approved, you receive an official private electronic prescription PDF via email.
After Starting HRT: Reviews and Common Side Effects
Starting hormone therapy requires scheduled follow-up to ensure that the regimen is effective and well-tolerated.
NICE recommends reviewing HRT 3 months after you start, to check how well it works and how you tolerate it, and then once a year. Furthermore, Spanish product information emphasizes that the benefits and risks should be weighed carefully at least once a year, and treatment maintained only as long as benefits outweigh risks.
| Timeline | What to expect and clinical review schedule |
|---|---|
| First 6 Months | If you have a uterus, vaginal bleeding is a common side effect in the first 6 months of HRT. |
| At 3 Months | A routine medical review is conducted to assess treatment efficacy and tolerability, and to check on any early bleeding patterns. |
| Annually (Yearly) | An annual evaluation to reassess the balance of benefits and risks, review side effects, and verify that the lowest effective dose is maintained. |
If you have a uterus, vaginal bleeding is a common side effect in the first 6 months of taking systemic HRT or within 3 months of changing the dose or preparation. NICE advises seeking medical help promptly for unscheduled bleeding beyond these timeframes.
Red Flags: When to Seek Urgent In-Person Care
Telemedicine has strict clinical boundaries. Some symptoms and medical histories make online HRT prescribing unsafe and require in-person examination, specialist care, or emergency services.
When to Call 112 Immediately
According to the Spanish patient leaflet for an HRT gel, you must be aware of the possible signs of a blood clot. Call 112 straight away if you experience:
- Pain and swelling in a leg
- A sudden cough
- Severe chest pain (sometimes also in the arm)
- Difficulty breathing
- A severe, unusual headache
- Loss of vision or double vision
- Difficulty speaking clearly
- Dizziness
- Seizures
- Weakness or numbness affecting a part of the body
- Difficulty walking or holding things
When to Stop Treatment and See a Doctor Immediately
The Spanish patient leaflet also instructs that you must stop using HRT and see a doctor immediately if you notice:
- Yellowing of the skin or the whites of the eyes (which may indicate liver problems)
- Swelling of the face, tongue, or throat with difficulty swallowing, or hives, together with difficulty breathing (call 112 if you experience difficulty breathing)
- A large rise in blood pressure (which may present as headache, tiredness, or dizziness)
- A migraine-type headache occurring for the first time
- Pregnancy
Breast and Bleeding Red Flags
Certain changes cannot be evaluated remotely and require immediate in-person clinical assessment:
- Breast changes: A new breast lump or any other change in your breasts needs an in-person examination, which a video call cannot do.
- Undiagnosed bleeding: Vaginal bleeding that has not been diagnosed is one of the reasons HRT may not be suitable, so it must be checked in person first.
- Prolonged or late bleeding on HRT: As outlined in both the Spanish patient leaflet and NICE guidelines, see a doctor in person as soon as possible if unexpected bleeding or spotting lasts beyond the first 6 months, starts after more than 6 months of use, or continues after stopping.
Clinical Referrals and Exclusions for Online Prescribing
AEEM, Spain's menopause society, says menopause before 40 needs a medical assessment. Our doctors refer women under 40 to specialist care rather than prescribing HRT online.
Additionally, our doctors do not prescribe HRT online, and refer instead, for:
- Current or past breast cancer, or another estrogen-dependent cancer
- Unexplained or undiagnosed vaginal bleeding
- A past blood clot or a known clotting disorder
- A history of stroke, heart attack, or angina
- Active liver disease (or past liver disease while liver function tests remain abnormal)
Frequently Asked Questions About Starting HRT in Spain
Can I start HRT in Spain without seeing a gynaecologist?
Yes. Spanish law lets any licensed doctor (médico) prescribe prescription-only medicines, and it requires no particular specialty under Real Decreto Legislativo 1/2015. Our licensed doctors can evaluate your medical history and symptoms via video consultation and issue a private electronic prescription if they determine it is clinically appropriate. If your medical history indicates a need for an in-person pelvic exam or specialist care, the doctor will refer you accordingly.
Do I need a blood test before starting HRT?
If you are 45 or over, otherwise healthy and have menopause symptoms, NICE, the UK's guideline body, says perimenopause and menopause are identified from your symptoms and your periods, without laboratory tests. Furthermore, AEEM, Spain's menopause society, says hormone levels fluctuate unpredictably in perimenopause, so a normal blood test does not rule it out. Laboratory tests like FSH are generally reserved for women under 45 experiencing early symptoms.
Can I start HRT at 60?
According to AEEM, for healthy women who start HRT before 60 or within ten years of their last period, the balance of benefits and risks is favourable. NICE notes that the increase in stroke risk with HRT taken by mouth is greater the older you are when you first start it - for estrogen-only HRT, if you start after 60 - while stroke risk is unlikely to increase with HRT through the skin. The doctor weighs your age and the time since your last period together with your medical history to decide whether initiating treatment is appropriate.
What is the best HRT after a hysterectomy?
NICE recommends estrogen-only HRT for people who have had a total hysterectomy, whereas combined HRT (estrogen with a progestogen) is recommended for people with a uterus to protect the womb lining. The doctor decides the type, dose, and form based on your specific medical background, using the lowest effective dose. There is no single "best" brand or formulation for every patient.
Is bleeding normal when you start HRT?
If you have a uterus, vaginal bleeding is a common side effect in the first 6 months of HRT; NICE advises seeking medical help promptly for unscheduled bleeding after that. If bleeding or spotting persists beyond 6 months, begins after you have been taking HRT for more than 6 months, or continues after stopping treatment, you must consult a doctor in person as soon as possible.
Do I need a prescription for HRT patches in Spain?
Yes. HRT is prescription-only in Spain: in the Spanish medicines agency's CIMA database, every HRT product on sale is a 'Medicamento Sujeto A Prescripción Médica', a prescription-only medicine. This applies to all forms, including transdermal patches, gels, sprays, and oral tablets. A licensed medical doctor must issue a prescription before a pharmacy can dispense it.
Is HRT a contraceptive?
HRT is not a contraceptive. Spanish product information confirms that it does not restore fertility, and AEEM notes that pregnancy is still possible during perimenopause. You still need contraception during this transition - ask the doctor when you can stop.
To discuss your symptoms and explore your treatment options in English with a licensed doctor, book an online medical consultation for HRT in Spain.
