Double the number of women suffering with the menopause should get HRT than at present, the health watchdog says.
NHS advisory body NICE says one in four women with severe symptoms would benefit from hormone replacement therapy.
And they say up to eight in ten should consider it. But experts say only around one in ten currently receive it.
Officials say more than a million women stand to gain from the new advice — the first on the treatment from NICE.
The watchdog’s Christine Carson said: "Women don’t always get the help they need from their GP, practice nurse or hospital specialist to manage their symptoms but this guideline recommends effective treatments which can help."
Experts say for "most women" HRT is an effective treatment for menopausal symptoms, including low moods and hot flushes.
The British Menopause Society estimates around 200,000 women currently have HRT for menopause.
NICE said there had been a fall in uptake over the past decade, blamed on cancer scares and reluctant doctors. But GPs should look again at the treatment and prescribe with confidence after discussing the risks and benefits with patients.
HRT does increase the risk of some cancers and stroke but a US study last month suggested this had been overstated.
Consultant gynaecologist Mary Ann Lumsden said: "For most women, HRT is a very effective treatment."
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