Hormone Replacement Therapy (HRT)

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Hormone Replacement Therapy (HRT) is used to relieve the symptoms of the menopause. We offer tablets and patches to women who have previously been prescribed HRT. HRT requires temporarily introducing oestrogen and progesterone back into

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Treatments

About

What is hormone replacement therapy (HRT)?

Hormone replacement therapy (HRT) is a type of hormonal treatment used to relieve the symptom of menopause in women. It is also used to prevent osteoporosis (weakening of the bones) in postmenopausal women. During menopause, the level of oestrogen produced by the ovaries declines, leading to symptoms such as hot flushes and night sweats, irregular periods, mood swings and vaginal dryness.

How does HRT work?

HRT works by subsidising the body’s natural hormones, relieving symptoms and, in some cases, preventing the onset of osteoporosis. Oestrogen-only HRTs are suitable for women who have had a hysterectomy or who have an intrauterine device (IUD) fitted. Women who have not had a hysterectomy, or who do not have an IUD fitted, will need to take a combined form of HRT containing progesterone, which counters the thickening effect of oestrogen on the womb lining. 

When should you start HRT?

The onset of menopause usually occurs between the ages of 45 and 55, but can occur anywhere between the ages of 30 and 60. It is recommended to receive a full evaluations of you hormonal health in the early stages of menopause, at whatever age that might be. Women who are under the age of 60 and within 10 years of the onset of menopause are likely to experience the full benefits of HRT.

What are the benefits of HRT?

HRT is considered the most effective treatment for managing the symptoms of menopause, which can greatly impact women’s lives. By supplementing the body’s natural hormones, HRT can relieve symptoms such as night sweats and hot flushes, mood swings, irregular periods and vaginal dryness. It is also an effective treatment for delaying the onset of osteoporosis, and many women continue to use HRT for many years with successful results.

Treatment

What are the different types of HRT?

There are several different types of HRT which are better suited to different women. Women who have had a hysterectomy, or who have an IUD fitted, can safely use an oestrogen-only form of HRT without worrying about the risk of developing endometrial cancer, endometrial hyperplasia or endometriosis. Oestrogen-only form so of HRT can be taken orally (Elleste Solo, Premarin) or applied to the skin as transdermal patches (Elleste Solo MX80, Elleste Solo MX40, Evorel). Women who are experiencing menopausal symptoms but still experience regular periods (or have experienced a natural period within the past 12 months) are recommended to start with a cyclical form of HRT which allows for a regular bleed (Prempak-C, Trisequens, Elleste Duet). Post-menopausal women (women who have not had a natural period for over a year) can use a continuous combined HRT, which involves taking oestrogen and progesterone every day without a break for a bleed (Kliovance, Climesse, Elleste Duet Conti). 

HRT patches vs pills

Tablets to be taken orally are the most commonly used form of HRT. It is important to be aware that ora HRTs carry a slightly higher risk of blood clots than other forms. Transdermal patches are an alternative for people who struggle to remember to take a tablet each day, or who struggle with side effects of oral medication such as indigestion. Oestrogen gels are another option, as are implants and IUDs. Vaginal oestrogen is available in the form of a cream, pessary or ring, and helps relieve localised symptoms such as vaginal dryness. This form of HRT does not carry any of the risks associated with other forms, but also does not help relieve symptoms such as mood swings and hot flushes.

Alternatives to HRT

HRT is widely considered to be the most effective and popular treatment for the symptoms of menopause, and can be accessed via the NHS or online at Dr Felix. Some women choose to try herbal supplements and remedies for the relief of symptoms such as hot flushes and mood swings, although their effectiveness is unknown. Make sure to speak to a pharmacist for advice about herbal supplements before purchasing them.

Side Effects

What are the side effects of HRT?

Like all treatments, HRT can have side effects. Side effects are usually mild and not everyone will experience them. The main side effects associated with oestrogen and progesterone supplements include:

  • Breast tenderness, swelling of the breast or other parts of the body
  • Bloating
  • Nausea and abdominal pain
  • Back pain
  • Leg cramps
  • Headaches and migraines
  • Indigestion
  • Acne
  • Depression
  • Mood swings
  • Vaginal bleeding

Different types of HRT may be more suitable for different people. If side effects persist and are troubling you, speak to your doctor about trying a different type of HRT.

What are the risks of HRT?

Many women are put off HRT but the potential risks. While it is important to understand what these risks are, it is also important to understand that they are small and generally outweighed by the benefits.

As a hormonal treatment, HRT has been linked to oestrogen-sensitive cancers. Studies suggest that the risk of developing breast cancer while using combined HRT increases from 22 cases in 1 000 to 27 in 1 000. This risk factor decreases once you stop using HRT, and while it is only a small increase, it is important to go for regular breast cancer screening appointments while using HRT. The link between HRT and ovarian cancer is widely debated, with studies suggesting that for every 1 000 women using HRT for five years, there is one extra case of ovarian cancer.

Women who have not had a hysterectomy, or who do not have an IUD to supply them with progesterone, will not be able to use and form of oestrogen-only HRT. This is because the thickening effect of oestrogen on the womb lining can, if left uncontrolled, lead to endometrial cancer, endometrial hyperplasia, or endometriosis. Using a form of HRT that contains both oestrogen and progesterone largely eliminated this risk.

The other risk to be aware of is between HRT and blood clots, which can be serious if lodged in a blood vessel. It is thought that the risk of developing a blood clot is between 2 and 4 times higher for women using HRT, although this is heavily dependent on lifestyle and other risk factors. For every 1 00 women using taking HRT tablets for 7 years, it is estimated that less than 2 will develop a blood clot. HRT patches and gels have no link to an increased risk of blood clots. When started under the age of 60, HRT is not associated with a significant risk of cardiovascular disease, such as heart disease or stroke. 

If you are worried about the potential risks of HRT, speak to your doctor or nurse for more information.   

How does HRT affect your sex life?

Research suggests that HRT can significantly increase interest in sex in postmenopausal women. It often relieves symptoms such as vaginal dryness and clitoral atrophy and has been known to boost libido in postmenopausal women.

Will HRT make you gain weight?

Many women are wary of HRT as they believe it will make them gain weight. However, there is no evidence to support this claim, particularly since women’s bodies react to HRT in different ways. Menopause is often a cause of weight gain, which may or may not affect you regardless of whether you are using HRT. Weight gain with menopause can be managed by exercising regularly, eating healthily, and generally maintaining a healthy lifestyle.

Q&A

Do you get your period when taking HRT?

For women who experience menopausal symptoms, but who have had a natural period in the last 12 months, it is recommended to use a form of cyclical HRT. Monthly HRT causes a synthetic bleed every 4 weeks and is recommended for women experiencing regular periods. Three-monthly HRT is recommended for women experiencing irregular period, allowing for a bleed every three months.

Is HRT safe?

HRT is widely considered to be a safe and effective treatment for the symptoms of menopause. Though risks do exist, and it is important to be aware of them, they are small and generally outweighed by the benefits. While using HRT, it is important to go for regular health check-ups, including breast cancer screening and smear tests. 

Is HRT for menopause the same as HRT for gender transition?

HRT for menopause is not the same as HRT for gender transition. Both are hormonal treatments, but serve different purposes and are not interchangeable. 

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