Hormone replacement therapy

Hormone replacement therapy or HRT for short is a well known form of treatment for the symptoms of the menopause. This treatment deals with both the physical and emotional signs of the menopause.

But what is HRT? Is it safe? Can anyone take HRT?

These are the most commonly asked questions about HRT which over the years has attracted a degree of controversy. It is effective at dealing with the symptoms of the menopause but, it is not without its risks.

This section of the guide looks at HRT in more detail and is structured as follows:

Each of these subsections is discussed individually within this section of the guide.

But before you look at these, find out more about what HRT is, the different types of HRT and how it works.

What is HRT?

This is a treatment which is designed to replace the female hormones oestrogen and progesterone which are lost as a result of the menopause. These hormones start to decrease in the years preceding, during and after the menopause which causes the symptoms you are currently experiencing.

These include night sweats, hot flushes, vaginal dryness, mood swings and loss of libido (drop in sex drive).

Every woman experiences the menopause. It is a natural stage in life in which your hormones fall and your ovaries gradually stop producing an egg every month.

Your fertility levels are also dropping.

Menstruation ceases and so does your ability to become pregnant.

Different types of HRT

There are more than 60 different forms of HRT but there are three main versions which are:

Oestrogen only HRT
Combined-continuous HRT
Cyclical HRT

There is another version called progesterone only HRT. This is available in synthetic form known as progestin or progestogen. This is only used by a small minority of women who take this to replace the loss in progesterone during the menopause.

Progesterone only HRT

This form of treatment is utilised in the same manner as oestrogen only HRT and the combined oestrogen-progesterone HRT.

It is chosen by women who for a variety of reasons, do not want the oestrogen only HRT. But the problem with this is that they are only receiving half the benefits.

They will receive the benefits of restored progesterone levels but, not oestrogen which means that they are missing out on a range of benefits which include protection against osteoporosis and improved mental wellbeing.

There are risks as well as benefits from taking progesterone only HRT which are discussed further in our risks of hormone replacement therapy section.

Oestrogen only HRT

This is as the name says. It is a form of HRT which replaces a loss of oestrogen as a result of the menopause.

It is ideal for women who have undergone a hysterectomy as it means that they do not have to take a progesterone replacement as well. This is due to the fact that they no longer have a uterus (womb) which means that they are no longer at risk of cancer within this part of the body.

Combined-continuous HRT

This form of HRT is a combination of oestrogen and progesterone replacement hormones which works best for women in the postmenopausal stage.

Cyclical HRT

This is a form of HRT which is administered in two types of cycles:

Monthly HRT
Three monthly HRT

It is more effective in women who are in the early stages of the menopause.

Monthly HRT

This involves taking HRT each day for a month. You take progestin as well but not until the end of your menstrual cycle.

Progestin is taken for 14 days only.

Monthly HRT works best for women who have a regular menstrual cycle but are experiencing many of the symptoms of the menopause.

Three monthly HRT

This involves taking oestrogen for 3 weeks on a daily basis. You also take progestin for 14 days and do this every 13 weeks.

Three monthly HRT is a good choice for women who have irregular periods, e.g. they have their menstrual period every 3 months.

How does HRT work?

What HRT does is to restore your levels of oestrogen and progesterone so that your body functions in the same way as it did previously.

The oestrogen used in HRT is not as strong as that found in contraception, e.g. birth control pills.

It is a good idea to start off with a low dosage HRT as this will keep the side effects to a minimum. You then have the option of increasing this dose at a later date but see how your body reacts to the initial low dose before you do.

If the initial dose does not appear to be working or you are having problems with it then speak to your GP. He or she can adjust your dose if need be or recommend an alternative form of HRT.

Who is suitable for HRT?

Your GP will decide if you are suitable for HRT. If so then you will be prescribed this treatment which can be done without a test to confirm if you are going through the menopause.

HRT is not recommended in the following situations:

Pregnancy
Liver disease
History of blood clots or clotting disorders
History of breast and/or ovarian cancer
History of heart disease and/or strokes
Uncontrolled high blood pressure

HRT works in different ways for every woman so the results you get will not necessarily be the same as for another woman. Every woman is different and because of this, is difficult to predict how your body will react.

How to take HRT

HRT is taken in any number of ways which include:

Patch: this is stuck onto your skin
Implant: tiny pellets of this are inserted under the skin of your stomach, thighs or buttocks.
Cream: this is applied inside the vagina or on the skin
Gel: same as above
Tablets: placed inside the vagina or taken orally (by mouth)

You will have noticed that there are several options which can be inserted directly into the vagina. These are taken by women who are suffering from vaginal dryness.

The others, such as implants or a patch works best for women who are experiencing symptoms such as hot flushes or night sweats.

How long should you take HRT for?

Your GP will advise you as to the length of time you should take your form of HRT. This is usually from 2 to 5 years.

When you come to the end of your HRT reduce the dosage slowly rather than suddenly stopping the treatment.

You may experience a mild relapse of the menopause symptoms but these will ease after a short period of time.