Hormone Replacement Therapy in Menopause: Is HRT right for you?

Hormone Replacement Therapy in Menopause: Is HRT right for you?

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Hormone Replacement Therapy in Menopause: Is HRT r...

Hormone Replacement Therapy in Menopause: Is HRT right for you?

03/10/2023 / Zoya Ali BSc, MSc

Medically Reviewed by Hertility on July 18, 2024

Hormone replacement therapy (HRT) is a common treatment for easing menopause symptoms, like hot flashes, brain fog, joint pain, low mood and low libido. But how does it work and what are the signs you need hormone replacement therapy? Read on to find out.

Quick facts:

The hormones used in HRT are oestrogen, progesterone and sometimes testosterone.
HRT can be taken in pills, patches, gels, sprays, creams and pessaries.
There are lots of benefits to taking HRT, including easing symptoms and reducing the risk of menopause-associated health risks
There are also several risks with taking HRT, like all treatments
You can speak to one of our Menopause Specialists to discuss whether HRT is right for you.

HRT explained

Hormone Replacement Therapy for menopause is a treatment that uses hormones to relieve the symptoms of menopause and to prevent health problems that can occur after menopause.

The hormones commonly used in HRT are oestrogen, progesterone and sometimes testosterone. It does what it says on the tin—replaces the hormones that are declining in your body during this natural part of ageing, with synthetic or bioidentical hormones. These hormones mimic your natural hormones, relieving symptoms.

HRT can be taken in a variety of ways, including pills, patches, gels, sprays, vaginal cream and pessaries. The best method to take HRT will depend on your individual needs, preferences and medical history.

Do you need HRT?

You can take HRT to relieve menopause symptoms if you’re in perimenopause (the years leading up to menopause before your periods stop) or postmenopause.

Challenging symptoms like brain fog, night sweats, vaginal dryness, reduced sex drive, insomnia and concentration issues can interrupt your daily life. Hormone replacement therapy helps to restore hormonal balance to provide relief.

Whether or not you’ll need HRT will depend on your symptoms and physiology and is always a personal choice. For personalised advice, you can book an appointment with one of our Menopause Specialists.

They can prescribe HRT based on your individual needs and preferences and can offer expert guidance on navigating symptoms and treatment options.

Different types of HRT

There are different types of HRT to choose from. Which type is right for you will depend on:

your medical history
what stage of menopause you’re at
your current hormone levels
your personal preferences.

HRT options can contain different hormones, including oestrogen, progestogen, a combination of both, and sometimes testosterone.

HRT can be taken in different ways tablets, including patches, gels, sprays, implants, coils, or creams. It can also be taken using different regimens, including cyclical or sequential treatments, or continuous treatments.

Tablets

Tablets are one of the most common ways of taking HRT. You usually take them once a day. Tablets are available in both oestrogen-only and as combined HRT.

Although it’s small, the risk of developing blood clots is higher with tablets compared to other HRT methods like patches, gels and sprays.

Skin patches

HRT patches are available in both oestrogen-only and combined. They are stuck to the skin, usually on the lower half of your body, and gradually release small amounts of hormones through the skin. You’ll usually change your skin patch every few days.

Patches could be a preferred option if you have difficulty swallowing tablets, get indigestion or are likely to forget to take tablets. Some patches can leave marks and cause redness or irritation.

Oestrogen skin gels and sprays

You apply oestrogen-only skin gels by smoothing them onto your skin. Apply sprays by spraying them on the inside of your arm or thigh once a day. Your body absorbs the oestrogen gradually.

Vaginal oestrogen

Low-dose vaginal oestrogen is also available in tablets, pessaries, creams or vaginal rings that you insert into your vagina. This can help to provide relief for particular menopause symptoms like vaginal dryness and pain during sex (dyspareunia).

Testosterone

Like oestrogen and progesterone, menopause also causes your testosterone to decline. This can make you feel tired, unmotivated and low in libido. While testosterone isn’t currently licensed to treat menopause symptoms in the UK, specialists may prescribe it.

It’s given in the form of a gel that you can rub over the skin where it’s gradually absorbed. Although uncommon, possible side effects of taking testosterone include acne, unwanted hair growth and weight gain.

Intrauterine system (IUS) or Mirena coil

If you have a womb and are using oestrogen-only HRT, you’ll need to also take a form of progesterone HRT to protect against endometrial cancer. You can do this with the Mirena coil, an intrauterine system (IUS).

Inserted into your womb, the Mirena coil gradually releases progestogen (levonorgestrel) into your body. Once inserted, the Mirena coil can stay in place for up to five years and double up as contraception to prevent pregnancy.

Benefits and risks of HRT

Like other medications, there are benefits and risks associated with HRT.

Benefits of HRT

Most of the symptoms of menopause are associated with declining oestrogen levels. People have found that HRT is useful to manage symptoms including:

hot flushes
night sweats
brain fog
sleep problems
mood swings
anxiety
low mood
vaginal dryness
low libido.

There are several long-term effects associated with low oestrogen. Taking HRT can help to reduce the risk of:

osteoporosis
heart disease
stroke
joint aches and pains
reduce the risk of breaking bones.

Risks of HRT

The risks of any serious side effects are usually very low, and depend on:

the type of HRT you take
how long you take it for
your predisposed health risks.

HRT can slightly increase the risk of breast cancer. If you’ve had breast cancer or have a family history of it you’ll usually be advised not to take HRT.

Currently, the risk of breast cancer when using HRT has been found to be an extra 5 in every 1000 women who take combined HRT for 5 years. The risk increases the longer you take it, and the older you are. It falls again after you stop taking it.

Oral HRT can increase the risk of blood clots and in rare cases, stroke. If your medical history would indicate that you are at an increased risk of blood clots or strokes you should be recommended HRT patches, spray or gel rather than tablets, which have been found to not carry this risk.

Weighing up the risks and benefits of taking HRT needs to be considered on an individual basis. It has been found in more recent studies that usually the benefits outweigh the risks and why HRT is now so commonly used.
If you haven’t had a hysterectomy, you’ll need to take oestrogen and progesterone combined to protect against cancer. Oestrogen thickens the womb lining which can increase the risk of developing endometrial cancer. Progesterone helps to protect against it by ensuring the lining is shed regularly.

The HRT timeline: How long before results?

Once you begin taking HRT, you may notice results within a few weeks or months. Some women report symptoms reducing within a few days, but it’s worth continuing with treatment for at least three months before assessing other methods to give your body time to adjust.

Beyond traditional HRT: Exploring alternatives

HRT isn’t for everyone. You might consider HRT alternatives if:

you want to address one menopause symptom only
you have concerns about the safety and side effects of HRT
you prefer alternative and natural treatment methods.

HRT alternatives that could reduce menopause symptoms include lifestyle management, supplements and complementary therapy like yoga or CBT.

Some studies show that phytoestrogens, naturally occurring plant compounds found in particular foods, can provide similar benefits to HRT by mimicking oestrogen in the body.

Lifestyle changes can often provide relief to specific symptoms too. Exercising more, eating a healthy, balanced diet and getting enough sleep can go a long way in supporting improved mood, less tiredness and reduced joint pain.

Periods and HRT: What to expect

With all the changes to your hormones, you may be wondering if HRT stops your periods. If you’re perimenopausal, you can take cyclical HRT that will trigger a menstrual cycle. You’ll have a bleed every one or three months depending on how often you take progestogen. This will also depend on how regular your periods are when you start taking HRT.

HRT will not stop your periods, and there’s a chance you can become pregnant while taking it. If you are sexually active, you should discuss contraception with your doctor.

Once you’re in postmenopause (you’ve not had a period for 12 months), continuous, combined HRT that doesn’t cause a withdrawal bleed is often preferred.

As you move to the next stage in your life, it’s important to understand menopause, hormone replacement therapy and HRT alternatives so you can make an informed decision on how to best care for your body and thrive in life.

Menopause HRT FAQs

What can I do if I don’t want to take HRT?

Maintaining a healthy lifestyle can help ease menopausal symptoms. This includes a well-balanced and nutrient-rich diet (Mediterranean-style), being regularly active and trying to get that 8 hours of sleep a night.

CBT, yoga and meditation have also been found to aid in dealing with menopausal symptoms.

Ensuring a sufficient intake of vitamin D, calcium and magnesium will help with bone health. Taking Omega-3’s and minimising salt can help with heart health, either through diet or supplementation. If you would like any further information regarding nutrition please speak with one of our nutritionists.

Wearing loose fitting clothes and using a fan at night can help with hot flashes and night sweats. Minimising caffeine, alcohol, smoking and spicy food can also help with reducing hot flashes. If you’re experiencing vaginal dryness, there are a selection of vaginal lubricants and moisturisers that may help.

How many years can I take HRT?

There is no fixed limit on how long you can take HRT for, it is dependent on your individual needs. Most women stop HRT once menopausal symptoms have ceased, usually between 2-5 years. Your GP needs to review your treatment yearly.

How long will it take to feel the difference on HRT?

It usually takes a few weeks to feel the benefits of HRT, but it can take up to three months to feel the full effects.

How do I know if I’m on the right dose of HRT?

As a safety precaution your doctor will start you on a low dose of HRT to trial in the first three months. After three months of taking HRT you should have a follow up appointment with your doctor who can review your dose, symptoms and overall well-being and alter the dose as required.

Is HRT suitable for vegans?

The vast majority of oral HRT is not suitable for vegans due to containing lactose. Alternative forms of HRT i.e. patches, gels, vaginal rings are vegan-friendly.

Resources:

hormones HRT menopause menopause and hormones

Zoya Ali BSc, MSc

Zoya is a scientific researcher with a Bachelor's degree in Biotechnology and a Masters in Prenatal Genetics & Foetal Medicine from University College London. Her research interests are reproductive genetics, fertility preservation, gynaecological health conditions and sexual health.

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