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

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

Hormone replacement therapy (HRT) can ease menopause symptoms like hot flashes, brain fog, joint pain, low mood and low libido. But how does it help and what are the signs you need hormone replacement therapy?

HRT Explained

When it comes to discussing menopause, there are three letters that appear in almost every conversation. HRT, which stands for hormone replacement therapy. It 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 and progesterone and sometimes testosterone. 

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. 

Recognising the Signs: Do You Need HRT?

You can take HRT to relieve menopause symptoms if you’re in perimenopause (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.

You can now book an appointment with our Menopause Specialist Hazel, who can prescribe HRT based on your individual needs and preferences. 

You can learn more about the potential need for HRT during a call with our menopause specialist. Your call will be in-depth and completely personalised, offering expert guidance on navigating symptoms and treatment options including HRT.

Understanding HRT: Types and Their Differences

HRT delivers synthetic hormones, oestrogen and progestogen, that mimic those lost during menopause. 

There are different types of HRT to choose from depending on your medical history, which stage of menopause you’re at, your current hormone levels, and personal preferences.

HRT options can:

  • contain different hormones – oestrogen, progestogen, a combination of both, and sometimes testosterone.
  • be taken in different ways – tablets, patches, gels, sprays, implants, coils, or creams.
  • be taken at different times – treatments can be cyclical (sequential) or continuous.

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.

Tablets

Tablets are one of the most common ways of taking HRT. You usually take them once a day and they’re available in both oestrogen-only and 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 (both oestrogen-only and combined) are stuck to the skin, usually on the lower half of your body, to gradually release a small amount 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 them. But some patches 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, a burning sensation or pain during sex (dyspareunia).

Intrauterine system (IUS), or Mirena coil

If you have a womb and are taking or using oestrogen tablets, sprays, or gels, the Mirena coil, an intrauterine system (IUS), is a suitable option to give you the progestogen you need to protect against endometrial cancer. 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 work as contraception to prevent pregnancy.

Testosterone

Like oestrogen and progesterone, menopause also causes your testosterone to decline. This can make you feel tired, unmotivated, and have a lack of desire for sex.

While testosterone isn’t currently licenced to treat menopause symptoms in the UK, specialists may prescribe it

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

Benefits and Risks with HRT

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

Most of the symptoms of menopause are associated with declining oestrogen levels. 

Hormone therapy for menopause involves replacing your hormones which are at naturally low levels with small doses of either synthetic or bioidentical oestrogen, progesterone or both or testosterone in some cases.  

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 (sex drive).

There are a number of long term effects associated with low oestrogen and taking HRT can help reduce the risk of  osteoporosis, heart disease, stroke and joint aches and pains and help maintain muscle strength, reduce joint aches and pains, and reduce the risk of breaking bones, HRT can help to strengthen your bones and make fractures less likely.

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 and your own 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. 

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 individually.
  • 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, cyclical HRT delivers hormones, oestrogen and progestogen, that trigger a menstrual cycle and bleed every month or three months depending on how often you take progestogen. (This will 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, so 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.

FAQs

What are the benefits of HRT?

Hormone therapy for menopause involves replacing your hormones which are at naturally low levels with small doses of either synthetic or bioidentical oestrogen, progesterone or both.  

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 (sex drive).

There are a number of long term effects associated with low oestrogen.   Taking HRT can help reduce the risk of osteoporosis, heart disease, stroke and joint aches and pains. It can also help maintain muscle strength, and reduce the risk of  breaking bones.

What are the risks?

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 as well as any pre-existing health conditions you may have. 

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 indicates that you are at an increased risk of blood clots or strokes you should be recommended HRT patches, spray or gel. The tablet form of HRT has e not been found to carry this risk.

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 diet), 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 Hertility’s 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 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. It is important for your GP to review your treatment yearly.

How long will it take to feel a difference? 

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?

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 ring are vegan-friendly.

How can I find out more about the individual types? 

 

References

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https://www.womens-health-concern.org/
Zoya Ali BSc, MSc

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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