What Is Hormone Replacement Therapy?
Hormone Replacement Therapy or HRT is a common treatment prescribed to women experiencing many of the symptoms related to the menopause. These include hot flushes, night sweats, mood swings, vaginal dryness and low libido.
It works by replacing hormones that are at a lower level as the woman transitions through to the menopause, the stage known as the perimenopause. As hormone levels continue to decline the amount of HRT a woman is taking may need to increase.
What Are The Benefits of HRT?
Hormone Replacement Therapy offers many women relief from the unpleasant symptoms associated with the menopause. Menopause symptoms can have a serious impact on a woman's personal and professional life - as shown in our study on menopause in the workplace.
HRT not only offers relief from menopause symptoms, but it also helps prevent diseases associated with declining hormone levels such as osteoporosis.
“As women are spending an extended part of their lives in the menopausal state, ensuring you empower yourself with up to date information to make informed decisions, will enable you to ensure maintaining quality of life during this phase of your life” Dr Nicky Keay CMO Forth.
What Are The Risks?
There has been a lot of misleading information in the press on the increased risks of developing breast cancer due to HRT. However, having an unhealthy lifestyle such as being overweight, smoking and drinking too much alcohol pose a far higher risk of developing breast cancer than taking HRT.
How Long Can You Take HRT?
HRT can be taken for as long as needed, however, the risks of developing breast cancer increase if HRT is taken for longer than 1 year.
When To Stop Taking HRT
Once a woman has reached menopause and is no longer experiencing symptoms, the HRT treatment can be stopped. It is advised that women come off HRT gradually to prevent the short-term return of symptoms.
What Are The Different Types Of HRT?
The two main hormones used in Hormone Replacement Therapy are:
- Oestrogen (estradiol, estriol and estrone)
- Progesterone (a synthetic version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel)
The different types of HRT available are the combined HRT which includes oestrogen and progesterone, and oestrogen-only HRT. As Dr David Edwards, GP and specialist in female sexual dysfunction, explains:
“HRT involves either taking both of these hormones (combined HRT) or just taking oestrogen (oestrogen-only HRT). Most women take combined HRT because taking oestrogen on its own can increase your risk of developing womb cancer. Taking progestogen alongside oestrogen minimises this risk. Oestrogen-only HRT is usually only recommended for women who have had their womb removed during a hysterectomy.”
How To Take HRT
HRT is available in several preparations that are taken in different ways. These include tablets, skin patches, gels and implants:
Tables are usually taken once a day and are one of the most common ways of taking HRT.
2. Skin Patches
Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days. Patches may be a better option than tablets if you think you might find it inconvenient to take a tablet every day.
3. Gels, Creams And Pessaries
Oestrogen gel is an increasingly popular form of HRT. It's applied to the skin once a day and is absorbed by the body. However, you'll also need to take some form of progesterone to reduce your risk of womb cancer. This does not apply to women who've had a hysterectomy
Vaginal oestrogen which is prescribed to help relieve vaginal dryness is also available in the form of a cream, pessary or ring that is placed inside your vagina. However, this won't help with other symptoms such as hot flushes.
HRT can be given using small pellet-like implants inserted under your skin. The implants release oestrogen gradually over time and can stay in place for several months before needing to be replaced. This may be a convenient option if you don't want to worry about taking your treatment every day or every few days. As with oestrogen gel, some form of progesterone will also need to be taken separately.
If you're taking a different form of oestrogen and need to take progestogen alongside it, another implant option is the intrauterine system (IUS). An IUS releases a progestogen hormone into the womb. It can remain in place for a few years and also acts as a contraceptive.
What Are The Different HRT Treatment Courses?
There are two different types of HRT treatment courses, these are cyclical (or sequential) HRT and continuous HRT.
“Different treatment courses of HRT are also available, depending on whether you're still in the early stages of the menopause or have had menopausal symptoms for some time,” states Dr Edwards.
1. Cyclical HRT
Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT who have menopausal symptoms but still have their periods. There are two types of cyclical HRT:
- Monthly HRT - oestrogen daily, progestogen alongside it for the last 14 days of the cycle
- Three-monthly HRT - oestrogen every day, and progestogen alongside it for around 14 days every three months
2. Continuous Combined HRT
Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually said to be post-menopausal if she has not had a period for a year. As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.
What Are The Alternatives To HRT?
There are many women who, either for medical reasons or personal choice, prefer not to take HRT.
“These women may find it helpful to try herbal remedies such as black cohosh and St John’s Wort, which have been clinically proven to help relieve common menopause symptoms,” suggests Dr Edwards. “Rhodiola rosea has been shown to help relieve symptoms of stress without causing sedation or a foggy brain. Make sure you choose one which carries the THR kite mark as this guarantees quality, safety and includes approved dosage.”
You can learn more about alternatives to HRT in our blog 'Natural Alternatives To HRT'.