Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces hormones that are at a lower level at the time of the menopause.
Different types available
Different types of HRT are available. The main hormones used in HRT are:
- Oestrogen (estradiol, estriol and estrone)
- Progesterone (a synthetic version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel)
- Testosterone can also be a useful hormone to consider in some women
“HRT involves either taking both of these hormones (combined HRT) or just taking oestrogen (oestrogen-only HRT),” explains Dr David Edwards, a GP and specialist in female sexual dysfunction. “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.”
HRT is available in several preparations that are taken in different ways:
- Tablets, which are usually taken once a day, are one of the most common ways of taking HRT.
- 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.
- Oestrogen gel is an increasingly popular form of HRT. It's applied to the skin once a day and is absorbed by the body. But if you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.
- Implants. HRT can be given using small pellet-like implants inserted under your skin, although these aren't widely available and aren't used very often. 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. But if you still have your womb, you'll need to take progestogen separately too.
- Intra-uterine system (IUS) If you're taking a different form of oestrogen and need to take progestogen alongside it, another implant option is the intra-uterine 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.
- Vaginal oestrogen. Oestrogen is also available in the form of a cream, pessary or ring that is placed inside your vagina. This can help relieve vaginal dryness but won't help with other symptoms such as hot flushes.
“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.
The two types are cyclical (or sequential) HRT and continuous 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
- 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.
Benefits of HRT
“The main benefit of HRT is that it can help relieve most of the menopausal symptoms, such as hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive,” says Dr Edwards. Many of these symptoms pass in a few years, but they can be very unpleasant and taking HRT can offer relief for many women. “HRT can also help prevent osteoporosis, which is more common after the menopause. In addition, vaginal dryness and urinary symptoms can be treated with both local oestrogens and vaginal moisturisers or used separately,” he says.
However, 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.”