As the hormonal changes of the menopause affect every woman differently, each woman needs to work out how best to manage their individual symptoms. Management should be tailored to each individual, with attention given to improving diet and lifestyle. Replacing declining oestrogen in the body with Hormone Replacement Therapy (HRT) is also an option.
If HRT is taken after a hysterectomy, usually oestrogen alone is required. If HRT is taken when the womb (uterus) is still present, then oestrogen is taken with a progesterone, which prevents estrogenic stimulation and thickening of the womb lining. Oestrogen can be taken by a daily tablet, twice weekly or weekly patch, daily gel or implant. People respond differently to different types, routes and doses of oestrogen and sometimes several adjustments of therapy are required. If possible, any type should be tried for three months before deciding whether a change is required.
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.
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 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.
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. 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.