Hormonal Replacement Therapy

What Is HRT?

Hormone replacement therapy (HRT) is the most effective and commonly used treatment to relieve the symptoms associated with menopause. It works by replacing low levels of the female hormones oestrogen and progesterone, which decline naturally as you approach the menopause. The menopause, sometimes referred to as the "change of life" describes the period of time in which a woman stops menstruating.

Menopause should be diagnosed by a doctor based on your symptoms and medical history before beginning HRT. Oestrogen is the hormone that helps to release eggs from the ovaries. It also controls periods and helps with conception. Lower levels of oestrogen cause most symptoms associated with the menopause.

Symptoms include:

•Vaginal dryness
•Night sweating
•Hot flushes
•Loss of sex drive
•Bone thinning
•Incontinence, when you cough or sneeze

Increasing levels of oestrogen via HRT can help to normalise hormone levels, thereby alleviating the symptoms. Symptoms of menopause normally pass in two to five years, but vaginal dryness may get worse if not treated.

Progesterone is normally used in combination with oestrogen as part of HRT treatment in order to reduce the risk of womb cancer. The hormone progesterone helps to prepare the womb for pregnancy. You do not need progesterone and can take oestrogen only HRT tablets if you have had a hysterectomy.

Treatment

There are a number of treatment options for HRT including tablets, patches, oestrogen gel and an implant. We offer tablets and patches to women who have previously been prescribed HRT

Patches

These are small, plaster like pads which are stuck to the skin. The hormones pass through the patch onto the skin and enter the bloodstream. Always apply the patch to dry, clean and unbroken skin. Avoid placing it near the breasts.

Tablets

This is the most common choice for the menopause. There are different types of tablet available through Oxford Online Pharmacy.

You should be able to stop taking HRT after your menopausal symptoms end, which typically is after two to five years. You should gradually reduce the dose and may have a recurrence of symptoms, but this should stop in a few months

There are benefits and risks associated with HRT, but most experts conclude that the benefits outweigh the risks when HRT is used for no more than five years.

Risks Of HRT

There has been a lot of media attention around the potential risks of HRT and it is important to understand these risks, when considering whether HRT is right for you. Risks, as outlined in the latest NICE guidelines include: A small increased risk of breast cancer – some studies have suggested that for every 1,000 women taking combined HRT, there will be around five extra cases of breast cancer (from a normal risk of 22 cases of breast cancer per 1,000 menopausal women to 27). The risk of breast cancer decreases when you stop taking HRT – estimates suggest the level of risk returns to normal after about five years.

Oestrogen-only HRT is associated with little or no change in the risk of breast cancer Because of the risk of breast cancer, it's especially important to attend all your breast cancer screening appointments if you're taking combined HRT.

Studies looking at whether HRT can increase your risk of ovarian cancer have so far had conflicting results. It's thought that if there is any increase in cases of ovarian cancer in women taking HRT, the risk is very small. A recent study found that for every 1,000 women taking HRT for five years, there will be one extra case of ovarian cancer. Any risk of ovarian cancer is thought to decrease once you stop taking HRT.

Oestrogen-only HRT can increase the risk of womb cancer, which is why it's only used in women who don't have a womb (for example, because they've had a hysterectomy). Taking combined HRT, particularly a course of continuous HRT (where you take both medications without a regular break), largely eliminates the risk of womb cancer. If you still have a womb and you're taking HRT, it's important to take both medications as advised by your doctor to avoid increasing your risk of womb cancer.

Taking HRT tablets can increase your risk of blood clots but there's no increased risk of blood clots from HRT patches or gels. It's thought that the risk of developing a blood clot is about two to four times higher than normal for women taking HRT tablets. But as the risk of menopausal women developing blood clots is normally very low, the overall risk from HRT tablets is still small. It's estimated that for every 1,000 women taking HRT tablets for 7.5 years, less than two will develop a blood clot. Blood clots can be serious if they become lodged in a blood vessel and block the flow of blood.

HRT doesn't significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age. Oestrogen-only HRT is associated with no, or reduced, risk of heart disease. Combined HRT is associated with little or no increase in the risk of heart disease. Taking oestrogen tablets is associated with a small increase in the risk of stroke, although the normal risk of women under 60 having a stroke is very low, so the overall risk is small. If you are considering taking HRT and are worried about any of the risks outlined above speak to your GP.

Q&A

Q: Do you prescribe HRT for transgender patients?

A: We are completely sympathetic to the situation of transgender patients. However, as this is a very specialised field, which we do not feel we cannot safely prescribe for you. This must be done through your GP, who we feel sure will be equally sympathetic.

Q: I thought taking HRT was dangerous?

A: There are benefits and risks associated with HRT, but most experts conclude that the benefits outweigh the risks when HRT is used for no more than five years. A full overview of the latest NICE can be found here.

Q: Does HRT make you gain weight?

A: There is no evidence to suggest that this is the case. Women will gain a little weight around menopause whether they are on HRT, or not.

Q: Who is Hormone Replacement Therapy not Suitable for?

A: If you have blood clots, cancer, heart or liver disease, have known or suspected pregnancy, have a history of stroke or heart attack HRT is not advisable.

Q: What are the benefits of HRT?

Medical research from across the world has indicated several benefits for HRT including: improved muscle function, a reduction in the changes of muscle proteins associated with ageing, protection against brain aneurysms. HRT also reduces the risk of heart failure and heart attack.

Authored by Stuart Gale, on 13 September 2018. Reviewed by Robert Bradshaw, on 14 December 2018.