Taking HRT during the Menopause

Menopause is the period in a woman’s life when menstruation ceases. In normal cases this usually occurs after the age of 45.

During this time ovarian function declines and periods become irregular, unpredictable and eventually stop. This decline in ovarian function means the decreased release of hormones oestrogen and progesterone, and this change in hormone level causes menopause symptoms such as hot flushes, night sweats, mood swings, lack of libido and vaginal dryness.

To support the body through menopause, many women choose hormone replacement therapy (HRT) which replaces the hormones that the ovaries were producing so that the symptoms are minimised.

What are the benefits of HRT? 

Apart from reversing troublesome symptoms of menopause and improving quality of life. HRT also helps with the prevention of osteoporosis (thinning of bones) and cardiovascular events such as heart attacks.

What are the different types of HRT? 

The two main hormones in HRT are oestrogen and progestogen. HRT involves either taking both of these hormones (combined HRT) or, in the case of women who have had a hysterectomy, just taking oestrogen (oestrogen-only HRT).

Are there any side effects? 

There are a number of side effects reported with HRT. These include weight gain, bloating, breast tenderness, bleeding, indigestion, and occasionally local irritation (patches). Often these side effects subside within a few weeks, but if they persist it may be advisable to change the way you are taking your HRT (e.g. moving from a tablet to a patch).

Are there any risks? 

HRT has been associated with increased risk of breast cancer, but choosing an appropriate delivery of progestogen mitigates this risk. Certain formulations of progestogen medication are associated with the lowering of this risk. In fact, using a Mirena intrauterine system (hormonal coil) to protect the endometrium may be a safer way to minimise increase in the risk of breast cancer.

Oral HRT medication is associated with increased risk of thrombosis (blood clot) but using transdermal HRT (oestrogen gel or patch) is safer in this respect. There is also a slightly increased risk of stroke but this applies more to older women with medical co-morbidities.

There is also a small increase in the risk of endometrial cancer.

How do you take HRT? 

There are several different ways that you can take HRT. Your GP or gynaecologist can help you decide which is best for you and your lifestyle.

1. Tablets: the most common way to take HRT. Daily tablets can either be oestrogen-only or combined HRT. The risk of blood clots is higher with tablets than with other forms of HRT.
2. Skin patches: these are small patches that are stuck to the skin, usually below the waist, and replaced every few days. Patches will survive the shower, bathing and swimming, and may be a better option if you don’t want to take a tablet every day. Patches may allow you to avoid some common side effects such as indigestion and they also don’t increase the risk of blood clots.
3. Oestrogen gel: a gel that is applied to the body, usually the arms or legs, daily. Similar to the patches, gel avoids an increased risk of blood clots. The gel comes in a pump pack and you will be advised as to how much you need to use. However, if you haven’t had a hysterectomy you will need to take progestogen separately to reduce your risk of endometrial cancer.
4. Implants: a pellet-like implant can be inserted under your skin and gives a gradual release of HRT over several months before needing to be replaced. Progestogen will need to be taken separately too.

When should you stop taking HRT? 

HRT should always be taken under medical supervision and should be reviewed annually. With appropriate supervision, there is no reason why HRT cannot be continued at least up to 60 years of age.

What if I don’t want to take hormones?

If you would like to support your body through menopause without HRT there are lifestyle changes you can make to aid menopause.

• A balanced diet with an appropriate amount of protein, calcium and certain food containing phytoestrogens (plant sources of oestrogen) can help. Common foods containing phytoestrogens are soya, nuts, lentils, chickpeas and oily seeds
• Stopping smoking and reducing alcohol consumption is beneficial
• Exercise, particularly aerobic and weight bearing exercise, is good for the bones and reduces the risk of osteoporosis
• Vitamin D is important for the bones and checking and maintaining optimum levels reduces the risk of osteoporosis
• Screening: breast and cervical cancer screening is important. Make sure you are up to date with your screening appointments

If you have any further questions about HRT or would like to book an appointment with one of our consultant gynaecologists, please give us a call on 0207 10 11 700.