Hormone Replacement Therapy (also known as HRT) is a treatment used to help women to manage certain symptoms associated with the menopause. It is important to fully understand how HRT works and what the risks and benefits of using it are before choosing to try it.
What is the Menopause?
The menopause is part of life that happens to every woman. At this time, usually in the late forties or early fifties, the menstrual cycle stops. This means that the woman is no longer releasing eggs (ovulating) and is no longer able to become pregnant. It also means that the woman no longer has menstrual periods each month. All of this happens when the ovaries, where the eggs are stored, no longer produce the female hormone oestrogen. Oestrogen is an important hormone for women of childbearing age. When production of oestrogen slows down as a woman ages, this has a number of effects on the body.
Symptoms of Menopause include:
- Night sweats
- Hot flushes
- Mood changes such as depression or anxiety
- Sleep problems such as insomnia
- Vaginal discomfort/dryness
- Concentration/memory problems
- Loss of libido (sex drive)
These are the most commonly experienced symptoms of the menopause but not every woman will experience all of them. These symptoms may occur for some time before periods actually stop. Every woman is different and while some find the menopause a difficult time, others have fewer symptoms. For those who do experience severe symptoms, Hormone Replacement Therapy is an effective treatment option.
What is Hormone Replacement Therapy?
HRT comes in different forms, but the aim of each treatment is the same; to replace or partially replace some of the hormones that are causing the symptoms of menopause. Hormone Replacement Therapy replaces the oestrogen that is declining as a woman goes through the menopause. HRT can be used while the symptoms of menopause are at their most severe, according to medical advice. While it is widely used as a treatment option, HRT is not suitable for everyone and so the individual needs of the woman must be considered before beginning treatment. Some women with other medical conditions or risk factors for certain diseases are not considered suitable for HRT, and for these women, other measures can be taken such as lifestyle changes and support for managing individual symptoms.
Types of Hormone Replacement Therapy
There are a number of ways of providing HRT, with different levels of replacement hormones and different methods of administering them. Tablets or patches that adhere to the skin may be used to deliver the hormones used in HRT. HRT usually consists of supplementation of two hormones; oestrogen and progesterone. This is because there is evidence that when women take oestrogen alone, they are at risk of womb cancer. By adding progesterone, this risk is reduced. Sometimes oestrogen-only therapy is prescribed, but this is usually only if a woman has had a hysterectomy (removal of the womb), as progesterone is not needed in these cases. For the majority of women using hormone replacement therapy, a combination of oestrogen and progesterone is used. This is known as Combined Hormone Replacement therapy (Combined HRT).
Types of Combined HRT include:
- Cyclical HRT (sometimes referred to as sequential HRT)
This is often recommended for women who are experiencing menopausal symptoms but who are still having regular or irregular menstrual periods. Cyclical HRT is taken on a monthly or three-monthly basis, allowing for breaks during which the woman will have a period. This is useful because it allows the woman and her health care provider to monitor the periods, so that it is clear when they stop. This is an indication that the woman has moved past the menopausal stage and is considered to be post-menopause.
- Continuous Combined HRT
This is usually prescribed after the menopause. A woman is considered to be post-menopause when her menstrual periods have stopped for at least a year. Continuous Combined HRT involves regular, continuous supplementation of oestrogen and progesterone. This requires the woman to take both oestrogen and progesterone every day without any breaks.
- Local Oestrogen
This is an option for women who are experiencing symptoms such as vaginal discomfort, irritation or intimate dryness. Application of oestrogen cream, the use of tablets or a ring inserted into the vagina can deliver oestrogen to the local area and help counteract the effects of reduced oestrogen on a local level. This does not have an impact on other symptoms of reduced oestrogen such as night sweats or low mood, but it also does not have the same risks as other forms of HRT and so is sometimes preferable for women who do not have severe symptoms.
For more specific information on the types of HRT available and what they are called, see here.
Risk and Benefits
The risks and benefits of each type of Hormone Replacement Therapy will depend on the symptoms of menopause that the woman is experiencing and how severe they are. It is generally agreed upon that HRT should be used at the lowest effective dose for the shortest period of time, and that the benefits outweigh the risks. There are links between HRT and some types of cancer, blood clots and cardiovascular disease. These risks are small and vary depending on the type of HRT used, and research is ongoing, so it is always best to talk to a healthcare provider when weighing up the risk and benefits of any treatment.
Managing the Menopause
While Hormone Replacement Therapy is a tried and tested option for dealing with severe menopause symptoms, there are also lifestyle changes that can really help menopausal women to feel better and more in control. A healthy balanced diet and plenty of exercises can make a big difference. Talking therapy such as Cognitive Behaviour Therapy can be very useful in helping with the emotional aspects of the changes that are taking place and can help with anxiety and low mood. Stress undoubtedly makes the symptoms of the menopause more difficult to deal with and so activities such as yoga, tai chi, meditation and mindfulness can be helpful. For more information about the menopause and how Hormone Replacement Therapy works, go here.