Hormone Replacement Therapy

Hormone replacement therapy (HRT) is used to treat the symptoms of the menopause.

HRT is also useful in preventing osteoporosis in premenopausal women and those with surgical menopause.

Hormone replacement therapy can be started as soon as you reach the menopause to treat its symptoms.

Menopausal symptoms that may benefit from HRT:

• Hot flushes
• Vaginal dryness/recurrent urine infections
• Urinary leaks
• Lack of libido and sex drive
• Reduce risk of osteoporosis
• Increased risk of osteoporosis

The menopause happens in most women in their mid 50s. There is a strong correlation with the maternal menopausal age.

During the menopause, the regular menstruation processes slows down, gets lighter then altogether ceases. The adjustment of the natural hormones within the body produce the above listed symptoms. The symptoms can be persistent for an average of 5 years and in 1 in 12 women they last for upto 12 years. It should be noted that not all women experience troubling menopausal symptoms.

Typical symptoms associated with the menopause:

• Change to your period
• Hot flushes
• Night sweats
• Loss of libido (sex drive)
• Vaginal dryness
• Vaginal itching
• Recurrent urinary tract infections
• Discomfort or pain during sex
• Osteopenia/osteoporosis
• Mood swings
• Anxiety
• Palpitations of the heart
• Joint swelling and pain

The rationale for HRT is to replace the female hormones lost during the menopause, this in turn should provide relief from the above-mentioned symptoms.

Osteoporosis and the menopause

Osteoporosis weakens the bones thereby increasing the risk of bone fractures (occasionally from the slightest fall). The lack of oestrogen during the menopause is associated with osteoporosis, thereby supplementing the oestrogen (HRT) should help to preserve bone strength.

HRT helps to restore oestrogen levels within the body. Some HRT formulations also contain progesterone, this is thought to help maintain uterine health and reduce the risk of endometrial cancer.

How long does HRT take to work?

It can take a few weeks until you feel the initial impact of HRT, and up to 3 months to feel the full effects of this treatment. Some women find it takes a while for their bodies to get used to HRT, and you may experience some side effects while you adjust to this new treatment. For example, HRT can cause bloating, nausea and headaches, and you may even feel some joint pain after starting HRT, as well as back pain.

If you are still experiencing side effects more than 3 months after starting HRT, you may need to change the type or adjust the dosage.  

There are a number of different types of HRT available, and it’s a good idea to think about which one might work best for you.

HRT comes in several different forms, such as:

• Tablets
• Skin patches
• Oestrogen gel
• Implants
• Vaginal oestrogen
• Testosterone

Your individual treatment routine for HRT will depend on a number of different factors, including whether you’re in the early stages of menopause or if you’ve had menopause symtoms for a longer period of time.

There are 2 different types of HRT treatment routines - cyclical HRT and continuous combined HRT.

Cyclical HRT

Cyclical HRT is often recommended for women with menopausal symptoms but who still have periods and are taking combined HRT. There are two different types of cyclical HRT.

Monthly HRT

This type involves taking oestrogen every day and taking progesterone alongside it for the last 2 weeks of your menstrual cycle. This is usually recommended for women having regular periods.

3-monthly HRT

This type involves taking oestrogen every day, and taking progesterone alongside it for 14 days every 3 months. This is usually recommended for women with irregular periods.

Continuous cycle

Unlike cyclical HRT treatment, continuous cycle is recommended for postmenopausal women. Postmenopausal is considered to be when a woman has not had a period for 1 year.

Continuous cycle HRT treatment involves taking both oestrogen and progesterone every day without any breaks.

At Access Doctor, we offer a wide variety of HRT treatments, including cyclical HRT brands, as well as treatments in tablet form and patches. 

How long can I take HRT for?

They can be taken until the symptoms of the menopause pass, however, It is not recommended to be taken for more than 5 years. However, if you are at low risk of complications some HRT products can be taken for longer.

It is recommended you gradually taper (lower your dose) slowly before coming off HRT altogether.

Does HRT provide contraceptive cover?

No, it is not a contraceptive method. It is recommended that you use contraceptive methods for two yours following your menopause to prevent unplanned pregnancies.

Is HRT suitable after a hysterectomy?

Yes, if you have menopausal symptoms it is still suitable for you. A full hysterectomy requires an oestrogen only product to be taken as there is no risk of uterine cancer.

A partial hysterectomy will require a combined (oestrogen and progesterone) product.

When completing the online consultation, accurately answer all your medical and surgical conditions, this will allow our doctors to review you request accurately and provide you with the best treatment option.

Hormonal therapy is always prescribed with extra care and monitoring. Short term use (less than 10 years) of HRT has been associated with very few risks. Our doctors will assess your request thoroughly and only prescribe what is suitable for you. It is important for you to inform your own doctor (GP) regarding this treatment so they can regularly monitor you.

Long term use of HRT has been associated with increased risk of developing various cancers including breast, ovarian and uterine. HRT is also associated with clotting of your blood (thromboembolism) and therefore unsuitable for women with previous history of blood clots.

HRT is not recommended if you:

• Are pregnant
• Currently have or have previously suffered from breast cancer, ovarian cancer or uterine (womb) cancer
• Have or are at risk of blood clots
• Currently have or have previously suffered stroke or heart disease
• Have high blood pressure (untreated)
• Have liver disease

Can HRT make you feel worse?

As with the majority of medicines, the hormones used in HRT can cause side effects.

The main side effects of taking oestrogen can include:

• Bloating
• Breast swelling or tenderness
• Nausea
• Headaches
• Indigestion
• Leg cramps
• Vaginal bleeding

The main side effects of taking progesterone can include:

• Breast tenderness
• Headaches or migraines
• Acne
• Stomach pain
• Back pain
• Mood changes
• Depression
• Vaginal bleeding

The good news is that these symptoms should improve over time. You should try to continue with the treatment for a minimum of 3 months, however if any of these side effects continue for longer, or your symptoms are severe, you should speak to your doctor. 

Does HRT cause weight gain?

It’s a common belief that HRT can cause weight gain. However, there is very little evidence to support this. It’s not uncommon to gain weight during the menopause, but this can happen regardless of whether you take HRT or not. Sticking to a regular exercise regime and eating a balanced diet will help you maintain a healthy weight.  

Does HRT make you tired?

Some women report feeling tired while taking HRT. This can be due to the fact that the progesterone in HRT can cause premenstrual symptoms, including fatigue.

The primary aim of all HRT treatments is to improve oetrogens levels within the blood.

Various active ingredients are used such as:

Conjugated oestrogens

Tibolone

Oestradiol

Progestogens

HRT formulations contain various combinations of the above active ingredients. We provide a wide range of products including tablets and Patches. Click on individual medications to find out more.

Non-medical treatment

The menopausal period is extremely difficult for many women causing emotional, psychological and physical symptoms. Lifestyle modifications can help to cope with the symptoms.

For hot flushes/night sweats:

• Keeping the room temperature cool
• Regular cool showers
• Cold drink
• Wearing loose light cotton clothing
• Avoid spicy foods
• Reduce alcohol and caffeine intake

For a low libido:

• Relationship openness/discuss with your partner
• Foreplay
• Counselling

Vaginal dryness:

• Vaginal moisturisers
• Lubricants

Well being:

• Meditation
• Yoga
• Counselling
• Support network of family and friends
• Exercise
• Healthy diet
• Stop smoking