Given that there are so many treatments to choose from, pinning down the right HRT for you can be a bit daunting. We’re here to make it a whole lot simpler.
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HRT, or hormone replacement therapy, is treatment that women take to help relieve menopausal symptoms like night sweats, hot flushes, vaginal dryness, poor sleep, brain fog, mood swings and lower sex drive.
How long you take it for can vary; many women take it for a year or two but some can take it for much longer than this. It’s a very individual thing. Certain types of HRT will also suit you more than others. Our clinician can talk you through the different options, and help you to decide which one is right for you.
As you enter the menopause, the levels of oestrogen that your body produces start to decrease, due to a shift in the balance of your sex hormones. This can cause symptoms such as hot flushes, night sweats and changes to your mood. HRT contains synthetic oestrogen, which makes up for the natural oestrogen that’s lost, and helps to tackle menopausal symptoms.
Combined forms of HRT also contain a second hormone: a synthetic form of progesterone. Without anything to keep it in check, oestrogen may increase your risk of getting endometrial cancer, as it can cause the womb lining to thicken more than it should. The progesterone in combined HRT offers protection from this, keeping the oestrogen in line and reducing the risk of womb cancer developing. It’s more convenient to take combined HRT as a pill or patch which contains both progesterone and oestrogen, but sometimes it’s better to take these separately.
If you’ve had a total hysterectomy though, because your womb has been removed, you’ll usually be prescribed oestrogen only HRT.
The menopause can also cause your bones to become more fragile and more prone to breaking. HRT can provide some protection against osteoporosis by helping the bones to stay strong. HRT isn’t a primary treatment for osteoporosis though, so if you’re looking to use it for this purpose, just let our clinician know and they can chat to you about it.
The major benefit of HRT is that it can help to ease many symptoms of the menopause (by as much as 75%, so quite a lot then).
The oestrogen and progesterone in combined HRT make a good team. The oestrogen helps to manage symptoms of the menopause whilst the progesterone helps to keep it in check and reduces your cancer risk.
And there’s the protection it can provide from osteoporosis too, when the bones in the body are more at risk of breaking or becoming brittle after the menopause.
Menopause hormone therapy: latest developments and clinical practice. Drugs in Context. NCBI. 2019; 8: 212551.
Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810.
Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810.
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There are a number of different types of HRT available, and we can talk you through your options.
Tablets are one of the most widely used types of HRT. There are tablet options for both combined HRT and oestrogen only HRT, and you normally take them once every day. They do carry a slightly increased risk of blood clots and breast cancer than other forms of HRT treatment, but it is only a small increase (nine more women develop a blood clot for every 10,000 women each year). Because of this increased breast cancer risk, make sure you attend your breast cancer screening (mammogram) appointments.
If you find having to remember to take a tablet every day a bit inconvenient, skin patches may be a more low maintenance treatment for you and they’re safer for your heart than tablets. You stick HRT patches to your skin, and change them twice a week. They’re available as a combined HRT treatment or as an oestrogen only medication. Skin patches can be a strong option if you’re prone to side effects such as indigestion, and they don’t increase your risk at all of developing a blood clot, unlike tablets.
More and more women are starting to use oestrogen gel for menopausal symptoms, and it’s probably because it’s really easy to use. You just need to rub it onto your skin once a day. It doesn’t increase your blood clot risk either, but if you still have your womb, you’ll need to use an additional progesterone, to limit your chances of getting womb cancer.
They’re not particularly common, but you can also get a HRT implant, which releases oestrogen slowly into the body and doesn’t need to be replaced for several months at a time. You’ll need to take a separate progesterone though if you’ve still got your womb.
Short-term and long-term effects of tibolone in postmenopausal women.
It depends on a number of factors, like what stage of the menopause you’re at, how sensitive you are to certain levels of hormones, and whether you prefer to take tablets or use patches, for example.
Whether or not you’ve had a total hysterectomy is also a factor, and if you have certain health conditions, that can play a big part too.
Here are your options. Our clinician can talk you through them, and recommend safe and suitable HRT treatments just for you.
If you’re getting menopausal symptoms and still having your period, combined sequential (or cyclical) HRT treatments are usually the recommended options. Combined HRT products like Femoston and Estalis Sequi patches are known as ‘combined’ treatments because they contain two hormones: a progesterone and an oestrogen.
With sequential HRT, you start your cycle with oestrogen only tablets (or patches) and then take a combination of oestrogen and progesterone tablets (or patches) part way through your cycle.
If you haven’t had a period for one year, you’re usually considered to be postmenopausal, and continuous combined HRT products like Angeliq and Estalis Continuous tend to be the suggested route. With continuous combined HRT treatments, you take a combination of oestrogen and progesterone every day, without a break (hence ‘continuous’). So they’re a little different to sequential HRT products.
Oestrogen only treatments such as Estrofem and Estradot patches are normally recommended for women who have had their womb removed during a hysterectomy. Like continuous combined HRT, you typically take oestrogen every day, without a break.
Side effects of HRT may also vary from one woman to the next, so some HRT medications won’t be safe (or suitable) for women to use on this basis, while other products will be. If you’re more sensitive to oestrogen, you may be better suited to lower-dose HRT products. And if you have a particular health condition, this can mean that certain HRT products won’t be safe for you to use either.
Our clinician can identify which treatments are appropriate for you and which aren’t, and make recommendations based on your medical background.
There’s a prescription HRT medicine called Tibolone (also branded as Livial, Livilan and Xyvial) that’s used to relieve menopausal symptoms and as a preventative treatment for osteoporosis. Tibolone is the active ingredient, so it’s a bit different to other forms of HRT, which contain oestrogen and progesterone (or just oestrogen).
It can help to ease symptoms like hot flushes, reduced sex drive and low mood, but research has suggested that Tibolone may be less effective than combined HRT. It’s also only a suitable option for women who are postmenopausal (so women who had their last period over a year ago).
Tibolone can produce side effects, including breast pain, vaginal discharge, pain in the pelvis, itching and abdominal pain.
The slightly increased risks of breast cancer and stroke that HRT carry are similar with Tibolone.
Clonidine is another prescription treatment that’s sometimes used to help tackle symptoms like flushing and night sweats. It’s a tablet that you take two or three times a day, and it has no effect on hormone levels, so there’s no increased risk of breast cancer for example. Studies suggest that it only has a small impact on easing flushing and night sweats though, and it can have unpleasant side effects too. Clonidine is a blood-pressure medication. It’s not licensed for treating menopause symptoms, but doctors might prescribe it to you ‘off-label’ if they think it’ll be a safe and suitable treatment for you.
Clonidine 25mcg Tablets BP - Summary of Product Characteristics (SmPC) - (emc).
Northern Devon Healthcare NHS Trust. Breast Pain.
Table 1: Summary of HRT risks and benefits during current use and current use plus post-treatment from age of menopause up to age 69 years, per 1000 women with 5 years or 10 years use of HRT.
Table 1: Summary of HRT risks and benefits during current use and current use plus post-treatment from age of menopause up to age 69 years, per 1000 women with 5 years or 10 years use of HRT.
Table 1: Summary of HRT risks and benefits during current use and current use plus post-treatment from age of menopause up to age 69 years, per 1000 women with 5 years or 10 years use of HRT.
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