Hormone Replacement Therapy: How The Menopause Treatment Works

According to the NHS, more than 1 million women in the UK use hormone replacement therapy (known as HRT) to relieve menopausal symptoms, from hot flushes to vaginal dryness. Recently, there has been a huge increase in demand and media attention around the wonder drug, leading to supply issues and shortages. So what is HRT and how does it work? We've put together the answers to all your questions below.

In a rush? Read this quick summary:

  • Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones at a lower level as you approach the menopause.
  • The main benefit of HRT is that it can help relieve most menopausal symptoms, such as hot flushes, night sweats and mood swings.
  • The benefits of HRT generally outweigh the risks. But speak to a GP if you have any concerns about taking HRT.
  • You can usually begin HRT as soon as you start experiencing menopausal symptoms, and usually will not need any tests first.
  • HRT may not be suitable if you have a history of breast cancer, ovarian cancer, blood clots, high blood pressure, liver disease or if you are pregnant.
  • There are different types of HRT and different ways to take the medication, so you should find one that's right for you.

What is HRT?

Hormone replacement therapy is a treatment to relieve symptoms of the menopause. As you approach the menopause, some hormone levels (particularly estrogen) lower, causing symtpoms such as hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive. Most of these symptoms naturally pass after a few years, however, taking HRT can speed up the process by replacing the hormones, in turn reducing or even completely eliminating the symptoms.

What are the different types of HRT?

HRT focuses on replacing the estrogen that your body no longer makes leading up to, and after menopause. There are two main types of therapy that used:

  • Systemic hormone therapy — systemic oestrogen comes in a pill, skin patch, ring, gel, cream or spray form, and contains a high dose of oestrogen that can be absorbed throughout the body.
  • Low-dose vaginal products — low-dose vaginal estrogen comes in cream, tablet or ring form and lessens the amount of estrogen absorbed by the body. Doctors tend to only prescribe low-dose vaginal estrogen when someone is experiencing only vaginal or urinary symptoms of menopause.

For hormone replacement therapy to work effectively, your hormones must be balanced. Because of this, doctors usually prescribe progesterone medication alongside HRT. This is because increasing your oestrogen levels alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. However, if you have had your uterus removed (hysterectomy), you might not need to take progestin.

What are the risks of hormone replacement therapy?

The benefits of HRT are generally believed to outweigh the risks. However, some types of HRT have been linked to an increase in breast cancer, heart disease, stroke, or blood clots. The risks are usually small, and depend on the type of HRT you take, how long you take it, and your health background.

Studies have suggested the increased risk of developing certain illnesses depends on:

  • Age — Women who begin taking HRT at 60 or above, or after more than ten years from the onset of menopausal symptoms are at greater risk. 
  • Health history — Your personal and family medical history are important factors in determining whether HRT is right for you.
  • Type of hormone therapy — The risks vary depending on the dose given and whether estrogen is given alone or alongside progestin.

If you're thinking about taking HRT or are already taking it and have any worries about the risks associated with it, be sure to speak with your GP. 

How can I get started on HRT?

If you think HRT might work for you, you'll need to speak with your GP first. They will run through your symptoms and a background check to see if you are eligible, and they will also explain the different types of HRT available and answer any questions you might have.

You can usually begin HRT as soon as you start experiencing menopausal symptoms, and there are no tests required.

Your doctor usually recommends starting on a low dose, which may be increased later. Typically, you will start on a trial period of three months to see if it helps. If after three months, you notice no improvements, they may change your dose or suggest another alternative type of HRT medication.

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Who can take HRT? 

Most women can take HRT if they are experiencing menopausal symptoms. However, HRT may not be suitable for you if you:

  • Have a history of breast cancer, ovarian cancer or womb cancer
  • Have a history of blood clots or stroke
  • Have high blood pressure
  • Have liver disease
  • Are pregnant

If any of the above apply to you, you should still discuss this with your doctor as other alternatives will be recommended instead. 

Are there any side effects when using HRT?

As with any medication, you may experience side effects, however, these will usually pass within three months of starting treatment.

Some common side effects include:

  • Breast tenderness
  • Headaches
  • Feeling sick
  • Indigestion
  • Stomach pain
  • Vaginal bleeding

If you experience any side effects when taking HRT, you should discuss this with your GP.

What are the alternatives to hormone replacement therapy if you can't take it?

Hormone replacement therapy isn't right for everyone and there are alternative ways to manage menopausal symptoms.

  • For hot flushes, you can try keeping cool, limiting caffeinated beverages and alcohol, and practicing relaxed breathing techniques. 
  • For vaginal concerns such as dryness, a lubricant or vaginal moisturizer can help to provide relief.
  • If you're experiencing painful intercourse, your doctor should be able to provide a prescription medication such as ospemifene.
  • If you're experiencing mood swings, your doctor may be able to provide you with prescription medication such as sertraline which works on regulating and stabilising your mood. 

Why is there currently a shortage of HRT?

Recently, there has been a shortage of hormone therapy replacement gels and patches in the UK, which has been widely discussed and debated in the media, by the likes of Davina McCall.

According to the Department of Health, the HRT shortage is due to a rise in demand, which is fuelled by greater awareness of menopause and more confidence among GPs prescribing the medication. The DH has stated they are currently working to resolve the shortage and limit supplies to three months per person to even out distribution.

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