Hormone Replacement Therapy (HRT) refers to synthetic hormones, taken by women to alleviate the symptoms of the menopause.
What is the menopause?
The menopause is the period of a woman’s life in which she stops menstruating and becomes infertile. It normally begins between the ages of 45 and 55 - although some women start earlier - and lasts for a few years. In this time, oestrogen and progesterone levels drop in the body, eventually rendering you unable to get pregnant. These falling hormone levels, however, are also responsible for symptoms such as:
- hot flushes - episodes lasting 30 seconds to 5 minutes (or longer)
- mood swings
- vaginal dryness and discomfort during sex
- urinary tract infections
For more information, see our article on Menopause Symptoms.
How does Hormone Replacement Therapy work?
Hormone Replacement Therapy works by replacing the hormones that have gone into decreased production in your body. There are three main types:
- oestrogen-only HRT (recommended for women who have had a hysterectomy)
- cyclical HRT (for women who are experiencing menopausal symptoms but are still having periods)
- continuous combined HRT (for women who are post-menopausal, i.e. not having periods)
Within these three categories there are various types of treatment, including creams, patches, tablets, vaginal rings and implants; the kind that you are prescribed will depend upon the nature of your symptoms, alongside the general state of your health.
A cream such as Ovestin contains a version of oestrogen. It is applied directly into the vagina to prevent dryness and irritation. If the only symptom you are experiencing is vaginal dryness, then your doctor may prescribe you a topical cream such as this.
Patches are small pads with an adhesive back that stick to the skin as a plaster would. They contain hormones which permeate the skin and enter the bloodstream. Patches should be applied to clean, dry, unbroken skin and should never be placed near or on the breasts. You can get various types of HRT patch including oestrogen-only, such as Elleste Solo MX, and combined, such as Evorel Conti. Most patches are reapplied every three to four days.
The most common treatment for menopausal symptoms is HRT tablets taken orally. Some HRT tablets, such as Ortho-Gynest, are inserted directly into the vagina to soothe dryness and irritation by releasing oestrogen into the surrounding tissue, but these are less common. There are many types of orally-taken tablets, incorporating both oestrogen-only (e.g. Premarin, Elleste Solo) and combined (e.g. Kliovance, Premique). Your doctor will prescribe you tablets and alter your dosage according to whether you need them cyclically or continuously.
A vaginal ring such as the Estring is made of flexible silicon and is worn in the vagina for three months. Like Ovestin, Estring is a topical treatment, designed to affect only the vaginal area. It releases oestrogen into the vaginal tissues, easing dryness and irritation, and is only recommended for short-term use.
The HRT implant involves a small pellet being inserted under your skin (while the area is anaesthetised) which then releases small amounts of oestrogen into your bloodstream. Generally this implant will last up to six months. If you have not had a hysterectomy, you will probably be prescribed progesterone to take whilst you have your implant - progesterone prevents the oestrogen in your blood from causing abnormalities in your womb lining.
Which HRT treatment is right for me?
Choosing the right HRT treatment has a lot to do with the nature of your menopausal symptoms, your health history and the sorts of risks associated with each method. If you have had a hysterectomy, for instance, you will be able to take oestrogen-only treatments. If the only symptom you are experiencing is dryness or discomfort in your vagina, you may be able to treat the problem topically with a vaginal cream, tablet or ring. Similarly, you might find that using patches irritates your skin, or that you have a bad reaction to taking a certain kind of tablet. The good news is that there are many different HRT treatments available and that, if you work together with your GP, you are likely to find one that suits you.
Is HRT safe?
There has been a great deal of controversy over whether or not Hormone Replacement Therapy puts women’s lives at risk. The current consensus, however, is that for the majority of women, HRT is safe to use for up to five years, at which point the risks begin to outweigh the benefits.
Research has shown that HRT increases the risks of breast cancer and ovarian cancer in women (the risks of breast cancer being reduced if you take oestrogen-only HRT). However, research also indicates that your risk of getting cancer will return to normal after a few years of not using HRT.
This means that, generally speaking, it is safe for most women to use HRT for a period of a few years. Most doctors agree that, although there is some risk involved, HRT can make a significant improvement to your quality of life, making it a worthwhile treatment for many women going through the menopause.
If you decide against HRT altogether, there are some alternative treatments you might be interested in. See Alternative Treatments for the Menopause.