What is HRT (Hormone Replacement Therapy) and what is HRT used for?
Hormone Replacement Therapy (commonly shortened to HRT) describes a range of treatments used to help make menopause more bearable.
HRT is used to treat specific symptoms of menopause including hot flushes, mood swings, low libido, night sweats and vaginal dryness.
How does HRT work?
A woman’s body produces the hormones oestrogen and progesterone, but this can lessen or fluctuate at menopause. HRT treatment replaces these hormones with the HRT hormones oestrogen and progestogen.
You may be prescribed a combined HRT treatment, which includes both hormones, or an oestrogen-only treatment. Most women are prescribed the combined treatment since oestrogen-only HRT can increase the risk of womb cancer. For this reason oestrogen-only HRT is generally only prescribed to women who have had a hysterectomy.
Your doctor is likely to begin with a 3-month course of HRT medication before seeing how well it works for you. If it hasn’t worked, they may then change the dosage or prescribe a slightly different kind of treatment to see if that works better.
What HRT treatment options are there?
HRT medication is available in different forms, including:
- Tablets: These are a very common way of taking HRT and include options such as Premique and Kliovance. They’re generally taken once a day. With tablets, there’s a slightly increased risk of blood clots.
- Patches: Patches are stuck to the skin and are replaced every few days. They’re available in combined versions, such as Evorel Conti or oestrogen-only versions, such as Elleste Solo. They can help you avoid some of the side effects associated with HRT and unlike tablets they don’t increase your risk of blood clots.
- Gels: Oestrogen gel is becoming more popular and is an easy way to take your HRT medication. It is rubbed into the skin once a day and absorbed by the body that way. With an oestrogen gel, if you have your womb you will need to take some form of progestogen too so as not to increase your risk of developing womb cancer.
- Implants: Implants are not as common or widely available. HRT implants are inserted under the skin of the tummy under a local anaesthetic. As with the gel, you will need to take progestogen separately as implants only contain oestrogen.
HRT treatment is either cyclical (also known as sequential) or continuous. Cyclical HRT is best for women who are having menopausal symptoms but are still having periods. It can be taken in a monthly cycle or a three-monthly cycle. In both cases you take oestrogen continuously and progestogen for 14 days of each cycle.
Continuous HRT is where you take the medication continuously without a break. Continuous combined HRT is recommended for post-menopausal women. Oestrogen-only HRT is also generally taken continuously.
It can take a few weeks to notice the effects of HRT.
Is HRT safe?
There are some risks and side effects associated with HRT, but these are generally considered to be outweighed by the positives. You should talk them all through with your GP before starting a course of treatment and if you are at all concerned at any point during your treatment.
There are specific side effects associated with each method of treatment, but the general side effects of HRT can include:
- Vaginal bleeding
- Sore breasts
- Abdominal pain
In most cases, side effects pass within three months of beginning HRT.
Some forms of HRT treatment can increase your risk of developing certain types of cancer and other conditions. Be sure you talk to your doctor to fully understand the risks involved before you begin a course of HRT.
There is a slightly increased risk with the following conditions:
- Breast cancer: There is a small increase in the risk of breast cancer when on combined HRT (oestrogen and progestogen).
- Ovarian cancer: Studies into the risk of ovarian cancer have had conflicting results, but if there is any increase in the risk it is very minimal.
- Womb cancer: Oestrogen-only HRT can increase the risk of womb cancer, so it tends to only be used in women without a womb (eg women who have had a hysterectomy).
- Blood clots: HRT tablets can increase your chance of developing a blood clot, but this isn’t the case with HRT patches and gels.
- Heart disease / stroke: Oestrogen tablets are associated with a small increase in stroke, but in general HRT doesn’t affect your risk of cardiovascular disease significantly.
See the NICE website for more information.
Are there any alternatives to HRT?
There are alternatives to HRT treatment but often they are less effective and there can be more side effects. Antidepressants, tibolone and clonidine are all medications that may be prescribed as alternatives to HRT.
There are some lifestyle changes you can make to help ease your menopause symptoms. These include:
- Giving up smoking
- Eating a healthy diet
- Cutting down on alcohol, caffeine, and spicy foods
- Exercising regularly
- Using a vaginal lubricant
- Trying to reduce your stress levels
Bioidentical hormones are a natural alternative to HRT. They aren’t recommended, however, as they aren’t regulated and it’s not known how effective they are.
Some other natural alternatives to HRT include evening primrose oil, St John's Wort, ginseng, black cohosh and angelica. You should talk to your GP before taking any complementary therapies.
There’s no limit on how long you can take HRT, but generally your doctor will want you to be taking the lowest dose for the shortest time possible. Many women stop taking HRT when they are no longer experiencing any menopausal symptoms.
However long you’ve been taking HRT, it’s important that you talk to your doctor before stopping altogether. When you do stop, you can either do it gradually or suddenly. Gradually decreasing the dose is less likely to make your symptoms come back.
Frequently Asked Questions
What are hormones?
Hormones are chemicals that help regulate processes within the body.
How long does it take for HRT to work?
It can take a few weeks to notice the effects of HRT. Your doctor will probably start you off on a 3-month course of HRT medication and evaluate how well it is working for you.