What is hormone replacement therapy (HRT) and what are the pros and cons?
With 80% of women suffering from night sweats, insomnia and hot flushes during the menopause, could HRT be the answer in alleviating some of more unpleasant side effects of the menopause?
What is HRT?
So, what is HRT? Hormone replacement therapy (HRT) is used to relieve women of symptoms associated with the menopause.
HRT replaces the female sex hormones oestrogen and progesterone which fall as a woman approaches the menopause. As these hormones are replaced whilst using HRT, symptoms such as mood swings, hot flushes and anxiety can be minimised and bring respite to women who may suffer from these symptoms.
There are 2 main types of HRT, one for if you are experiencing the menopause and another if your periods have stopped completely. The majority of women will take a blend of oestrogen and progesterone, however oestrogen only therapy is available for certain women.
Should I take HRT?
You should speak to your GP if you are interested in starting HRT but usually you will be able to begin as soon as you experience menopausal symptoms.
How long after starting HRT do you feel a difference?
It can take a number of weeks for you to feel the effects of HRT due to the low dosage you will start with. If after 6 weeks you have not seen any impact, you may wish to speak to your GP to see if your dosage can be altered.
There are number of ways in which you can take HRT such as through tablets, gels and creams as well as HRT skin patches. This will depend on your dosage and hormones required which your GP will be able to discuss with you and recommend the best course of action.
What are the benefits of HRT?
For many women, HRT can help relieve common symptoms that last on average around four years during and after the menopause – for example, hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive.
HRT can also help prevent osteoporosis (the weakening of the bones), which is more common after the menopause.
Professor Hasib Ahmed, consultant gynaecologist at Benenden Hospital, says:
“I find that HRT patches work particularly well. The hormones go straight through the skin and into the blood stream, and the patient receives a steady dose rather than the peaks and troughs that you can get with tablets. There are many different treatments and we endeavour to find one to suit the individual woman’s needs. There are tablets, patches, gels, intravaginal tablets and a hormone-containing coil, the Mirena.”
Are there any disadvantages of HRT?
There are some disadvantages associated with HRT, but evidence suggests the benefits usually outweigh the risks, for many. As with all medications, HRT can have some side effects. These can include headaches, breast tenderness and vaginal bleeding or spotting.
Some evidence also suggests that some types of HRT can increase breast cancer risk. However, this is a controversial topic as many other lifestyle factors, such as age, alcohol intake, and obesity, should also be considered.
The blood clot risk is greater with oral oestrogen, therefore, transdermal oestrogen given as a gel or patch is much safer. For those with a womb, continuous progesterone is better for endometrial health, however, do discuss your treatment options with a menopause specialist, or a GP.
When to take HRT?
This depends on your reasoning for starting HRT in the first place and is a very individual decision. But in general, your HRT will be slowly phased out of the system by gradually lowering the dosage or reducing the number of times you take HRT.
If hormone replacement therapy is being used purely for the symptoms of the menopause, generally it can be taken for as long as the menopause symptoms are causing a detrimental effect.
If preventing the risk of osteoporosis is a factor in your decision then you need to take HRT for a minimum of five years.
Your GP will review the pros and cons of HRT for you every year and any decision to stop should be made with a healthcare professional.
Why aren’t women seeking HRT treatment?
Part of the issue might be the mixed messages about HRT in the media.
In 2002, a study suggested links with an increased risk of breast cancer and stroke. However, updated analysis of the original data and subsequent studies have shown that when HRT is an appropriate treatment, and used in the correct setting, the increased risks of serious problems, such as blood clots and breast cancer, are small.
In short, for most women, the benefits of HRT are generally felt to outweigh the risks. However, prior to commencing with any treatment, you should consult with your GP to make sure you are aware of all the possible HRT side effects and that you are comfortable with any potential risks.
What about alternatives to HRT?
There are a number of lifestyle changes you can undertake in order to help reduce and manage some of the symptoms of the menopause:
Have a balanced diet – this ensures a healthy weight is maintained and ensures your bones stay healthy.
Cut down on triggers – alcohol, spicy food and caffeine have all been known to trigger hot flushes – giving up smoking will also help reduce hot flushes, as well as reducing your risk of developing heart disease or cancer.
Regular exercise – this improves sleep and can reduce hot flushes. Physical activity also improves your mental health and can boost your mood if you are feeling anxious or irritable.
Benenden Health have more information about managing with the menopause here, but don’t be afraid to see your GP if you are having trouble coping.
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Medically reviewed by Llinos Connolly in March 2024.
