Expert insight: Hormonal replacement therapy for menopause

Written by: Dr Masud Haq
Edited by: Sophie Kennedy

Hormonal replacement therapy (HRT) can be used to resolve some of the more troublesome symptoms of the menopause and can therefore help to improve women’s quality of life as they go through this period of change. In this informative article, revered consultant in diabetes and endocrinology Dr Masud Haq shares his expert insight on the advantages of HRT and associated safety concerns. The highly respected specialist additionally details how treatment of this type can be administered and how its effectiveness may be reviewed throughout a course of treatment.



What are the advantages of hormonal replacement therapy for menopause?


Hormone replacement therapy (HRT) can help reduce the classical symptoms of hot flushes and night sweats associated with menopause. Other benefits include an improvement in energy, mood, ‘brain fog’, sex drive (also referred to as libido), concentration levels, sleep and overall quality of life. Vaginal dryness and urinary symptoms can also improve.


Long-term benefits include an improvement in bone health and a reduction in osteoporosis and fracture risk. If prescribed before the age of sixty, or within ten years of the menopause, there is a reduction in the risk of heart disease.



How safe is hormonal replacement therapy for menopause? Are there any side effects?


There should be a holistic approach when managing patients as lifestyle changes can be very helpful. If HRT is considered, it is generally safe and effective for the majority of women. Treatment should always be tailored to the individual accounting for the woman’s age, medical history and preference.


The risk of breast cancer with combined HRT (oestrogen and progesterone) is very low, particularly when compared to lifestyle risk factors such as alcohol intake and obesity. There is a very small risk of venous thrombosis (blood clots) or stroke but this occurs with oral oestrogen. These risks can be avoided by using transdermal preparations.



Who is an ideal candidate for hormonal replacement therapy for menopause?


Most women over forty-five with menopausal symptoms can be offered HRT. They should be provided with information and seek help to discuss the benefits of treatment.


Women with possible premature ovarian insufficiency (POI) should have a FSH (follicle stimulating hormone) blood test on at least two occasions and if elevated, they should seek a specialist opinion. Women with early menopause (from the age of forty to forty-five) should also be offered HRT after receiving advice and support.



How is HRT administered?


There are many HRT preparations but they all contain oestrogen. Some preparations are combined with progestogens. Oestrogen is available as a tablet, gel, patch or spray. Transdermal oestrogen is preferred as it’s considered safer.


Progestogens are available as micronised progesterone which is plant derived and ‘bioidentical’ to the natural progesterone produced by the ovaries. The alternative is synthetic progesterone which is available as a tablet, patch or intrauterine progestogen releasing system (IUS). Low dose testosterone replacement can be considered in some women and can help improve libido but is also likely to help energy levels and mood.



How long is a typical course of HRT?


Whereas in the past, women would have only received HRT for two to five years or until age sixty, there is no set time limit for the duration of HRT.


As every patient is different, the length of treatment should be assessed by weighing up the benefits and risks. A treatment “holiday” can be considered to determine whether symptoms have resolved. After initiating HRT, patients are typically reviewed after three months and then annually.




If you think you could benefit from treatment with HRT and wish to schedule a consultation with Dr Haq, you can do so by visiting his Top Doctors profile.

By Dr Masud Haq
Endocrinology, diabetes & metabolism

Dr Masud Haq is a highly respected Consultant in diabetes and endocrinology based in London and Tunbridge Wells. He is renowned for his expertise in managing patients with thyroid problems, menopauseobesity and diabetes and also specialises in menstrual disorders and testosterone deficiency.

After obtaining a bachelor’s degree with honours, Dr Haq completed his medical training with honours at Guy’s and St. Thomas’ NHS Foundation Trust in 1995. After completing his specialist training in London, Dr Haq was awarded dual accreditation in diabetes and endocrinology and general medicine. During his training, Dr Haq also completed an MD in Thyroid disorders at the Royal Marsden Hospital, Institute of Cancer Research and University of London.

Dr Haq worked as a consultant at St George’s Hospital and the Chelsea and Westminster NHS Foundation Trust before taking up his substantive appointment as a consultant in diabetes and endocrinology at Maidstone and Tunbridge Wells Hospital NHS Trust in 2008. In 2010, Dr Haq was awarded a Fellowship of the Royal College of Physicians. In 2015, he was also awarded a Diploma from the Royal College of Obstetricians and Gynaecologists (DRCOG). Dr Haq was clinical lead of his department between 2012 and 2020, during which time he established the West Kent Diabetes Community model.

Dr Haq prides himself on providing the best possible management strategies for his patients, with a focus on ensuring his patients are well informed about their care. He sees private patients at the Spire Tunbridge Wells Hospital10 Harley Street in central London and Kingsbridge Private Hospital in Belfast.

In addition to his clinical responsibilities, Dr Haq has held a number of important roles in medical education. He was the foundation training programme director for second year trainees for ten years. In addition, he regularly provides training for GPs, practice nurses, junior doctors and medical students and has delivered informative presentations for patients on his areas of expertise.

Dr Haq is passionate about improving standards of patient care and has been an active member of his local Diabetes Clinical Commissioning Group. He received first prize for a Quality Improvement project at his Trust in 2022 and also gave a winning oral presentation at the Quality Improvement Conference, King’s College in the same year.

Dr Haq was a double finalist at the prestigious HSJ Value awards in 2021 in recognition of his diabetes work. He was shortlisted for a Marie Curie prize for research and was awarded an esteemed Wellcome scholarship. He is a member of a number of key professional bodies, including the British Thyroid Association and the Society of Endocrinology.

View Profile

Overall assessment of their patients

  • Related procedures
  • Alopecia
    Eating disorders
    Erectile dysfunction
    Polycystic ovary syndrome (PCOS)
    Hypertension (high blood pressure)
    Disorder of sexual desire of man
    Clinical nutrition
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.