What menopause and hormone replacement therapy (HRT) do to your body

Written by: Dr Nneka Nwokolo
Published: | Updated: 29/11/2023
Edited by: Laura Burgess

Menopause refers to the time in a woman’s life when the ovaries cease to function and menstruation stops. The period before this is called the perimenopause. Menopause usually occurs between ages 45 and 55, but this varies from country to country; in the UK, the average age of menopause is 51. Rarely, menopause may occur much earlier than this, sometimes before age 40. In most women, menstruation doesn’t suddenly cease; periods gradually become more irregular and less frequent.

As ovarian function declines, there is a fall in levels of the hormone oestrogen, which is necessary to maintain a healthy reproductive system and protects women from heart disease before the menopause. Oestrogen also helps keep bones healthy and prevent osteoporosis. Lack of oestrogen is the cause of many of the symptoms women experience during the menopause.

What are the symptoms of menopause?

During the perimenopause, periods, as well as becoming irregular, may also be heavier or lighter. Up to 80 per cent of women experience hot flushes - sudden feelings of heat often followed by drenching sweats. Other symptoms include insomnia, low mood, aches and pains and foggy thinking. Genital symptoms such as vaginal dryness, urinary frequency and incontinence are common. Many women lose interest in sex, sometimes because they find it uncomfortable, but also because they feel less sexually attractive.

What is HRT?

HRT (hormone replacement therapy) replaces the hormones that are no longer produced by the ovaries and can be taken orally, as a pill, or through the skin as a patch or gel. Replacing oestrogen relieves menopause symptoms and allows women to start feeling normal again.

When given on its own, oestrogen causes the womb (uterus) lining to thicken, which may carry a long-term risk of cancer. Women who have a uterus need to have progesterone as well to reduce this risk. Women who have had their uterus removed can have HRT with oestrogen alone.

What are the benefits of HRT?

Although confusing media reports in recent years have put many women off HRT, for the majority of women under the age of 60, HRT is safe and extremely effective at relieving symptoms. HRT also protects against, and is the treatment of choice for osteoporosis.

Studies show that women who take HRT within 10 years of menopause actually have a lower risk of heart disease. This does not mean that women who start HRT earlier in the menopause need to stop taking it when they get to 60. The general guidance is that HRT should be taken for as long as a woman needs it. In women over the age of 60, HRT may not be appropriate; the benefits and risks should be discussed with a doctor.

What are the risks of HRT?

Oral HRT may carry a very small risk of blood clots but transdermal (patches or gels) HRT does not. In women who start HRT over the age of 60, there may be an increased risk of heart disease and strokes; however, this risk is much lower in women under 60 or who start within 10 years of the menopause.

In women between 50 and 59 who take combined HRT (with oestrogen and progesterone) for over 5 years, there may be a tiny increase in breast cancer risk (an extra 3 cancers for every 1000 women taking HRT compared to women who aren’t). Drinking one small glass of wine a day carries a greater cancer risk than HRT!

Can HRT make you gain weight?

There is no evidence that HRT causes weight gain. Women often gain weight as they get older and their metabolism slows down. Because HRT is commenced during this time, women often mistakenly attribute weight gain to this. It’s very important to pay attention to diet and lifestyle as these often also help with menopause symptoms.

Women experiencing the menopause should consult a specialist to discuss the best treatment options available.

Dr Nneka Nwokolo

By Dr Nneka Nwokolo
Genitourinary Medicine

Dr Nneka Nwokolo is a London based consultant physician in Sexual Health and HIV Medicine who is known for her sensitivity and discretion.

Dr Nwokolo has extensive experience in the management of sexually transmitted infections STIs and HIV in men and women, and a special interest in the management of chronic and recurrent problems such as genital herpes, recurrent thrush and bacterial vaginosis. She has particular expertise in the treatment of syphilis and antibiotic-resistant gonorrhoea.

Other areas of expertise include contraception, management of the menopause, the sexual health of women and adolescents and pre and post-exposure prophylaxis against HIV infection.

She was the lead author of the 2015 UK National Guideline for the Management of Genital Chlamydia Infection. She has many publications in the fields of sexual health and HIV.

Dr Nwokolo provides the full range of contraceptive methods including implants and intrauterine contraception and is an instructing doctor for the Faculty of Sexual and Reproductive Health, providing training in contraception to doctors and nurses. She is the lead for young people in her NHS practice and provides sympathetic sexual health care and contraception to adolescents over the age of 16.


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