Hormone replacement therapy (HRT)

Specialty of Endocrinology, diabetes & metabolism

What is menopausal hormone therapy?

Menopausal hormone therapy involves taking medication to replace oestrogen lost during the menopause.

Menopausal hormone therapy is one of a many types of hormone replacement therapy. Hormone replacement can also be offered to:

Why is it done?

As women approach the menopause their levels of oestrogen fall, leading to a number of uncomfortable symptoms such as:

Hormone replacement can help to maintain the levels of oestrogen in the body, and combat some of these symptoms.

It is particularly recommended in women who experience an early menopause, as they are at a higher risk of heart disease, anxiety, depression, or parkinsonism if their oestrogen levels are too low.

Finally, hormone replacement has also been found to help prevent bone loss and reduce the risk of fragility fractures.

Hormone replacement therapy is not likely to be recommended if you have a history of womb, ovarian or breast cancer, or if you have a history of blood clots.

What does it involve?

Hormone replacement therapy involves taking medication on a regular basis.

There are different ways to take the medication, including as a pill, cream, or skin patch. You can also take the medication continuously or in cycles.

Unless you have had a hysterectomy, it’s likely you will need to take progesterone in addition to oestrogen, to reduce your risk of developing uterine cancer.

It’s important to discuss the risks and benefits of hormone replacement thoroughly with your doctor before making a decision. While there are many benefits (as described above), hormone replacement therapy can increase your risk of breast cancer and stroke. Side effects can include:

  • bloating and indigestion
  • headaches
  • tenderness or swelling in your breasts
  • nausea
  • vaginal bleeding

What are the alternatives?

If you ultimately feel that the risks and side effects for you outweigh the benefits, there are alternative ways of tackling menopause symptoms you can consider:

  • alternative medication – to tackle symptoms such as hot flushes or night sweats, your doctor may recommend trying tibolone,clonidine, or in some cases, antidepressants. These have their own risks and side effects and these should be discussed thoroughly
  • vaginal lubricant or moisturiser may tackle symptoms of vaginal dryness
  • regular exercise can reduce hot flushes and boost your mood
  • dietary changes – a healthy diet can keep your bones strong and help you maintain a healthy weight. Cutting down on caffeine or alcohol in particular can reduce hot flushes
  • Sleep hygiene – you can help improve your sleep by relaxing before going to bed, and making sure the room is cool to avoid night sweats
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