Hormone Replacement Therapy (HRT)

Types of Hormones

Oestrogen: – The most common type used is 17 beta-oestradiol, derived from the yam. It can be administered through patches, gels, oral tablets, or sprays.

Progestogen: – Essential for women with a uterus using oestrogen replacement to prevent thickening of the womb lining. Options include natural progesterone (Utrogestan), Mirena coil (releases progestogen), or other progestogens in patches or tablets.

Testosterone: – Some women may benefit from testosterone if experiencing low libido, arousal issues, and fatigue. Although no testosterone products are licensed for use in women in the UK, some healthcare professionals may prescribe them off-label.

Local Vaginal Oestrogen: – Used for symptoms like vaginal dryness, pain during intercourse, and urinary issues. It can be applied as a pessary, cream, gel, or a ring that stays in the vagina for 90 days.

When to start HRT?

HRT is recommended when symptoms negatively impact quality of life, often during the perimenopause. NICE guidelines suggest starting HRT early, preferably before the age of 60 or within 10 years of menopause, without waiting for periods to stop. There is evidence that oestrogen will benefit bone after the age of 60, so there is no arbitrary time limit on starting or duration of use.

What benefits can be expected using HRT?

Symptom Relief: HRT effectively relieves symptoms, with adjustments in dosage as needed.

Osteoporosis Risk Reduction: Reduces bone loss, lowering the risk of osteoporosis and fractures after menopause.

Cardiovascular Disease Risk Reduction: Initiating HRT within 10 years of menopause or before age 60 may be associated with a reduced risk of cardiovascular disease.

Reduced Future Risk: May lower the risks of type 2 diabetes, depression, bowel cancer, and osteoarthritis.

What are the risks associated with using HRT?

Breast Cancer: Risk varies based on factors like age, family history, and lifestyle. Studies show no increased risk with estrogen-only HRT, while combined HRT may slightly increase breast cancer risk. The risk may be minimized with Body Identical HRT.

Blood Clots:  It is important to differentiate between oral and transdermal HRT for clotting risks.  Only oral HRT and some synthetic progestogens have an increased clotting risk factor.  Oral HRT tablets carry a small increased risk of blood clots, especially in individuals with a history of blood clots, liver disease, or migraine. However, Transdermal HRT through the skin (patch, gel, or spray) does not pose an increased risk. Women with a history of blood clots can use transdermal oestrogens safely.

In conclusion, the decision to use HRT should be personalised, considering individual medical history, family history, and lifestyle factors. Consulting a healthcare professional with expertise in menopause is crucial for determining the most suitable HRT regimen.

Use the below links to find out more about Hormone Replacement Therapy.