Hormone Replacement Therapy

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.

HRT is a hormone treatment that includes the hormones oestrogen, often progestogen and in some cases testosterone. In this blog post, we are exploring the different types of HRT, when you should start, and associated benefits and risks.

The decision to undergo 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. Book a consultation now with one of our experienced practitioners.

What are the 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.

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.

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.

Local Vaginal Oestrogen

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

When should you start HRT?

What are the expected benefits of 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 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.

Autoimmune Disorders

How do female hormones impact Autoimmune Disorders?

Oestrogen has immunomodulatory effects, influencing the activity of the immune system. It may contribute to a more robust immune response. It is also known for its anti-inflammatory properties, potentially dampening the immune response in certain contexts.

Progesterone also has immunomodulatory effects, and its balance with oestrogen is crucial for maintaining immune system homeostasis. Progesterone exhibits anti-inflammatory properties, helping regulate immune responses.

Testosterone contributes to the regulation of immune responses. It may modulate the activity of immune cells and influence inflammation.

What are the benefits of Hormone Replacement Therapy (HRT) on Autoimmune Disorders?

The benefits of HRT on autoimmune disorders are individualized, and responses may vary based on factors such as the specific autoimmune condition, overall health, and genetic factors.

Modulation of Immune Responses: HRT, by providing a balance of hormones, may contribute to the balanced modulation of immune responses. This could be beneficial in autoimmune disorders where the immune system is overactive.
Anti-Inflammatory Effects: Oestrogen and progesterone in HRT may help reduce inflammation, potentially benefiting individuals with autoimmune disorders characterised by excessive inflammation.
Symptom Management: In some cases, HRT may help alleviate symptoms associated with autoimmune disorders, such as joint pain, fatigue, or skin manifestations.
Addressing Hormonal Changes: Fluctuations in hormone levels, especially during menopause, may impact autoimmune disorders. HRT can help manage these hormonal changes and their potential effects on the immune system.
Overall Well-being: HRT, when used as part of a holistic approach to wellness, may contribute to overall well-being, including the management of autoimmune disorder symptoms.

In summary, female hormones play a role in modulating immune responses, and HRT may offer benefits in balancing immune function and managing symptoms of autoimmune disorders.

Bladder Health

How is the bladder impacted by hormones?

Oestrogen contributes to the health of the urethra and vaginal tissues. Adequate oestrogen levels help maintain the elasticity and integrity of these tissues, supporting bladder function. Oestrogen plays a role in maintaining pelvic floor muscle tone, which is crucial for bladder control.

While progesterone’s direct impact on the bladder is less clear, its role in maintaining overall reproductive health may indirectly contribute to pelvic floor muscle function and bladder health.

Testosterone albeit present in smaller amounts in women, contributes to muscle strength, including the pelvic floor muscles. Adequate muscle strength is essential for bladder control.

What are the benefits of Hormone Replacement Therapy (HRT) on Bladder Health?

The benefits of HRT on bladder health are individualised, and responses may vary based on factors such as overall health, pre-existing conditions, and lifestyle. Some benefits may include:

Improved Urethral and Vaginal Health: HRT, particularly with oestrogen, can help combat vaginal atrophy and dryness, contributing to the overall health of the urethra and vaginal tissues.
Maintaining Pelvic Floor Muscle Tone: Oestrogen in HRT may help prevent the atrophy of pelvic floor muscles, maintaining their tone and strength for better bladder control.
Reduced Risk of Incontinence: HRT, by supporting bladder-related tissues and muscles, may reduce the risk of stress urinary incontinence and urge incontinence in postmenopausal women.
Enhanced Bladder Function: HRT, by influencing muscle tone and strength, can contribute to the optimal function of the pelvic floor muscles, providing better support to the bladder.
Addressing Bladder Symptoms: Some women may experience bladder symptoms, such as increased frequency or urgency, during menopause. HRT can help alleviate these symptoms by addressing hormonal imbalances.

Bone Health

How do female hormones impact bone joints?

Oestrogen plays a crucial role in maintaining bone density. It helps regulate the balance between bone formation and resorption, contributing to overall bone health. It may influence joint lubrication and reduce inflammation, promoting joint comfort and mobility.

Progesterone’s primary role is in the reproductive system, however, it may have indirect effects on bone remodelling, contributing to overall bone health.

Testosterone, though present in smaller amounts in women, contributes to the maintenance of bone density and strength. It plays a role in supporting overall bone health.

What are the benefits of Hormone Replacement Therapy (HRT) on Bone Joints?

The benefits of HRT on bone joints are individualized, and responses may vary based on factors such as genetics, overall health, and lifestyle. Some benefits of HRT may include:

Preservation of Bone Density: HRT, especially with oestrogen, helps preserve bone density and reduces the risk of osteoporosis, a condition characterised by weakened and porous bones.
Joint Comfort and Lubrication: Oestrogen in HRT may contribute to joint comfort and improved lubrication, potentially reducing symptoms of joint stiffness and discomfort.
Prevention of Osteoarthritis: HRT may play a role in reducing the risk of osteoarthritis, a degenerative joint condition, by supporting joint structures and function.
Enhanced Bone Remodelling: HRT, by providing a balance of oestrogen and, in some cases, progesterone and testosterone, supports healthy bone remodelling processes.
Overall Musculoskeletal Support: HRT, by supporting bone density and joint health, contributes to overall musculoskeletal support, helping maintain mobility and reducing the risk of fractures and joint-related issues.

In summary, female hormones, particularly oestrogen, play a crucial role in maintaining bone density and supporting joint health. HRT, when carefully considered and prescribed, may offer benefits in preserving bone density, reducing the risk of osteoporosis and osteoarthritis, and supporting overall musculoskeletal function.

HRT, Hypermobility & Ehlers-Danlos Syndrome (EDS)

Hormone Replacement Therapy (HRT) is often used to address hormonal imbalances in the body. In the context of hypermobility and Ehlers-Danlos syndrome (EDS), there may be a connection between hormonal fluctuations and the symptoms associated with these conditions. However, the relationship between hormones and hypermobility/EDS is complex, and research in this area is ongoing.

Some individuals with hypermobility or EDS may experience fluctuations in symptoms related to hormonal changes, such as those that occur during the menstrual cycle, pregnancy, or menopause. For this reason, some healthcare providers may consider HRT as part of a broader management plan for individuals with EDS or hypermobility.

It’s important to note that the use of HRT should be carefully considered on an individual basis, and the potential benefits and risks need to be thoroughly discussed with a knowledgeable healthcare professional. Hormonal therapies can have various effects on the body and may not be suitable for everyone. Additionally, there may be other approaches to managing hypermobility and EDS symptoms, such as physical therapy, pain management, and lifestyle modifications.

If you or someone you know is considering HRT for hypermobility or EDS, it’s crucial to consult with a healthcare provider who has experience in treating these conditions. They can assess your specific situation, discuss potential benefits and risks, and help you make an informed decision about whether HRT is an appropriate part of your treatment plan.

Hormone Replacement Therapy (HRT) involves the replacement of one or more hormones—oestrogen, progesterone, and testosterone. According to NICE guidelines from 2015, HRT is recommended as the first choice for women experiencing symptoms due to low or fluctuating hormone levels. It has been shown to provide effective relief for symptoms, with benefits generally outweighing risks for most women.

Insulin Resistance

How do female hormones impact Insulin Resistance?

Oestrogen is associated with improved insulin sensitivity. It helps cells respond more effectively to insulin, promoting glucose uptake and regulation. It has anti-inflammatory effects, and chronic inflammation is linked to insulin resistance. By mitigating inflammation, oestrogen may indirectly support insulin sensitivity.

While the direct impact of progesterone on insulin sensitivity is less clear, its balance with oestrogen is crucial for overall hormonal harmony and metabolic health.

Testosterone, though present in smaller amounts in women, plays a role in insulin sensitivity. It contributes to glucose metabolism and may support overall metabolic function.

What are the potential benefits of Hormone Replacement Therapy (HRT) on Insulin Resistance?

The benefits of HRT on insulin resistance are individualized, and responses may vary based on factors such as genetics, overall health, and lifestyle.

Improved Insulin Sensitivity: HRT, by providing a balanced mix of hormones, may help improve insulin sensitivity, reducing the risk of insulin resistance.
Metabolic Support: Oestrogen and, to some extent, testosterone in HRT may contribute to improved glucose metabolism, supporting overall metabolic health.
Reduced Inflammation: Oestrogen’s anti-inflammatory effects, supported by HRT, may help reduce inflammation, which is linked to insulin resistance.
Hormonal Management During Menopause: Insulin resistance may be affected by hormonal changes during menopause. HRT can help manage these changes and potentially support metabolic health.
Overall Metabolic Well-being: HRT, when used as part of a holistic approach to health, may contribute to overall metabolic well-being, including the management of insulin resistance.

In summary, female hormones, particularly oestrogen, play a role in insulin sensitivity, and HRT may offer potential benefits in managing insulin resistance.

Metabolic Disorders

How do female hormones impact Metabolic Disorders?

Oestrogen is associated with improved insulin sensitivity, which is crucial for glucose metabolism. It helps cells respond more effectively to insulin. It influences fat distribution, favouring subcutaneous fat over visceral fat. This distribution may contribute to metabolic health.

Progesterone while primarily associated with the reproductive system, may play a role in metabolic balance when in harmony with oestrogen.

Testosterone though present in smaller amounts in women, contributes to muscle mass maintenance and may impact overall metabolic function.

What are the potential benefits of Hormone Replacement Therapy (HRT) on Metabolic Disorders?

The benefits of HRT on metabolic disorders are individualised, and responses may vary based on factors such as genetics, overall health, and lifestyle.

Improved Insulin Sensitivity: HRT, by providing a balanced mix of hormones, may help improve insulin sensitivity, reducing the risk of metabolic disorders such as insulin resistance and type 2 diabetes.
Weight Management: Oestrogen in HRT may influence fat distribution, potentially supporting weight management and reducing the risk of metabolic complications associated with visceral fat.
Muscle Mass Preservation: HRT, including testosterone, when necessary, may contribute to the preservation of muscle mass, which is essential for metabolic health.
Reduced Inflammation: Oestrogen’s anti-inflammatory effects, supported by HRT, may help reduce inflammation, a factor linked to metabolic disorders.
Cardiovascular Health: Oestrogen’s influence on cardiovascular health, supported by HRT, may contribute to reducing the risk of metabolic disorders associated with heart disease.
Addressing Menopausal Changes: Metabolic changes often accompany menopause. HRT can help manage these changes and potentially support metabolic health during this transition.
Overall Well-being: HRT, when used as part of a holistic approach to health, may contribute to overall metabolic well-being, including the prevention or management of metabolic disorders.

In summary, female hormones, particularly oestrogen, play a crucial role in metabolic health, and HRT may offer potential benefits in improving insulin sensitivity, supporting weight management, and reducing inflammation.

Muscle Strength

How do female hormones impact muscle strength?

Oestrogen plays a role in preserving muscle mass, and its decline, particularly during menopause, may contribute to a decrease in muscle mass. It also influences collagen synthesis, providing structural support to muscles and connective tissues.

Progesterone has muscle-relaxing properties, especially during pregnancy, where it helps prevent uterine contractions. Hormonal fluctuations, including changes in progesterone levels, may affect exercise performance, influencing factors like muscle coordination.

While present in smaller amounts in women, testosterone contributes to muscle protein synthesis, promoting the growth and repair of muscle tissues. Testosterone replacement in women with low levels can lead to increased lean muscle mass and improved muscle strength.

What are the benefits of hormone replacement therapy (HRT) on muscle strength?

The benefits of HRT on muscle strength are individualised, and responses may vary based on factors such as genetics, overall health, and lifestyle.

Preservation of muscle mass: HRT, particularly with oestrogen, may help prevent age-related loss of muscle mass, contributing to improved muscle strength.
Enhanced exercise performance: HRT, including testosterone replacement, may contribute to improved muscle coordination and strength, potentially benefiting exercise performance.
Reduced risk of sarcopenia: sarcopenia, the age-related loss of muscle mass and function, may be mitigated with HRT, helping maintain muscle strength in postmenopausal women.
Optimizing bone health: HRT, especially with oestrogen, can contribute to optimal bone health. Strong bones provide a stable framework for muscles, supporting overall musculoskeletal health.
Management of fatigue: HRT, by addressing hormonal imbalances, may help reduce fatigue and improve energy levels, positively influencing muscle strength.
Maintaining functional independence: preserving muscle strength through h HRT can contribute to maintaining functional independence and a higher quality of life, especially in ageing women.

In summary, oestrogen, progesterone, and testosterone play vital roles in muscle health, and HRT may offer benefits in preserving muscle mass, improving strength, and addressing age-related changes. However, decisions regarding HRT should be approached cautiously, considering individual health profiles and consulting with healthcare professionals for personalized advice.

Palpitations & the Cardiovascular System

How do female hormones impact palpitations and the Cardiovascular System?

Oestrogen has cardio-protective effects, contributing to the dilation of blood vessels and improving blood flow. It helps maintain healthy blood vessel function. Oestrogen influences the electrical conduction system of the heart, promoting stable heart rhythms.

Progesterone may have a vasodilatory effect on blood vessels, helping to regulate blood pressure. It works in conjunction with oestrogen to maintain cardiovascular balance.

Testosterone contributes to cardiovascular health, affecting factors such as blood vessel tone and cardiac function.

What are the benefits of Hormone Replacement Therapy (HRT) on Palpitations and the Cardiovascular System?

The benefits of HRT on palpitations and the cardiovascular system are individualized, and responses may vary based on factors such as genetics, overall health, and lifestyle.

Reduced Cardiovascular Risks: HRT, particularly with oestrogen, may offer cardiovascular protection by improving blood vessel function, reducing the risk of atherosclerosis and related cardiovascular issues.
Stabilized Heart Rhythms: Oestrogen in HRT can contribute to stable heart rhythms, potentially reducing the incidence of palpitations and irregular heartbeats.
Blood Pressure Regulation: HRT, with the combined influence of oestrogen and progesterone, may help regulate blood pressure, contributing to overall cardiovascular health.
Improved Blood Flow: Oestrogen’s vasodilatory effects, supported by HRT, may improve blood flow, reducing the strain on the heart and promoting optimal cardiovascular function.
Alleviating Menopausal Symptoms: Palpitations and cardiovascular changes are sometimes associated with menopause. HRT can help alleviate these symptoms by addressing hormonal imbalances.
Holistic Approach: HRT, by supporting cardiovascular health, contributes to overall well-being and may reduce the risk of cardiovascular issues associated with hormonal changes.

In summary, female hormones, particularly oestrogen, play a significant role in cardiovascular health. HRT, when carefully considered and prescribed, may offer benefits in reducing cardiovascular risks, stabilizing heart rhythms, and alleviating symptoms such as palpitations.

Skin Health

How is the skin impacted by hormones?

Oestrogen promotes collagen production, a protein that provides structure and elasticity to the skin. Higher collagen levels contribute to firmer and more youthful-looking skin. Oestrogen also helps maintain the thickness of the skin by influencing the production of collagen and other components of the extracellular matrix.

Progesterone can influence skin hydration by affecting the activity of sweat and sebaceous glands. Like oestrogen, progesterone plays a role in maintaining collagen and elastic fibres in the skin, contributing to its strength and elasticity.

Testosterone, though present in smaller amounts in women, influences sebum production. Balanced serum levels contribute to skin hydration and may affect conditions such as acne.

What are the benefits of Hormone Replacement Therapy (HRT) on Skin?

The benefits of HRT on the skin are individualised, and responses can vary. Factors such as genetics, overall health, and lifestyle play significant roles. Some benefits may include:-

Collagen production
- Reduction of wrinkles: HRT, particularly with oestrogen, may help stimulate collagen production, reducing the appearance of wrinkles and fine lines associated with ageing.
- Improved skin elasticity: enhanced collagen levels can improve skin elasticity, leading to a more youthful and resilient complexion.
Hydration: HRT can contribute to maintaining skin moisture levels, addressing dryness and improving overall skin health.
Prevention of skin thinning: oestrogen in HRT may help prevent the thinning of the skin, which is common in postmenopausal women and can contribute to increased fragility.
Reduction of menopausal skin changes: menopause is often associated with skin changes such as dryness, loss of elasticity, and increased wrinkles. HRT can help alleviate these symptoms.
Management of acne: HRT may help regulate sebum production, benefiting women experiencing acne or oily skin, especially during hormonal fluctuations.

In summary, oestrogen, progesterone, and testosterone influence various aspects of skin health, and HRT, when carefully considered and prescribed, may offer benefits in maintaining skin vitality, reducing signs of ageing, and addressing specific skin concerns associated with hormonal changes.

Testosterone & ADHD in Women

Research on the link between testosterone and ADHD in women is an area of ongoing investigation, and findings are not yet fully conclusive.

ADHD is a complex neuro-developmental disorder, and its aetiology is likely influenced by a combination of genetic, environmental, and hormonal factors. Hormones, including testosterone, interact with neurotransmitters and brain regions implicated in ADHD.

ADHD is traditionally associated with males, and much of the research has focused on males, leading to a gap in understanding the disorder, particularly in females. However, recent studies have explored the potential role of testosterone in ADHD, especially in women. Some studies suggest that women with ADHD may have lower levels of testosterone compared to neurotypical women. Testosterone is typically considered a male hormone, but females also produce it, albeit in lower quantities.

What impact does testosterone have on ADHD Symptoms?

Research has explored the idea that testosterone may play a role in the development and expression of ADHD symptoms in women. It is thought to influence certain brain functions, including attention, impulse control, and executive functioning.

Hormonal fluctuations, such as those that occur during the menstrual cycle or pregnancy, may influence ADHD symptoms in women. Some women report changes in symptom severity during different hormonal phases.

What are treatment implications?

The potential link between testosterone and ADHD in women has led to discussions about hormonal interventions as a part of ADHD treatment. Some studies have explored the use of testosterone supplementation in women with ADHD, but more research is needed to establish the safety and efficacy of such interventions.

It’s crucial to note that the relationship between testosterone and ADHD is complex and not fully understood. ADHD is a multifaceted disorder, and various factors contribute to its development and manifestation. Additionally, individual responses to hormonal fluctuations can vary.

If you or someone you know is concerned about ADHD symptoms, it’s essential to consult with a healthcare professional, such as a psychiatrist or neurologist, for a comprehensive evaluation. Treatment plans for ADHD often involve a combination of behavioural interventions, psychotherapy, and, in some cases, medication, but the role of hormonal factors is still an area of ongoing research.