HRT

So what is the best HRT for me?

It depends on a number of factors, like what stage of the menopause you’re at, how sensitive you are to certain levels of hormones, and whether you prefer to take tablets or use patches, for example.

Whether or not you’ve had a total hysterectomy is also a factor, and if you have certain health conditions, that can play a big part too.

Here are your options. Our clinician can talk you through them, and recommend safe and suitable HRT treatments just for you.

Combined sequential HRT

If you’re getting menopausal symptoms and still having your period, combined sequential (or cyclical) HRT treatments are usually the recommended options. Combined HRT products like Elleste Duet and Evorel Sequi patches are known as ‘combined’ treatments because they contain two hormones: a progesterone and an oestrogen.

With sequential HRT, you start your cycle with oestrogen only tablets (or patches, gel, spray or implants) and then take a combination of oestrogen and progesterone tablets (or patches) part way through your cycle.

You’ll see a regular bleed once per month with sequential HRT.

Continuous combined HRT

If you haven’t had a period for one year, you’re usually considered to be postmenopausal, and continuous combined HRT products like Indivina and Evorel Conti tend to be the suggested route. With continuous combined HRT treatments, you take a combination of oestrogen and progesterone every day, without a break (hence ‘continuous’). So they’re a little different to sequential HRT products. You won’t see any bleeding with continuous HRT, but if it’s less than a year since your last natural period, starting continuous HRT might lead to some unpredictable bleeding. So it’s best to start with sequential HRT.

Oestrogen only HRT

Oestrogen only treatments such as Elleste Solo and Estradot patches are normally recommended for women who have had their womb removed during a hysterectomy. They can also be used by women who still have their womb, but a separate progesterone is required (either as a tablet, a vaginal capsule, or a gel for the skin). Like continuous combined HRT, you typically take oestrogen every day, without a break.

Side effects of HRT may also vary from one woman to the next, so some HRT medications won’t be safe (or suitable) for some women. If you’re more sensitive to oestrogen, you may be better suited to lower-dose HRT products. And if you have a particular health condition, this can mean that certain HRT products won’t be safe for you to use either.

Our clinician can identify which treatments are appropriate for you and which aren’t, and make recommendations based on your medical background.

What HRT alternatives are there?

Tibolone

There’s a prescription HRT medicine called Tibolone (branded as Livial) that’s used to relieve menopausal symptoms and as a preventative treatment for osteoporosis. Tibolone is the active ingredient, so it’s a bit different to other forms of HRT, which contain oestrogen and progesterone (or just oestrogen).

It can help to ease symptoms like hot flushes, reduced sex drive and low mood, but research has suggested that Tibolone may be less effective than combined HRT. It’s also only a suitable option for women who are postmenopausal (so women who had their last period over a year ago).

Tibolone can produce side effects, including breast pain, vaginal discharge, pain in the pelvis, itching and abdominal pain.

The slightly increased risks of breast cancer and stroke that HRT carry are similar with Tibolone.

Clonidine

Clonidine is another prescription treatment that’s sometimes used to help tackle symptoms like flushing and night sweats. It’s a tablet that you take two or three times a day, and it has no effect on hormone levels, so there’s no increased risk of breast cancer for example. Studies suggest that it only has a small impact on easing flushing and night sweats though, and it can have unpleasant side effects too.

Herbal treatments

Some studies show that medicinal plants including sage herb, black cohosh, evening primrose, ginkgo biloba, licorice, red clover and others can be effective in treating symptoms of menopause. For example, black cohosh roots contain terpene glycosides which bind to the oestrogen receptors, similar to conventional hormonal therapy. But much like any other medication, it comes with potential side effects, like stomach and gut inflammation, nausea, and vomiting.

If you’re using herbal treatments alongside other conventional medications, make sure to tell your clinician. This is really important because mixing them can cause possible side effects.

Talking therapy

Cognitive behavioural therapy (CBT) is a type of talking therapy which can help with psychological symptoms like mood swings and anxiety, and also physical symptoms like hot flushes and night sweats. If it’s something you’re interested in, you can get it through NHS.