HRT

What is HRT?

HRT, or hormone replacement therapy, is treatment that women take to help relieve menopausal symptoms like night sweats, hot flushes, vaginal dryness, poor sleep, brain fog, mood swings and lower sex drive.

How long you take it for can vary; many women take it for a year or two but some can take it for much longer than this. It’s a very individual thing. Certain types of HRT will also suit you more than others. Our clinician can talk you through the different options, and help you to decide which one is right for you.

How does HRT work?

As you enter the menopause, the levels of oestrogen that your body produces start to decrease, due to a shift in the balance of your sex hormones.^[1] This can cause symptoms such as hot flushes, night sweats and changes to your mood. HRT contains synthetic oestrogen, which makes up for the natural oestrogen that’s lost, and helps to tackle menopausal symptoms.

Combined forms of HRT also contain a second hormone: a synthetic form of progesterone. Without anything to keep it in check, oestrogen may increase your risk of getting endometrial cancer, as it can cause the womb lining to thicken more than it should. The progesterone in combined HRT offers protection from this, keeping the oestrogen in line and reducing the risk of womb cancer developing.^[2] It’s more convenient to take combined HRT as a pill or patch which contains both progesterone and oestrogen, but sometimes it’s better to take these separately.

If you’ve had a total hysterectomy though, because your womb has been removed, you’ll usually be prescribed oestrogen only HRT.^[6]

The menopause can also cause your bones to become more fragile and more prone to breaking. HRT can provide some protection against osteoporosis by helping the bones to stay strong.^[3] HRT isn’t a primary treatment for osteoporosis though, so if you’re looking to use it for this purpose, just let our clinician know and they can chat to you about it.

HRT benefits

The major benefit of HRT is that it can help to ease many symptoms of the menopause (by as much as 75%, so quite a lot then).^[4]

The oestrogen and progesterone in combined HRT make a good team. The oestrogen helps to manage symptoms of the menopause whilst the progesterone helps to keep it in check and reduces your cancer risk.^[5]

And there’s the protection it can provide from osteoporosis too, when the bones in the body are more at risk of breaking or becoming brittle after the menopause.

What forms of HRT are there?

There are a number of different types of HRT available, and we can talk you through your options.

Tablets

Tablets are one of the most widely used types of HRT. There are tablet options for both combined HRT and oestrogen only HRT, and you normally take them once every day. They do carry a slightly increased risk of blood clots and breast cancer than other forms of HRT treatment, but it is only a small increase (nine more women develop a blood clot for every 10,000 women each year).^[1]

Because of this increased breast cancer risk, make sure you attend your breast cancer screening (mammogram) appointments.

Skin patches

If you find having to remember to take a tablet every day a bit inconvenient, skin patches may be a more low maintenance treatment for you and they’re safer for your heart than tablets. You stick HRT patches to your skin, and change them twice a week. They’re available as a combined HRT treatment or as an oestrogen only medication. Skin patches can be a strong option if you’re prone to side effects such as indigestion, and they don’t increase your risk at all of developing a blood clot, unlike tablets.^[2]

Oestrogen gel

More and more women are starting to use oestrogen gel for menopausal symptoms, and it’s probably because it’s really easy to use. You just need to rub it onto your skin once a day. It doesn’t increase your blood clot risk either, but if you still have your womb, you’ll need to use an additional progesterone, to limit your chances of getting womb cancer.^[2]

Spray

The oestrogen spray is easy to use by simply applying it to your skin, and it dries up fast. Most people start by taking the lowest dose, which is one spray a day, but your doctor might increase your dose if needed. Like the gel and the patch, it doesn’t increase the risk of clots, but if you still have a womb you’ll need to take progesterone so that your risk of getting cancer doesn’t increase.^[2]

Implants

They’re not particularly common, but you can also get a HRT implant, which releases oestrogen slowly into the body and doesn’t need to be replaced for several months at a time. You’ll need to take a separate progesterone though if you’ve still got your womb.

Intrauterine system (IUS), or coil

The coil is a small device that also acts as birth control, it’s inserted into your womb by a doctor or a nurse. It slowly releases a type of progesterone called levonorgestrel into your system. Because it lasts for about 5 years, it’s usually a good choice if you’re not keen on taking tablets or changing patches regularly.