hormone replacement therapy

Hormone Replacement Therapy (HRT) for Women

Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of menopause by replacing the hormones that naturally decline during this time, mainly oestrogen and sometimes progesterone.
HRT can help manage symptoms like hot flushes, night sweats, mood changes, vaginal dryness, and reduced sex drive. It can also help protect against osteoporosis, a condition where bones become weaker and more likely to break.
HRT is commonly used by women going through perimenopause or menopause, usually between the ages of 45 and 55, though it can be started earlier in cases of premature or surgical menopause.

What are the symptoms of menopause?

Menopause symptoms can vary widely from woman to woman and may last for several years. Common symptoms include:

• Hot flushes: Sudden feelings of heat in the face, neck, and chest
• Night sweats: Excessive sweating during sleep that can disrupt rest
• Vaginal dryness: Discomfort during sex or increased risk of urinary tract infections
• Mood swings: Feeling more irritable, anxious, or low than usual
• Sleep disturbances: Trouble falling or staying asleep
• Reduced sex drive: A decrease in sexual desire or enjoyment
• Joint aches and muscle pain: Stiffness or discomfort in joints and muscles
• Problems with memory or concentration: Sometimes referred to as 'brain fog'

If these symptoms are affecting your daily life or wellbeing, HRT may be an effective option to help manage them.

Types of HRT

The type of HRT you are offered will depend on your symptoms, age, and whether you still have a womb. There are several types of HRT available:

Combined HRT (oestrogen and progestogen):

• Recommended for women who still have their womb to protect the womb lining
• Can be taken continuously or in a cyclical (monthly) pattern depending on whether you're still having periods

Oestrogen-only HRT:

• Used for women who have had a hysterectomy (removal of the womb)
• Reduces menopause symptoms and supports bone health

Local oestrogen (vaginal HRT):

• Comes as creams, pessaries, or vaginal rings
• Used for symptoms like vaginal dryness or discomfort during sex
• Does not require progestogen and carries fewer risks

Body-identical HRT:

• Uses hormones chemically identical to those made in the body
• Typically available as gels, patches, or micronised progesterone capsules
• Some women prefer this option due to its natural profile

How is HRT taken?

HRT can be taken in several different forms depending on your preference and medical history:

• Tablets: Taken orally, usually once a day
• Skin patches: Applied to the skin and changed every few days
• Gels and sprays: Applied to the skin once daily, allowing flexible dosing
• Vaginal creams, rings, or pessaries: Applied directly for local symptoms like dryness or irritation

Your healthcare provider will help you decide which form suits your lifestyle and needs best.

Will HRT work?

Most women find HRT highly effective at relieving menopausal symptoms, particularly hot flushes, night sweats, and vaginal dryness.
It can also improve sleep, mood, and overall quality of life. Bone health also benefits from oestrogen replacement, reducing the risk of fractures in later life.
However, it may take a few weeks to feel the full effect, and adjustments to dose or type may be needed over time.

HRT side effects and risks

Like all medications, HRT can have side effects. These usually settle within a few weeks but can include:

• Breast tenderness
• Headaches
• Nausea
• Leg cramps
• Irregular bleeding (especially in the first few months)

There are also some risks associated with long-term use of HRT, including:

• Slightly increased risk of breast cancer: Mainly with combined HRT and typically decreases after stopping treatment
• Increased risk of blood clots: Especially with tablet forms of HRT
• Increased risk of stroke: Slightly raised in older women using oral HRT

The benefits of HRT usually outweigh the risks for most women under 60 or within 10 years of menopause, especially when used at the lowest effective dose for the shortest duration needed.