A Guide to Hormone Replacement Therapy – HRT
Gynaecology and Obstetrics // October 21st, 2019
HRT or Hormone Replacement Therapy is often talked about in the media but there is much misunderstanding and misinformation about the treatment. HRT replaces female sex hormones, principally oestrogen and progesterone produced by the ovaries during a woman’s reproductive years.
Do we need HRT?
As the menstrual cycle becomes more irregular with increasing intervals between periods, most women will experience symptoms of oestrogen deficiency to some extent. The commonest of these are the hot flushes and night sweats, but there are often many other manifestations such as mood disturbance alteration in sexual function and complaints of dry skin and hair loss. Oestrogen def1c1ency may also lead to thinning of the bone mass (osteoporosis).
The introduction of Hormone Replacement Therapy can prove extremely effective at resolving these problems and improving quality of life.
Can I take HRT?
HRT is aimed at women who are both in the menopause and have menopausal symptoms. As with any medication there are associated risks so treatment should not be taken without a clear need.
The majority of women will enter the menopause between 45 to 55 years of age. If you are diagnosed as being in early menopause, that is, under the age of 45, then you may still consider taking HRT.
Menopausal symptoms can persist for a very variable length of time commonly 3-4 years but often much longer than this.
HRT may not be suitable for you if:
• You have suffered from breast or uterine cancer (oestrogen dependent tumours)
• A past history of fibroids or endometriosis
• You have a history of abnormal blood clotting tendency
• You have uncontrolled high blood pressure (hypertension)
• You have liver disease
If any of the above apply to you one of our specialist consultants can recommend potential alternatives to consider.
What types of HRT are available?
HRT can be either ‘sequential’ or ‘continuous combined’, the ‘no bleed’ version Sequential HRT contains oestrogen only for the first half of the 4 week cycle, followed by oestrogen and progesterone for the second 2 weeks. This will produce a regular bleeding pattern each month and is suitable for women who still have some menstrual bleeding.
Continuous Combined HRT as the name suggests contains both oestrogen and progesterone throughout the cycle, resulting in no bleeding occurring This will only work for those women who have been period free for at least one year.
If you have had a hysterectomy then progesterone is not required and an oestrogen only preparation 1s prescribed. Testosterone is sometimes prescribed to improve libido and sexual function.
How do I take HRT?
There are various treatment plans and ways of taking HRT that can be discussed with one of our consultants. We have years of experience guiding women through what can be an unsettling time.
Together we can decide whether cyclical or continuous treatment would be best for you. There are a variety of HRT medications including oral tablets, skin patches, vaginal creams, pessaries and hormone implants.
How long can I take HRT for?
Assuming HRT is proving beneficial in alleviating symptoms, and is not causing any adverse effects, it can be taken for several years. When considering discontinuing treatment, it is important for this to be withdrawn gradually, to minimise the likelihood of a return of symptoms.
HRT and Side Effects
• Common side effects of HRT include:
• Abdominal tenderness
• Breast tenderness
• Vaginal spotting or bleeding
Hormone Replacement Therapy is a direct way of combating the symptoms of the menopause. If the medication is not suitable for you there are some alternatives to be considered and discussed at consultation.
Clonidine – this is a non-hormonal medication aimed at reducing symptoms such as night sweats and hot flushes.
Antidepressants – these can again help with night sweats and hot flushes and can assist with managing mood. This class of drugs have their own side effects to be considered however Herbal Remedies – none have any proven evidence in human clinical tries to be both safe and effective. Avoid until more is known.
Lifestyle changes – Exercise is known to have a significant effect for a number of menopausal women. Other standard self care is recommended such as a reduction in caffeine, alcohol and smoking.
More information can be found here.
If you are interested in meeting one of our experienced consultants to discuss further call us now on 0207 079 2102.