Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause.
Benefits of HRT
The main benefit of HRT is that it can help relieve most of the menopausal symptoms, such as:
Many of these symptoms pass in a few years, but they can be very unpleasant and taking HRT can offer relief for many women.
It can also help prevent weakening of the bones (osteoporosis), which is more common after the menopause.
Risks of HRT
Some types of HRT can increase your risk of breast cancer.
The benefits of HRT are generally believed to outweigh the risks. But speak to a GP if you have any concerns about taking HRT.
How to get started on HRT
Speak to your GP if you're interested in starting HRT.
You can normally begin HRT as soon as you start experiencing menopausal symptoms and won't usually need to have any tests first.
Your GP can explain the different types of HRT available and help you choose one that's suitable for you.
You'll usually be started off on a low dose, which can be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.
Your GP will normally recommend trying treatment for three months to see if it helps. If it doesn't, they may suggest changing your dose or changing the type of HRT you're taking.
Who can take HRT
Most women can have HRT if they're experiencing symptoms associated with the menopause.
But HRT may not be suitable if you:
- have a history of breast cancer, ovarian cancer or womb cancer
- have a history of blood clots
- have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
- have liver disease
- are pregnant – it's still possible to get pregnant while on HRT, so you should use contraception until two years after your last period if you're under 50 or for one year after the age of 50
In these circumstances, alternatives to HRT may be recommended instead.
Types of HRT
There are many different types of HRT and finding the right one for you can be tricky.
There are different:
- HRT hormones – most women take a combination of the hormones oestrogen and progestogen, although women who don't have a womb can take oestrogen on its own
- ways of taking HRT – including tablets, skin patches, gels and vaginal creams, pessaries or rings
- HRT treatment regimens – HRT medication may be taken continuously without a break, or in cycles where you take oestrogen continuously and only take progestogen every few weeks
Your GP can give you advice to help you choose which type is best for you. You may need to try more than one type before you find one that works best.
Read more about the different types of HRT.
There's no limit on how long you can take HRT, but talk to your GP about the duration of treatment they recommend.
Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.
Women who take HRT for more than 1 year have a higher risk of breast cancer than women who never use HRT. The risk is linked to all types of HRT except vaginal oestrogen.
The increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.
When you decide to stop, you can choose to do so suddenly or gradually.
Gradually decreasing your HRT dose is usually recommended because it's less likely to cause your symptoms to come back in the short term.
Contact your GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again.
Risks and side effects of HRT
As with any medication, HRT can cause side effects. But these will usually pass within three months of starting treatment.
Common side effects include:
Alternatives to HRT
If you're unable to take HRT or decide not to, you may want to consider alternative ways of controlling your menopausal symptoms.
Alternatives to HRT include:
- lifestyle measures – such as exercising regularly, eating a healthy diet, cutting down on coffee, alcohol and spicy foods, and stopping smoking
- tibolone – a medication that's similar to combined HRT (oestrogen and progestogen), but may not be as effective and is only suitable for women who had their last period more than a year ago
- antidepressants – some antidepressants can help with hot flushes and night sweats, although they can also cause unpleasant side effects such as agitation and dizziness
- clonidine – a non-hormonal medicine that may help reduce hot flushes and night sweats in some women, although any benefits are likely to be small
Several remedies (such as bioidentical hormones) are claimed to help with menopausal symptoms, but these aren't recommended because it's not clear how safe and effective they are.
Bioidentical hormones are not the same as body identical hormones. Body identical hormones, or micronised progesterone, can be prescribed to treat menopausal symptoms.
Read more about alternatives to HRT.
Different types of hormone replacement therapy (HRT) are available.
If you're considering HRT, talk to your GP about the options suitable for you, as well as possible alternatives to HRT.
HRT replaces the hormones that a woman's body no longer produces because of the menopause.
The two main hormones used in HRT are:
- oestrogen – types used include estradiol, estrone and estriol
- progestogen – a man-made version of the hormone progesterone, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel
HRT involves either taking both of these hormones (combined HRT) or just taking oestrogen (oestrogen-only HRT).
Most women take combined HRT because taking oestrogen on its own can increase your risk of developing womb (endometrial) cancer. Taking progestogen alongside oestrogen minimises this risk.
Oestrogen-only HRT is usually only recommended for women who have had their womb removed during a hysterectomy.
Ways of taking HRT
HRT is available in several preparations that are taken in different ways. Talk to your GP about the pros and cons of each option.
The main forms of HRT are outlined below.
Tablets, which are usually taken once a day, are one of the most common ways of taking HRT.
Oestrogen-only and combined HRT tablets are available. For some women this may be the simplest way of having treatment.
Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days. Oestrogen-only and combined HRT patches are available.
Patches may be a better option than tablets if you think you might find it inconvenient to take a tablet every day.
Oestrogen gel is an increasingly popular form of HRT. It's applied to the skin once a day and is absorbed by the body.
Like skin patches, this can be a convenient way of taking HRT while avoiding an increased risk of blood clots.
But if you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.
HRT can be given using small pellet-like implants inserted under your skin (usually in the tummy area) while your skin is numbed with local anaesthetic, although these aren't widely available and aren't used very often.
The implants release oestrogen gradually over time and can stay in place for several months before needing to be replaced.
This may be a convenient option if you don't want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.
If you're taking a different form of oestrogen and need to take progestogen alongside it, another implant option is the intrauterine system (IUS). An IUS releases a progestogen hormone into the womb. It can remain in place for a few years and also acts as a contraceptive.
Oestrogen is also available in the form of a cream, pessary or ring that is placed inside your vagina.
This can help relieve vaginal dryness, but won't help with other symptoms such as hot flushes.
It doesn't carry the usual risks of HRT and can be used without taking progestogen even if you still have a womb.
Testosterone is available in the form of a gel that you rub in your skin. It is usually only recommended for women whose low sex drive (libido) does not improve after using HRT. It is used to supplement, rather than replace, your current HRT type.
Current testosterone products available in the UK (such as Tostran and Testogel) are currently unlicensed for the treatment of low sex drive. This means the manufacturers of these products have not specified that they can be used in this way. Despite this, there is evidence that testosterone can be effective.
Your GP should be able to provide more information on testosterone products.
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