Hormone Replacement Therapy: Complete Medical Guide
Hormone replacement therapy represents a cornerstone of menopausal medicine, offering relief when the body's natural hormone production declines. Understanding the full scope of treatment options empowers informed healthcare decisions.
The Science of Hormone Replacement
Menopause occurs when ovaries stop producing eggs and hormone levels decline. This natural transition typically happens between ages 45-55, though timing varies considerably. The hormonal changes - particularly declining oestrogen - trigger various symptoms that hormone replacement therapy addresses.
Perimenopause, the transition period before menopause, can last several years. Fluctuating hormones during this time create unpredictable symptoms. Hormone replacement therapy can provide stability during this challenging phase.
Comprehensive HRT Options
Bioidentical Hormones
Bioidentical hormones have the same molecular structure as hormones produced naturally by your body. Many standard HRT preparations contain bioidentical oestradiol. The term "bioidentical" doesn't automatically mean safer or more effective - what matters is appropriate prescribing and monitoring.
Body-identical hormones available on the NHS include oestradiol patches, gels, and spray, plus micronised progesterone. These regulated preparations undergo rigorous testing for safety and efficacy.
Compounded Hormones
Some clinics offer compounded bioidentical hormones, custom-mixed preparations tailored to individual hormone levels. However, these lack standardisation and quality control of regulated medicines. Most experts recommend regulated preparations unless specific circumstances require alternatives.
Testosterone Supplementation
Although not licensed for women in the UK, testosterone supplementation may help some women with low libido despite adequate oestrogen replacement. Specialist prescription requires careful monitoring and discussion of potential effects.
Systematic Approach to Treatment
Baseline Assessment
Before starting hormone replacement therapy, comprehensive assessment establishes your health baseline. This includes blood pressure, weight, and breast examination. Family history of breast cancer, clotting disorders, and cardiovascular disease influences treatment choices.
Bone density scanning may be appropriate for women with early menopause or additional osteoporosis risk factors. Mammography should be up-to-date according to screening guidelines.
Choosing Preparations
Selecting appropriate hormone replacement involves multiple considerations:
Symptom pattern and severity
Medical history and risk factors
Lifestyle and preferences
Previous treatment responses
Your GP guides selection based on current evidence and clinical experience.
Dose Optimisation
Starting with the lowest effective dose minimises side effects while providing symptom relief. Gradual titration finds your optimal dose. Some women need higher doses initially, reducing once symptoms stabilise.
Managing Side Effects
Common Initial Effects
Breast tenderness, nausea, and breakthrough bleeding commonly occur when starting hormone replacement therapy. These typically resolve within three months as your body adjusts. Persistent side effects may require changing preparation or dose.
Breakthrough Bleeding
Unexpected bleeding requires investigation, though it's often related to the HRT regimen. Adjusting progesterone dose or timing usually resolves this. Persistent irregular bleeding needs further assessment to exclude other causes.
Weight Considerations
Many women worry hormone replacement therapy causes weight gain. Research shows HRT doesn't directly cause weight gain - menopausal metabolic changes are responsible. Some women find HRT helps maintain stable weight by improving energy and sleep.
Special Circumstances
Early Menopause
Women experiencing menopause before age 45 have different risk-benefit considerations. Hormone replacement until natural menopause age is usually recommended to protect bone and cardiovascular health. These women typically need higher doses than older women.
Surgical Menopause
Hysterectomy with ovary removal causes immediate menopause. Sudden hormone withdrawal often causes severe symptoms. These women particularly benefit from hormone replacement therapy, and can use oestrogen-only preparations.
Medical Conditions
Certain conditions require specialist input for hormone replacement decisions:
Previous breast cancer
Clotting disorders
Liver disease
Migraine with aura
Uncontrolled hypertension
Modified regimens or alternative treatments may be appropriate.
Monitoring and Follow-Up
Three-Month Review
Initial follow-up assesses symptom response and any side effects. Blood pressure and weight are checked. This visit provides opportunity to adjust treatment if needed.
Annual Reviews
Yearly consultations review ongoing need for hormone replacement therapy. Discussion includes:
Symptom control
Side effects
New medical developments
Lifestyle factors
Duration of treatment
Long-Term Considerations
No arbitrary limit exists for hormone replacement duration. Decisions balance ongoing benefits against potential risks. Some women take HRT for decades; others for just a few years. Regular review ensures treatment remains appropriate.
Alternative and Complementary Approaches
Non-Hormonal Medications
Several medications help menopausal symptoms without hormones:
SSRIs/SNRIs for hot flushes
Clonidine for vasomotor symptoms
Vaginal moisturisers for dryness
Gabapentin for night sweats
These provide options when HRT is unsuitable or unwanted.
Lifestyle Modifications
Evidence supports various lifestyle approaches:
Regular exercise reduces hot flushes
Yoga and mindfulness help mood symptoms
Dietary changes may improve symptoms
Weight management benefits overall health
These complement or sometimes replace hormone therapy.
Need expert hormone replacement therapy guidance? Book your online GP consultation via WhatsApp for personalised treatment plans based on latest evidence and your individual needs.
