HRT: Comprehensive Hormone Replacement Therapy Guide

Hormone replacement therapy remains one of the most effective treatments for menopausal symptoms, yet navigating HRT options can feel overwhelming. Understanding the evidence helps you make informed decisions about your health.

Understanding HRT Basics

HRT replaces hormones that naturally decline during menopause, primarily oestrogen and progesterone. This decline typically begins in the perimenopause, sometimes years before periods stop completely. The resulting symptoms - hot flushes, night sweats, mood changes, and vaginal dryness - can significantly impact quality of life.

Modern HRT comes in various forms, each with specific benefits. The choice depends on your symptoms, medical history, and personal preferences. What works brilliantly for one woman may not suit another, making personalised medical advice essential.

Types of HRT

Combined HRT

Women with a uterus typically need combined HRT containing both oestrogen and progesterone. The progesterone protects the uterine lining from thickening, which unopposed oestrogen might cause. This combination comes in sequential (cyclical) or continuous forms.

Sequential HRT suits perimenopausal women still having periods. You take oestrogen daily with progesterone for part of the month, maintaining a regular bleed. Continuous combined HRT, taking both hormones daily, suits women at least one year post-menopause.

Oestrogen-Only HRT

Women who've had a hysterectomy can take oestrogen alone since there's no uterine lining to protect. This simplifies treatment and may reduce some side effects associated with progesterone.

Local HRT

Vaginal oestrogen treats localised symptoms like dryness and urinary problems. These preparations - pessaries, creams, or rings - deliver hormones directly where needed with minimal systemic absorption. They're safe for most women, even some who cannot take systemic HRT.

Delivery Methods

Tablets

Oral HRT remains popular due to convenience. However, tablets must pass through the liver, slightly increasing clotting risk. They suit many women but may not be appropriate if you have certain risk factors.

Patches

Transdermal patches deliver hormones through the skin directly into the bloodstream, bypassing the liver. This reduces clotting risk compared to tablets. Patches need changing once or twice weekly, depending on the brand.

Gels

Oestrogen gel applied daily to the skin provides flexible dosing. You can adjust the amount based on symptoms, offering personalised control. The gel absorbs quickly without leaving residue.

Vaginal Preparations

Local treatments effectively manage urogenital symptoms. Pessaries, creams, and rings deliver oestrogen directly to vaginal tissues. Most women can use these safely long-term, even alongside systemic HRT.

Benefits of HRT

Symptom Relief

HRT effectively treats vasomotor symptoms - hot flushes and night sweats affect 75% of menopausal women. Most experience significant improvement within weeks of starting treatment. Sleep quality, mood, and concentration often improve as symptoms resolve.

Bone Protection

Oestrogen maintains bone density. HRT reduces fracture risk by approximately 30% when taken for at least five years. This protection continues while taking HRT but gradually decreases after stopping.

Cardiovascular Considerations

Starting HRT before age 60 or within 10 years of menopause may provide cardiovascular benefits. The timing hypothesis suggests early treatment might reduce heart disease risk, though this remains an active research area.

Quality of Life

Beyond physical symptoms, HRT often improves overall wellbeing. Many women report better energy, mood stability, and restored confidence. Sexual function may improve through both systemic effects and reduced vaginal symptoms.

Risks and Considerations

Breast Cancer Risk

The relationship between HRT and breast cancer is complex. Combined HRT slightly increases risk - approximately 4 extra cases per 1000 women taking it for 5 years. Oestrogen-only HRT shows minimal or no increased risk. Context matters: being overweight or drinking alcohol daily carries similar or greater risk.

Blood Clots

Oral HRT slightly increases venous thromboembolism risk. Transdermal preparations show little or no increased risk. Personal and family history guide appropriate choices.

Individual Assessment

Risk-benefit balance varies individually. Factors including age, time since menopause, symptoms severity, and personal medical history influence decisions. What's right for your friend may not suit you.

Making HRT Decisions

Initial Consultation

A thorough consultation reviews your symptoms, medical history, and concerns. Blood tests aren't usually needed for diagnosis but may exclude other causes of symptoms. Discussion should cover all treatment options, not just HRT.

Trial Period

Starting HRT involves finding what works for you. Initial prescriptions typically last three months, allowing time for benefits to develop while monitoring for side effects. Adjustments to type, dose, or delivery method optimise results.

Regular Reviews

Annual reviews assess ongoing need, effectiveness, and any concerns. These consultations provide opportunities to discuss new research and adjust treatment as needed.

Ready to discuss HRT options? Book your online GP consultation via WhatsApp for personalised hormone therapy advice from experienced doctors who understand your needs.