Hormone replacement therapy (HRT) is most commonly prescribed to women who require relief from the menopause symptoms, especially in women with early-onset menopause. It’s also recommended to women who are undergoing menopause as a result of surgery or those in perimenopause.
Medicines used in HRT mostly contain artificial oestrogen and/or progestogen or ingredients that have similar properties. When HRT treatments are used they act in the body to replenish hormone levels that drop as a result of menopause.
There is a wide selection of treatments available, which allows doctors to prescribe the most appropriate treatment based on each individual patient’s needs. Which treatment you are prescribed will depend on if you are still having your periods, how sensitive you are to oestrogen, if you have had your womb removed and whether you can use steroid medications.
Examples of some of the ingredients contained in HRT medications include estradiol, norethisterone acetate, tibolone and conjugated oestrogen.
HRT can be administered in the form of a patch, tablet, cream, gel or implant. Creams and gels can be applied directly to the vagina, as can some tablets, although these largely tend to be taken orally. Patches are convenient because they don't have to be taken daily and only need to be changed twice a week, although they can cause skin irritation in some women. Oestrogen implants are more long term, which has its own risks, especially if side effects are a worry, although there isn’t any need to remember to take a tablet or change a patch.
HRT is mainly beneficial because it can help alleviate symptoms such as vaginal itching, night sweats, hot flushes and vaginal dryness, to name a few. However, taking HRT can also help in osteoporosis prophylaxis, because oestrogen levels are kept constant.
HRT medication often contains similar ingredients to hormonal oral contraceptives, but doesn’t offer the same protection. This is the case even after menopause. You can remain fertile for as long as two years after menopause, but if this happens after the age of 50 a doctor won’t usually prescribe an oral contraceptive due to health concerns, which is why barrier methods such as a condom might be preferable. If menopause occurs before the age of 50, however, a doctor may prescribe a combined oral contraceptive to help relieve menopause symptoms.
All prescription medications have risks, and medications used for HRT are no different. It is the doctor’s responsibility to ensure that when they prescribe a HRT medication to you to use, any potential health risks are outweighed by the benefits.
HRTs are primarily hormone-based, which means that they can influence many processes within the body. Oestrogen, which is the main ingredient of many HRT treatments, has a very important function and while it can be very beneficial and helpful in alleviating menopausal symptoms, it can also increase a woman's risk of endometrial cancer, stroke and coronary heart disease, especially in old age. Taking HRT treatments with additional clinical progestogen can minimise the risk of endometrial cancer, but a doctor will still ask any patient on HRT to come for regular check-ups. They will also ensure that you use the lowest dose possible for the shortest period of time.
Using HRT carries with it an increased risk of oestrogen-dependent cancer, which is why you will not be recommended HRT if you have a history of breast cancer, endometrial cancer or ovarian cancer. However, even if you’ve never had any of the aforementioned cancers or you don’t have a family history of cancer, using HRT long term can increase your risk, which is why it’s usually recommended that you don’t use it for longer than 10 years after menopause and that you are monitored by your doctor on a regular basis.
The length of time you’ll need to use HRT medicines will differ for each individual but in general you shouldn’t be on HRT for longer than 10 years after menopause.
Yes, your doctor may take you off HRT if they find that the risks of continuous treatment outweigh the benefits. This may be the case if you start developing serious side effects or you don’t experience an improvement in your symptoms.