What exactly is HRT?
HRT is used to replace the Oestrogen that is lost as ovaries stop working. The aim of Oestrogen is to top up and eventually replace our own lost Oestrogen.
Oestrogen that is produced in the ovaries controls the reproductive cycle, protects bones, controls skin temperature and keeps the vagina moist and lubricated. HRT comes in the form of tablets, sprays, gels and patches. In rare cases it is available as an implant which slowly releases oestrogen over a few months. For vaginal and bladder symptoms oestrogen in the form of cream, pessary or ring can be inserted into the vagina to provide oestrogen where it is needed. This is known as local oestrogen and has very few side effects.
Patches, gels, tablets and sprays are known as systemic oestrogen and will be used after an assessment of a woman’s symptoms, as well as what stage she is in her menopause and whether she has had a hysterectomy or not.
As already mentioned, Oestrogen is the main ingredient in HRT as this is the hormone that relieves menopausal symptoms and helps to maintain bone strength. Oestrogen alone should only be used by women who have had a hysterectomy where the womb has been completely removed including the neck (cervix). This is because Oestrogen when taken alone can lead to thickening of the lining of the womb (endometrium) and long term could lead to endometrial cancer although this is rare.
Progestogen is therefore added to Oestrogen in women who have not had a hysterectomy as this thins out the lining of the womb and negates the thickening that Oestrogen causes. This is known as combined HRT. The way in which the progestogen is used will depend on where a woman is in her menopause journey. If a woman is still having periods then progestogen should be added for 12/14 days of each cycle. This keeps the period regular and is especially good during the peri-menopausal years when periods can be irregular or heavy. This is known as sequential or cyclical HRT.
Continuous combined HRT means that you take Oestrogen and Progesterone continuously and is for women who are more than ONE year post periods over the age of 50 and TWO years under the age of 50, however, this should be discussed with your Healthcare provider.
Women who have endometriosis should always be started on continuous combined HRT to avoid stimulating the endometriosis. This is also correct for women who have an ablation and women who are on the progesterone only pill.
So can all women take HRT?
Most women can take HRT however women will need a specialist referral if a woman has or has ever had:
Endometrial or breast cancer (this will be a complete NO at the present time)
A family history of breast cancer or any BRCA diagnosis
A history of blood clots
A heart attack, angina or stroke
Unusual untreated vaginal bleeding or endometrial thickening.
A thorough history should always be taken to ensure the risks are explored.
What are the side effects of HRT?
These usually only last for a few weeks at the start of commencing HRT and are usually due to the upsurge in hormones. These include:
Tender, larger breasts
Cramp in legs
Nausea, feeling sick
If this happens and does not settle after 4 weeks it is important to speak to your Healthcare Professional who can go through these issues and may decide on a different formulation.
We are all individuals and not all HRT will suit all women. So often you may need to try different HRT’s before you find the right one for you.