Hormone Replacement Therapy (HRT)
Hormone replacement therapy, or HRT, is used for the treatment of the symptoms of the menopause. During the menopause, the production of oestrogen and other hormones ceases, and the aim of HRT is to replace these hormones. Around 75% of women in the UK experience symptoms of the menopause, and these can last for years.
What are the benefits of HRT?
Hot flushes and night sweats – HRT is the most effective treatment to alleviate hot flushes which can interfere with work and be very embarrassing. Night sweats can significantly affect the quality of sleep and leave women feeling tired and drained.
Bones – HRT is a very effective treatment for maintaining bone density if started before the age of 60. Preserving bone density is important in preventing osteoporotic fractures later in life. This is especially relevant as life expectancy is increasing. Oestrogen also helps the intervertebral discs in maintaining the collagen, and so prevent fractures of the vertebral bones.
Heart – there is good evidence that HRT started around the time of the menopause, prevents coronary heart disease and heart attacks in later life. This timing hypothesis is called ‘the window of opportunity’. Starting HRT below the age of 60 can reduce heart disease significantly, whilst starting HRT after the age of 60 can increase the risk.
Depression and mood – declining oestrogen levels are related to low mood and depression. Women who have previously suffered with premenstrual or postnatal depression are especially prone to experiencing cyclical depression in the 2-3 years leading up to the menopause. Oestrogen can be especially helpful in these cases.
Sexual function – declining oestrogen levels cause a reduction in collagen in the vaginal tissues leading to vaginal dryness and painful intercourse. In some cases, libido can be affected, caused by a reduction in androgen production by the ovaries, which is more pronounced in women who have surgery to remove the ovaries. The menopause can have an effect on the bladder, causing urgency, frequency and dysuria. These symptoms are part of genitourinary syndrome of menopause, which can be treated with systemic and local oestrogen.
Skin – as oestrogen levels fall, the collagen in the tissues reduces, leaving skin looking thin and dry. Oestrogen HRT can help retain the vitality of the skin.
Alzheimer’s and dementia – there is evidence that HRT started at the time of the menopause can reduce the risk of dementia in later life.
General wellbeing – many women report feeling more anxious and irritable, with tiredness and memory loss. HRT can significantly improve mood, and general function to allow you to continue to live good quality life.
What risks are associated with HRT?
HRT containing both oestrogen and progesterone (combination HRT) is necessary for women who have not had a hysterectomy to protect the lining of the womb. This is associated with a small 1 in 1000 increase in the risk of breast cancer if taken for more than 5 years. Taking oestrogen on its own (for women who have had a hysterectomy)is associated with a small but significant decrease in the risk of breast cancer. The risk of stroke is not increased with the use of gels and patches, so is often the preferred route of administration. When HRT is taken during the window of opportunity below the age of 60, it is not associated with an increase in heart disease.
How do I take HRT?
HRT comes as tablets, gels, patches, implants and pessaries. The exact type of HRT suitable for individuals varies and a tailored approach allows for treatment of specific symptoms. A holistic approach incorporating HRT but also emphasising measures to promote general physical and mental wellbeing are key to optimal management of the menopause.