Hormone replacement therapy (HRT)

Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces the female hormones that are at a lower level as you experience the menopause.

Oestrogen and progesterone are female hormones that play important roles in a woman’s body. Falling levels cause a range of physical and emotional symptoms, including hot flushes, mood swings and vaginal dryness.

The aim of HRT is to restore female hormone levels, which can bring relief to many women.

How to get started on HRT

Speak to your local GP practice if you're interested in starting HRT.

You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first. However, a blood test to measure your hormone levels may be carried out if you're aged 40 to 45. Blood tests may also be carried out to help diagnose suspected premature menopause if you’re under 40 and have menopausal symptoms.

Your GP can explain the different types of HRT available and help you choose one that's suitable for you.

Types of HRT

There are two main types of HRT:

• Combined HRT (oestrogen and progestogen) – for women who still have their womb
• Oestrogen-only HRT – for women who have had their womb removed in a hysterectomy

There are several ways that oestrogen can be taken, including:

• tablets – which can be taken by mouth
• a patch that you stick on your skin
• an implant – under local anaesthetic
• oestrogen gel – which is applied to the skin and absorbed
• oestrogen spray—which is applied to the forearm

When required to protect the womb lining from being stimulated by oestrogen, progestogen is available as:

• combined with oestrogen in tablets
• combined with oestrogen in patches
• separately as tablets or a progestogen releasing coil

Choosing the right HRT for you

It is important to find the correct HRT to help your symptoms.

A low dose of HRT hormones is usually prescribed to begin with. If you need to, you can increase your dose at a later stage.

Once you've started HRT, it's best to take it for a few months to see if it works well for you. If not, you can try a different type or increase the dose. It's really important that you talk to your GP if you have any problems with HRT.

Shortage of some HRT products

There are ongoing supply problems with some HRT products. For some products this is because of irregular supply while for others it's a longer-term shortage. There are lots of different reasons why medicines can be in short supply. Work is happening with the pharmaceutical manufacturers who make the medicines to help the situation.

If your pharmacy can’t supply the specific HRT product you've been prescribed, they may supply an alternative product. This will usually have the same ingredient, but may be made by a different manufacturer. Your pharmacy might also reduce the amount they provide you with to help ensure that as many woman as possible can get access to their required medication.

Disruptions in the availability of HRT will be worrying if it has been prescribed for you. However, there are always alternative options. If you are concerned about this contact your GP, pharmacist or specialist doctor to discuss the best treatment options for you.

When HRT is not suitable

HRT may not be suitable, or a specialist opinion may be needed, if you:

• have a history of breast cancer, ovarian cancer or womb (uterus) cancer
• have a history of blood clots, tablet HRT is not recommended but taking HRT through the skin can be considered
• have a history of heart disease or stroke
• have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
• have liver disease
• are pregnant or breastfeeding

In these circumstances, a different type of medication may be prescribed to help manage your menopausal symptoms.

Side effects of HRT

Both hormones used in hormone replacement therapy (HRT), oestrogen and progestogen, have side effects.

Side effects usually improve over time, so it's best to try the treatment plan you have been prescribed for at least 3 months.

If side effects continue after this time, see your GP so your treatment plan can be reviewed.

Hormones used in HRT can have associated side effects, including:

• fluid retention
• bloating
• breast tenderness or swelling
• headaches
• indigestion
• depression
• vaginal bleeding

If side effects persist, your GP may recommend an alternative treatment plan.

Weight gain

Many women believe taking HRT will make them put on weight, but there is no evidence that this is the case.

You may gain some weight during the menopause, but this often happens whether you take HRT or not.

Exercising regularly and eating a healthy diet can help you to maintain a healthy weight.

Understanding the benefits and risks

Recent findings show that although not completely risk-free, HRT remains the most effective solution for helping with symptoms of menopause and is also effective for the prevention of osteoporosis. It may also provide protection against heart disease.

When deciding whether to have hormone replacement therapy (HRT), it is also important to understand the risks.

You may have heard about a link between breast cancer and HRT. Guidelines from the National Institute for Health and Care Excellence (NICE) say that HRT is effective and recommend that it should be offered to women with menopausal symptoms.

If you would like to start HRT, it is a good idea to have an initial discussion with your GP or practice nurse at your local primary care practice. They can discuss the risks and benefits with you, so you can decide what is right for you.

Every woman experiences the menopause differently, so there is no way of knowing how long symptoms will last and so how long HRT will need to be taken. Some women who have continued symptoms into the longer term, may need to keep taking HRT to help with symptoms and good quality of life.

Further information about the benefits and risks of HRT

When to stop taking HRT

Most women are able to stop taking HRT after their menopausal symptoms finish, which is usually two to five years after they start (but in some cases this can be longer).

Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may find that your menopausal symptoms come back after you stop HRT, but these should pass within a few months.

After you have stopped HRT, you may still need help to manage vaginal dryness and to prevent osteoporosis. Read about the best ways to prevent osteoporosis.

Cream, lubricants and local oestrogen preparations are available for vaginal dryness and discomfort. You don't need to suffer from vaginal dryness and discomfort without treatment.

Alternatives to HRT

If you decide that you do not wish to take HRT, there are a number of alternative treatments to manage your menopause symptoms.

Further information about treating menopause symptoms