Once you’ve started HRT to replace natural hormones, take it for a few months to see if it works.
Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of menopause. It replaces the female hormones that are at a lower level as you experience menopause.
Estrogen 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 a doctor 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.
A doctor 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 (estrogen and progestogen) – for women who still have their wombs;
Estrogen-only HRT – for women who have had their womb removed in a hysterectomy.
There are several ways that estrogen can be taken, including:
- tablets – which can be taken by mouth;
- a patch that you stick on your skin;
- an implant – under local anesthetic;
- estrogen gel – which is applied to the skin and absorbed;
- estrogen spray — which is applied to the forearm.
When required to protect the womb lining from being stimulated by estrogen, a progestogen is available as:
- combined with estrogen in tablets;
- combined with estrogen 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 a doctor if you have any problems with HRT.
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), estrogen 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 a doctor so your treatment plan can be reviewed.
Hormones used in HRT can have associated side effects, including:
- fluid retention;
- breast tenderness or swelling;
- vaginal bleeding.
If side effects persist, a doctor may recommend an alternative treatment plan.
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 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.
If you would like to start HRT, it is a good idea to have an initial discussion with a doctor. They can discuss the risks and benefits with you, so you can decide what is right for you.
Every woman experiences 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.
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.
Non-urgent advice: Speak to a doctor if:
- you have symptoms that persist for several months after you stop HRT;
- you have particularly severe symptoms.
Treatment may need to be restarted, usually at a lower dose.
After you have stopped HRT, you may still need help to manage vaginal dryness and prevent osteoporosis.
Cream, lubricants, and local estrogen preparations are available for vaginal dryness and discomfort. You don’t need to suffer from vaginal dryness and discomfort without treatment.
Please contact one of our qualified experts to apply for a free consultation if required.