FAQs about Hormone Replacement Therapy (HRT)

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Hormone Replacement Therapy (HRT) replaces the oestrogen and progesterone that your body no longer produces once you’ve hit menopause and relieves those hard-hitting menopause symptoms. Read on for some simple facts about HRT, how it works and how to take it.

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Is HRT safe?

The generation of women before us stopped taking HRT overnight after a 2003 report by the Women’s Health Initiative linked HRT with an increased risk of breast cancer, heart disease, blood clots and stroke. Overwhelming concern with the study's research methods and the conclusions, led to further analysis of this study and the overall safety of HRT.  It’s now believed that the risks in this study were overstated or non-existent. Our doctor, Karen Morton says that it is ‘absolutely clear’ that the risks of taking HRT are ‘very, very minimal’.  Royal College of Obstetricians and Gynaecologists (RCOG) say ‘that HRT remains a low risk and beneficial treatment for most women.’ See our article HRT, to take or not to take? That is the question, for more on this.

Are there different types of HRT?

Yes, there are two kinds of HRT: Combined HRT (oestrogen and progesterone) & pestrogen-only HRT. How you take HRT will to some extent be determined by whether or not you’re still having periods or if you’re having a surgically induced menopause.

Combined HRT is prescribed for those who still have wombs and is given two ways:

  • sequential or cyclical combined oestrogen & progesterone HRT is prescribed for those women still having regular periods. Here you take oestrogen every day, adding progesterone for the last 14 days of your cycle. At the end of the cycle you’ll have monthly withdrawal bleeding/period’. (Where periods are more irregular, three-monthly HRT may be prescribed).
  • continuous combined HRT is likely to be prescribed for those who haven’t had a period for two years or more. There’s no break in the dosage, meaning no bleed/’period’.

Oestrogen only HRT is for women who have had a hysterectomy and won’t need progesterone to protect the lining of the uterus.

How do I take HRT?

Knowing the different options may help you to decide, in consultation with your doctor, considering your risk factors, what you think will work for you. All available on prescription, take your pick from:

  • A daily patch (my GP’s preferred method) stuck on the area of skin specified in the instructions supplied with the prescribed patches. As it’s transdermal (absorbed by the skin) the HRT doesn’t pass through the liver. Available as oestrogen only and as combined HRT.
  • Daily tablets. Side effects can be a little more pronounced as tablets cause hormone levels to fluctuate.
  • Cream, pessary or ring supplying vaginal oestrogen. A topical treatment used to relieve vaginal dryness and urinary symptoms only.
  • Gels applied to the skin once a day.
  • The Mirena coil, an intrauterine device which releases levonorgestrel, a form of progesterone that works locally. Often used by women who have problems taking progesterone, needs to be used alongside oestrogen. (It can cause bleeds/periods for 4-5 months. Bleeds should then stop as one of the functions of the mirena coil is to stop periods).

Should women take Testosterone? 

You may come across articles raving about testosterone helping with low libido in menopause. Before you hot foot it  to the GP, testosterone patches and gels for women, were withdrawn from use in the UK in 2012. The only licensed option for women is through a testosterone pellet implanted under the skin, via a limited number of NHS clinics or private clinics. (Some clinics will prescribe a testosterone gel licensed for men).

How long does it take to feel any benefits from HRT?

It can take a few weeks and up to three months for any positive effects to be felt. During this time, you may feel side effects such as nausea, bloating and breast tenderness which should disappear after 6-8 weeks, so worth sticking with it. If side effects persist, discuss this at your 3-month review to see if the type or dose of HRT needs to be changed. If you experience unexpected bleeding, see your GP immediately.

Does HRT make women gain weight?

No. Women gain weight as going through menopause as the rate at which we burn calories slows down.  Our bodies lay down fat stores, fat distribution shifting from buttocks and hips, to the waist leading to a menopause middle age spread. There’s no scientific evidence that HRT causes women to gain weight. Watch our vlog with gynaecologist, Dr Karen Morton talking about menopause and weight gain for more information. 

How long can I take HRT for?

As long as you like. HRT will deal with your menopause symptoms. Once you stop taking it, your symptoms may possibly return but at least you’ll be in charge of when that will be

Check out more menopause health advice