Coping with menopause: The ins and outs of hormone replacement therapy (HRT)

As women age, hormonal changes can take a toll on their physical and emotional well-being. However, hormone replacement therapy (HRT) offers a safe and effective solution for addressing the symptoms of menopause and low testosterone levels. Many individuals hope to see rapid results when they begin HRT treatment, but it's essential to understand that this therapy doesn't produce immediate effects. The timeline for experiencing improvements varies, with some women noticing changes relatively quickly, while others may take several weeks or even months to see results. In this article, Dr Rupa Parmar explores the different stages of HRT treatment, its benefits, and potential risks.

Understanding HRT and its purpose

In simple terms, hormone replacement therapy (HRT) is a medical treatment designed to alleviate the hormonal changes that occur with age. It is most commonly used to manage menopausal symptoms by replenishing hormones that have decreased. These symptoms can range from hot flashes and night sweats to vaginal discomfort and reduced libido. While many menopausal symptoms tend to resolve on their own within a few years, research indicates that the transition through menopause can last as long as fourteen years. This extended duration explains why some women opt for HRT to balance their hormones and reduce these symptoms.

Types of HRT

HRT comes in various forms. It can include a combination of both oestrogen and progestogen, referred to as combined HRT, or just oestrogen (oestrogen-only HRT). The latter is typically prescribed for women who have had a hysterectomy and no longer have their uterus. Moreover, HRT can be administered through different methods such as tablets, skin patches, oestrogen gel, implants, and vaginal oestrogen. Depending on the stage of menopause, HRT medication may be used cyclically, with progestogen taken every few weeks and oestrogen without interruption, or both hormones taken continuously.

Benefits of HRT

The primary benefit of HRT is its ability to provide relief for women by reducing common menopausal symptoms, including hot flashes, mood swings, low libido, night sweats, and vaginal dryness. Additionally, HRT can help prevent osteoporosis, a condition linked to oestrogen deficiency, which leads to bone weakening in postmenopausal women.

Risks and side effects

It's important to be aware that certain types of HRT medications may increase the risk of developing breast cancer, with the risk rising the longer HRT is used. However, this risk tends to decrease over time after discontinuing HRT. The risk of developing cancer due to HRT is generally considered low. While the benefits often outweigh the risks, it is essential to consult with your healthcare provider to determine the most suitable treatment option for you. Like any treatment, HRT may lead to side effects, including abdominal pain, breast tenderness, headaches, indigestion, nausea, and vaginal bleeding. In most cases, these side effects diminish within three months of initiating treatment.

Starting HRT and duration

If you are considering HRT, it is advisable to schedule a consultation with your healthcare provider. In most instances, you may not require extensive testing. Your doctor will discuss the available HRT types and work with you to identify the best treatment plan. Typically, HRT begins with a low dose, which can be adjusted over time. It may take several weeks to observe improvements, and you may experience initial side effects. Physicians usually recommend trying HRT for about three months to assess its suitability. If it proves ineffective, they may suggest altering the type or dosage of HRT.

Timelines for experiencing the effects of HRT

The timeline for experiencing the effects of HRT varies among women. While some may notice improvements relatively quickly, others may require up to three months to experience the full benefits.

Eligibility for HRT

Although most women experiencing menopausal transitions can consider HRT, it may not be suitable if you have untreated high blood pressure, a history of blood clots, a history of breast, ovarian, or uterine cancer, liver disease, or if you are pregnant. It is crucial to use contraception for a certain period while taking HRT to prevent unintended pregnancies.

Alternatives to HRT

For individuals for whom HRT is unsuitable, alternative methods for alleviating menopausal symptoms include antidepressants (which can help with hot flashes and night sweats but may cause dizziness and agitation), clonidine (a non-hormonal medication that can reduce hot flashes and night sweats in some women), and lifestyle changes such as regular exercise, a healthy diet, and quitting habits like smoking and excessive alcohol consumption.

Stopping HRT

 Once menopausal symptoms have subsided, it is advisable to discontinue HRT. While there is no set limit on how long one can use this treatment, discussing when to stop with your healthcare provider is essential. Using HRT for over one year may increase the risk of breast cancer, unless you are taking vaginal oestrogen. This elevated risk decreases over time, but some residual risk persists for more than ten years. Gradually reducing your HRT dose, rather than abruptly discontinuing it, can help prevent the short-term recurrence of symptoms. If your symptoms persist for several months after discontinuation or are particularly severe, consult your healthcare provider about resuming HRT.

Dr Rupa Parmar is a distinguished general practitioner with over 20 years pf experience. You can schedule an appointment with Dr Parmar on her Top Doctors profile.