Your essential guide to HRT (hormone replacement therapy)

Menopause and perimenopause are natural phases in a woman’s life that bring about hormonal changes that can result in a range of symptoms, affecting physical, emotional, and psychological wellbeing.

Here, Dr Nina Wilson, renowned menopause specialist, offers her expert insight into the role of HRT (hormone replacement therapy) as a treatment option to alleviate symptoms associated with the menopause and the perimenopause, enhancing the quality of life of women during this transformative stage.

What is HRT?

Menopause is the time when periods stop for good. The levels of hormones from the ovaries that usually drive periods - oestrogen and progesterone - become low. This can be responsible for a wide range of symptoms including hot flushes, night sweats, low mood, anxiety, insomnia, and vaginal dryness.

HRT is medicine to replace these lost hormones, which alleviates symptoms.

What is the perimenopause?

‘Perimenopause’ is the word used to describe the time around the last period.

Before periods stop completely, there is a gradual reduction in the amount of hormones being produced by the ovaries. Hormone levels can go up and down quite erratically during this time.

Women most commonly start to experience symptoms during the perimenopause, well before periods stop altogether. Perimenopausal symptoms can even occur anywhere up to 15 years before the final period.

Why do people opt for HRT?

HRT is the most effective treatment for menopausal and perimenopausal symptoms. Insomnia, hot flushes, night sweats, depression, anxiety, vaginal discomfort, and sexual difficulties can seriously disrupt quality of life. This can have consequences at work, at home, and for a woman’s wellbeing. The aim of HRT is to improve those symptoms and restore quality of life. Millions of women have experienced the benefits.

When should I start HRT?

Taking HRT is a choice, which is based on a discussion between you and your doctor as to whether it is the right treatment for you. Some women get few symptoms as they transition through their menopause, and thus don’t feel they need treatment. Other women have symptoms they feel they can manage by themselves. A healthy lifestyle - regular exercise, not smoking, minimal or no alcohol - can all help to reduce menopausal symptoms.

However, many women do have symptoms that interfere with daily life, and thus are likely to benefit from treatment. There is no set age at which you ‘should’ start treatment, but most women will choose to commence when their symptoms have reached a point where they need to be managed by a healthcare professional. This usually, but not always, occurs before periods have stopped completely i.e. in the perimenopause.

What are the benefits of HRT?

HRT is the single most effective treatment for all menopausal symptoms. If taken within 10 years of the final period, studies show that it also helps to maintain a healthy heart and blood vessels as we age. HRT at any age will maintain bone-strength as well, stopping the gradual reduction in bone density that we see beginning around the time of the menopause. Women report a range of benefits, depending on how the low hormone levels have affected them.

Oestrogen is also very effective at treating ‘genitourinary syndrome of menopause’, a term encompassing vaginal discomfort, soreness, itching, dryness, and thinning of the skin caused by low oestrogen. An increased need to pass urine is another symptom of this. In this case, it is not necessary to take medicine that affects the whole body, because oestrogen can be applied locally to the vaginal skin. Many women report that this alone substantially improves their sleep.

What are the risks of HRT?

Studies of HRT have indicated that combined HRT (oestrogen and progesterone) is associated with a small increased risk of breast cancer. However, the risk is small and it depends on how long you use HRT for (it takes several years before any increased risk is detectable). For most women, the benefits of HRT will outweigh the risks. However, if you have already had a diagnosis of breast cancer, you would usually be advised not to take HRT.

In the 1940s and 50s, women were given just one hormone – oestrogen - to treat their symptoms. Oestrogen causes the endometrium (lining of the womb) to build up, and in time this causes bleeding. Over a longer time, just taking oestrogen on its own can increase the risk of endometrial cancer. When this risk was recognised, progesterone was added to HRT to counteract the effect of oestrogen on the lining of the womb.

Now, women who take oestrogen and progesterone have a lower risk of endometrial cancer than women who don’t take HRT at all. This means that progesterone, as well as oestrogen, is an important part of HRT for women who still have their uterus (womb). In addition, it is also needed in women who have had their womb removed to treat a condition called endometriosis.

To schedule an appointment with Dr Nina Wilson, head on over to her Top Doctors profile today.