Hormone replacement therapy (usually called HRT) is a treatment to relieve symptoms of menopause in aging women.

It replaces hormones that are at a lower level as you approach menopause.

Benefits of HRT

The main benefit of HRT is that it can help relieve most of the menopausal symptoms, such as:

  • hot flushes;
  • night sweats;
  • mood swings;
  • vaginal dryness;
  • reduced sex drive.

Many of these symptoms pass after a few years, but they can be unpleasant, and taking HRT can offer relief for many women.

It can also help prevent the weakening of the bones (osteoporosis), which is more common after menopause.

Risks of HRT

Some types of HRT can increase your risk of breast cancer.

The benefits of HRT are generally believed to outweigh the risks. But speak to a GP if you have any concerns about taking HRT.

How to get started on HRT

Speak to a GP 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.

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

You’ll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.

A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose or changing the type of HRT you’re taking.

Who can take HRT

Most women can have HRT if they’re having symptoms associated with menopause.

But HRT may not be suitable if you:

  • have a history of breast cancer, ovarian cancer, or womb cancer;
  • have a history of blood clots;
  • have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT;
  • have liver disease;
  • are pregnant – it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50.

In these circumstances, alternatives to HRT may be recommended instead.

Types of HRT

There are many different types of HRT and finding the right 1 for you can be difficult.

There are different:

  • HRT hormones – most women take a combination of the hormones estrogen and progestogen, although women who do not have a womb can take estrogen on its own
    ways of taking HRT – including tablets, skin patches, gels, and vaginal creams, pessaries, or rings;
  • HRT treatment plans – HRT medicine may be taken without stopping, or used in cycles where you take estrogen without stopping but only take progestogen every few weeks.

A GP can give you the advice to help you choose which type is best for you. You may need to try more than 1 type before you find 1 that works best.

Stopping HRT

There’s no limit on how long you can take HRT but talk to a GP about how long they recommend you take the treatment.

Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.

Women who take HRT for more than 1 year have a higher risk of breast cancer than women who never used HRT. The risk is linked to all types of HRT except vaginal estrogen.

The increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.

When you decide to stop, you can choose to do so suddenly or gradually.

Gradually decreasing your HRT dose is usually recommended because it’s less likely to cause your symptoms to come back in the short term.

Contact a GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again.

Side effects of HRT

As with any medicine, HRT can cause side effects. But these will usually pass within 3 months of starting treatment.

Common side effects include:

  • breast tenderness;
  • headaches;
  • feeling sick;
  • indigestion;
  • abdominal (tummy) pain;
  • vaginal bleeding.

Alternatives to HRT

If you’re unable to take HRT or decide not to, you may want to consider alternative ways of controlling your menopausal symptoms.

Alternatives to HRT include:

  • lifestyle measures. such as exercising regularly, eating a healthy diet, cutting down on coffee, alcohol, and spicy foods, and stopping smoking
  • tibolone – a medicine that’s similar to combined HRT (estrogen and progestogen), but may not be as effective and is only suitable for women who had their last period more than 1 year ago
  • antidepressants – some antidepressants can help with hot flushes and night sweats, although they can also cause unpleasant side effects such as agitation and dizziness
  • clonidine – a non-hormonal medicine that may help reduce hot flushes and night sweats in some women, although any benefits are likely to be small

Several remedies (such as bioidentical hormones) are claimed to help with menopausal symptoms, but these are not recommended because it’s not clear how safe and effective they are.

Bioidentical hormones are not the same as body identical hormones. Body identical hormones, or micronized progesterone, can be prescribed to treat menopausal symptoms.

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