What you need to know about Hormone Replacement Therapy (HRT)

What is HRT?

Hormone replacement therapy, commonly known as HRT, is treatment used to manage the symptoms at every stage of menopause. There are several forms of HRT including tablets, capsules, skin patches, gels, and sprays. 

Common symptoms of menopause

The menopause effects everyone differently, with some experiencing mild symptoms and others they may be more severe and may impact your quality of life. Even each individuals symptoms may change; symptoms may change as you progress through the menopause, some of which can improve on their own. 

Symptoms can include:  

• Irregular periods: This is often the first sign of menopause and may include changes in the length of your cycle, missed periods and changes in your flow.  

• Hot flushes: A feeling of heat in your upper body, normally lasting a few minutes.  

• Night sweats: Hot flushes during the night may cause you to wake up hot and drenched in sweat.  

• Mood changes: May include low mood, irritability, and anxiety.  

• Sleep problems: Such as difficulty falling asleep, poor quality sleep, and waking up frequently. 

• Problems with memory and concentration: Commonly known as “brain fog.”  

• Weight gain: The drop in hormones during perimenopause changes how fat is stored in your body, making you more likely to carry weight around your tummy. Your metabolism also slows with age, and you may be less physically active.  

• Low libido: Losing interest in sex is common during menopause and can be due to several factors including a drop in hormone levels, fatigue, stress, and discomfort during sex.  

• Vaginal dryness: As oestrogen levels drop, the vaginal walls lose elasticity and lubrication which can cause dryness and discomfort and lead to pain during sex and frequent urinary tract infections (UTIs). 

How does HRT work to support menopause?

During menopause, oestrogen levels drop and it is this that causes the symptoms you experience. HRT contains oestrogen and aims to relieve these symptoms. Some HRT medications act locally, relieving specific symptoms or may act systemically, where the hormones circulate your body helping to relieve more general symptoms. As oestrogen, is used by the body to protect your bones, HRT containing oestrogen also helps protect against osteoporosis.

Types of HRT

There are two main types of HRT:  

• Oestrogen-only HRT: Is suitable for women who have had a hysterectomy (an operation to remove your womb). 

• Combined HRT: Contains oestrogen and progesterone and is suitable for women with a womb. Progesterone helps protect the lining of the womb from thickening caused by oestrogen.

If you choose to try HRT to manage your symptoms, your clinician will prescribe the most suitable medication  for you based on your general health, medical history, and your personal preference.  

Oestrogen-only HRT 

If you have had a hysterectomy, you will be prescribed oestrogen-only HRT which is available as tablets, patches, gels and sprays. Oestrogen-only HRT is also available as a cream, pessary or ring that releases oestrogen directly into your vagina to relieve vaginal dryness and discomfort.  

Combined HRT  

If you have a womb, you’ll need to take combined HRT which contains both oestrogen and progesterone. Oestrogen causes the lining of your womb to build up, which slightly increases the risk of endometrial cancer, though this risk is small and for most people, the benefit from HRT outweighs the risks further. Taking progesterone with oestrogen decreases this risk. Depending on whether you are still having periods, your clinician may prescribe combined sequential HRT or combined continuous HRT.  

• Combined sequential HRT: This is recommended if you’re having menopause symptoms and are still having periods, or your last period was less than 12 months ago. With this type of combined HRT, you take progesterone for part of your cycle and then take a break during which time you will have a bleed, like a period.  

• Combined continuous HRT: This is recommended if your last period was over a year ago. With this type of combined HRT, you take progesterone every day. You typically do not have a monthly bleed with combined continuous HRT.

Natural or synthetic HRT

HRT can contain natural (body identical) hormones or synthetic hormones which have similar but not identical structures to your body’s hormones.

Body identical hormones match those your body naturally makes (e.g. oestradiol and micronised progesterone) They are usually given as vaginal and oral capsules. Micronised progesterone is often well tolerated and may have a lower risk of side effects compared to synthetic progestogens.

There are many different combinations of HRT available, taken in various ways. The dose and type can be adjusted to suit individual needs. Your doctor will help you decide which treatment is right for you.

The benefits and risks of HRT

Your prescriber will assess the suitability of HRT for you, the benefits usually outweigh the risk. They look at factors such as your age and medical history to make this decision. Recent evidence suggests that any risks of serious side effects from HRT are very low.

Older studies that found potential risks of HRT, and made people reluctant to take it are now seen as out of date.

Benefits of HRT

There are many benefits to taking HRT, all help to improve your quality of life. These include;

• Symptom relief such as improving sleep problems, vaginal dryness, hot flushes and night sweats

• Prevention of osteoporosis by providing bone protecting hormones

• May help maintain muscle strength

Risks of HRT

Though very low, there are risks to taking HRT. These risks aren't the same for everyone as their development is affected by factors such as the hormone used and your medical history among others. Your prescriber will assess these before deciding if HRT is appropriate for you.

HRT can slightly increase the risk of breast cancer, and women who have previously had breast cancer are usually advised not to take HRT. For combined HRT (oestrogen and progestogen), the increase in risk is small, around 5 additional cases per 1,000 women after 5 years of use. The risk of breast cancer is higher with combined HRT (containing oestrogen and progestogen) than with oestrogen-only HRT. Emerging evidence suggests that micronised progesterone may be associated with a lower risk compared to some synthetic progestogens.

Current evidence also shows a small increase in ovarian cancer risk with HRT, particularly with current or long duration use. A major meta-analysis of 52 studies found that current HRT use was associated with a relative risk of 1.43 for ovarian cancer, with risk declining after stopping treatment. The UK medicines regulator (MHRA) also includes ovarian cancer as a recognised but rare risk in its HRT safety update.

If you are at higher risk of blood clots or stroke, you will usually be advised to use patches, spray or gel instead of tablets. This is because the small increase in risk is associated with oral oestrogen, whereas transdermal oestrogen does not carry this increased risk.

Your doctor will assess your general health and medical history to minimise any risks and assess whether HRT is suitable for you.

(If you are on HRT and you experience any unusual symptoms then you should call 111 or speak to your GP- not sure to include this?)

Side effects of HRT

Like all medicines, HRT can cause side effects in some people. 

Most side effects are mild and improve within a few months. You can often manage  these  yourself with over-the-counter medicines, and self-care. If your side effects are bothering you, are getting worse, or not getting better, speak to your clinician.  

Common side effects of HRT include:

• Headaches 

• Feeling sick  

• Leg cramps 

• Painful or tender breasts 

• Muscle cramps 

• Vaginal bleeding or spotting 

• Mood changes including low mood or depression  

• Hair loss  

• Itchy skin or a mild rash 

• Diarrhoea

Always remember to read the patient information leaflet provided before starting any medication. 

Where can I get HRT? 

Already have an NHS prescription for HRT? We can deliver it to your door for free. Register today 

Some menopause treatments like vaginal creams and supplements are available over the counter from our Pharmacy2U Online Shop.

FAQs

Can I take HRT for perimenopause? 

Yes, you can take HRT during perimenopause if you are experiencing menopause symptoms such as irregular periods, hot flushes, night sweats and mood changes.  

Which type of HRT is best for me?  

The best type of HRT for you depends on several factors including your general health, medical history, whether you have a womb, when your last period was, and your personal preference.

How long will I need to be on HRT? 

There is no limit to how long you can take HRT, though it is usually so long that the benefits of symptom control and improvement to quality of life outweigh the risks. We recommend reviewing your treatment with your clinician every 12 months to assess your general health, see how well your treatment is working, and make any necessary changes. Most women take HRT for 2 to 5 years.  

How long does HRT take to work? 

How long HRT takes to work varies from person to person and may help relieve some symptoms faster than others. While you may notice an improvement in your symptoms within a few weeks, it can take up to 3 months to feel the full benefits. If you don’t see any improvement after 3 months, talk to your clinician.  

Can I change my HRT? 

Yes, you can change your HRT, but it’s important that you do so under the guidance of your clinician. You may decide to change your HRT if your medical situation changes (for example, if you have a hysterectomy), if you are experiencing unpleasant side effects, or if you would like to try a different form of HRT such as switching from tablets to patches.  

Useful resources:  

Menopause Overview NHS 

Hormone Replacement Therapy (HRT) NHS  

Menopause: Things you can do NHS 

Types of Hormone Replacement Therapy (HRT) The Menopause Charity  

The benefits of HRT  The Menopause Charity