Hormone Replacement Therapy and Menopause Treatment

When we talk about the menopause, there are often three stages we refer to. These are: 

• Perimenopause (before the full onset of menopause) 

• Menopause (the time when most changes occur) 

• Postmenopause (when oestrogen levels have permanently fallen) 

Perimenopause usually begins in the mid to late 40s. The ovaries will stop releasing eggs, and as a result, hormone levels fluctuate, and periods may become irregular. Menopause symptoms can develop gradually at this stage, and you might not attribute changes you notice to the menopause straightaway.  

Menopause is considered to start after 12 straight months of no menstrual bleeding (as a result of hormone levels dropping rather than another reason such as contraception, pregnancy, breastfeeding, or illness). Once this has happened, you quickly move into the third and final stage.  

Postmenopause is the last stage, and although you may still experience symptoms for another 5-7 years, the hormonal changes that trigger menopause have finished.  

Remember, everyone’s different and your menopause experience might look very different to someone else’s. We’re here to help you navigate this stage of your life and you can find information and resources at our Health Hub.  

Like any medication, there are some known risks with HRT and it might not be the right treatment for everyone. The NHS advises that HRT’s benefits probably outweigh the risks if you’re under 60 and experience menopause symptoms, and aren’t at an increased risk of developing blood clots or breast cancer.  

Read more about the benefits and risks of HRT on the NHS website.  

Yes, you can take HRT for perimenopause if you’re affected by menopause symptoms. We’ll ask you about your symptoms and your stage of menopause during your consultation. This way we can recommend the best treatment for you.  

Everyone will experience the menopause differently. Some symptoms are more common than others. A 2016 survey by the British Menopause Society found that hot flushes were the most common, with 79% of women surveyed experiencing this symptom. Other symptoms include night sweats, disturbed sleep, disruption to periods, mood changes, weight gain, low energy, and difficulty concentrating. HRT can support with many symptoms of the menopause. There are also over-the-counter treatments available for symptoms such as vaginal dryness, muscle aches, and joint pains. Visit our Women’s Health collection for a choice of products to help with a range of menopause symptoms.  

HRT treatments typically come in the form of patches, tablets, and gels. The treatment you’re prescribed will depend on whether you’ve had a hysterectomy. If you’ve had this, our clinicians will recommend an oestrogen-only HRT treatment. Otherwise, you’ll be advised to take a combined HRT treatment with both oestrogen and progestogen. This combined treatment approach helps to protect against the risk of womb cancer. 

Although rare, HRT is associated with a small number of serious side effects:  

• Deep vein thrombosis (DVT) – stop using HRT and seek immediate medical help if you have pain, swelling, or redness in your legs (usually on the calf) 

• Blood clot (pulmonary embolism) – stop using HRT and seek immediate medical help if you experience sudden chest pain or shortness of breath 

• Stroke – stop using HRT and seek immediate medical help if you experience severe headache with vision changes 

• Breast cancer – see your GP if you notice any changes to either breast and attend any breast screenings you’re invited to while taking HRT 

• Womb cancer – monitor any changes to vaginal bleeding after 2-3 months of starting your treatment and see your GP if this occurs 

Like all medicines, HRT treatments can cause side effects for some people. These are usually mild and can be managed with over-the-counter pain relief, alongside self-care such as drinking plenty of fluids to keep hydrated.  

These side effects may include:  

• Headaches 

• Nausea 

• Muscle cramps 

• Sore or tender breasts 

• Some vaginal bleeding or spotting 

• Mood changes 

• Itchy skin that may include a mild rash 

• Diarrhoea 

Although there’s no limit on how long you can take HRT for, the NHS recommends reviewing your treatment with a clinician every 12 months. This gives you the opportunity to discuss any changes and make sure HRT is still helping you. It also means the clinician can review your medical history and ensure you’re not at any increased risk of continuing your HRT treatment. For symptoms like hot flushes, HRT is usually effective for around 2-5 years. This can be longer in some cases, and your body’s response to treatment will be individual to you.  

The NHS recommends allowing 3 months to see how HRT is improving your menopause symptoms. You might notice an improvement sooner than this, but 3 months is the suggested time to see how effective it is for you.  

If your medical circumstances change (for example if you have a hysterectomy), you can let your clinician know and they’ll give you guidance on next steps, including any proposed changes to your treatment.  

If you find that you want to change the way you take HRT (switching from a tablet to a patch for example), our clinician will be able to provide a recommendation and check your suitability for an alternative.