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Hormone replacement therapy (HRT)

Your ovaries make the hormones oestrogen and progesterone as part of your menstrual cycle. As you approach the menopause, your body produces less of these hormones which can lead to a number of symptoms. Hormone replacement therapy (HRT) aims to top up or restore the levels of these hormones to help treat some of the symptoms of the menopause.

As the levels of oestrogen and progesterone decrease, among other changes you may notice your periods aren’t as regular. This is known as the perimenopause. Once you fully enter the menopause, your ovaries stop releasing eggs and your periods stop permanently. But you can still get pregnant during the perimenopause and, depending on your age, for up to two years after your last period. So it’s important to keep this in mind – remember that HRT isn’t a contraceptive. Speak to your GP for advice about contraception while you’re going through the menopause.

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  • Types What are the main types of hormone replacement therapy (HRT)?

    There are two main types of HRT.

    • Oestrogen-only HRT. This contains the hormone oestrogen, which helps relieve symptoms of the menopause and also maintains bone strength.
    • Combined HRT. This contains the hormones oestrogen and progesterone (which protects the lining of your womb).

    Oestrogen and progesterone usually work together during your menstrual cycle. Oestrogen stimulates the cells of your womb lining (endometrium) to grow so it thickens; it also causes an ovary to release an egg. Progesterone prepares your womb lining to receive an egg if it’s fertilised. If this doesn’t happen, the lining breaks down and you have a period. If your body doesn’t produce progesterone to stimulate a period or you take just oestrogen, the cells in your womb lining may grow uncontrollably. This can increase your risk of developing womb cancer (endometrial cancer).

    If you’re going through the menopause and have had a hysterectomy (an operation to remove your womb) you can take oestrogen-only HRT. If you haven’t had a hysterectomy, you will need to take a combination of oestrogen and progesterone (combined HRT).

    Talk to your GP about which type of HRT is best for you.

  • Taking the medicine How to take hormone replacement therapy (HRT)

    You can take HRT in a number of different ways, depending on your medical history and your personal choice. Some examples are listed below.

    • Cyclical HRT. This means you take oestrogen every day and add progesterone for 12 to 14 days in a month to mimic your menstrual cycle. You will usually have a period at the end of each course of progesterone.
    • Continuous combined HRT. This means you take both oestrogen and progesterone every day, which will stop you having a period (if you still have any). Usually, you start taking cyclical HRT and then change to continuous combined HRT a year or two later.
    • Oestrogen-only HRT. This is only suitable if you have had a total hysterectomy to remove your womb (you only need progesterone to prevent the cells in the lining of your womb from growing too much).

    There are a number of different ways you can take HRT including:

    • tablets that you take daily
    • patches that you put on your skin (below your waistline) once or twice a week
    • a gel that you put on your lower back or on your thighs every day
    • a pessary (a small tablet that you put into your vagina) or a vaginal ring

    Your GP will talk to you about your options and help you choose how to take HRT.

  • Special care Special care

    HRT can increase your risk of having a stroke, developing breast cancer and blood clots. Some studies have also suggested that HRT may increase your risk of developing ovarian cancer but it isn’t known for sure yet. For some women the risks of HRT can outweigh the benefits. Your GP won’t usually prescribe HRT if you have, or ever had:

    If you're concerned, talk to your GP about your options.

    See our frequently asked questions for more information.

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  • Side-effects Side-effects of hormone replacement therapy (HRT)

    Side-effects are the unwanted effects of taking a medicine. Side-effects of HRT can include:

    • tender breasts
    • cramp in your legs
    • feeling sick
    • feeling bloated
    • mood swings
    • depression
    • fluid retention – this is when fluid builds up in your ankles or face, which can cause swelling

    If you have side-effects, it’s important to talk to the GP who prescribed your HRT before you stop taking it. Most side-effects get better within a few months. If they don’t improve, your GP may suggest a different type of oestrogen or progesterone for you to try.

    If you’re taking HRT, it’s important to be ‘breast aware’. This means knowing how your breasts look and feel so you’re more likely to notice any changes. If you’re worried about any changes to your breasts, contact your GP as soon as possible.

    It’s unusual but one potential complication of HRT is venous thromboembolism. This is when a blood clot forms in a vein, usually in your leg, part or all of which can move to your lungs. See your GP if you:

    • have swelling or pain in one of your calves
    • have severe chest pain
    • suddenly find it difficult to breathe
    • have a cough – you may cough up bloody mucus

    This section doesn’t include every possible side-effect of HRT. Please read the patient information leaflet that comes with your medicine and speak to your GP, pharmacist or healthcare professional for more details.

  • Stopping Stopping hormone replacement therapy (HRT)

    After about one or two years of using HRT, your GP may suggest you stop taking it for a short period of time. This is to check if you still need it but it will depend on whether you have had any symptoms during this time.

    You may find that some of your symptoms, such as hot flushes and sweats, return when you stop taking HRT. But generally they go away after a few months. To reduce the risk of any symptoms returning, your GP may advise you to reduce your HRT dose gradually over a period of time.

    Ask your GP for more information about the risks and benefits of stopping HRT.

  • Common names Names of common hormone replacement therapy (HRT) medicines

    Examples of the main types of HRT are shown in the table below. The type of HRT your GP prescribes you will depend on a number of things including what suits you best.

    You may have noticed that your medicine has two or more names. All medicines have a generic name. Many medicines also have one or more brand name(s). Generic names are in lower case, whereas brand names start with a capital letter.

    Type of HRT medicine Brand name
    conjugated oestrogens with progesterone Premique, Prempak-C
    estradiol with progesterone Angeliq, Climagest, Climesse, Clinorette, Cyclo-Progynova, Elleste-Duet, Evorel, Femoston, FemSeven Conti, FemSeven Sequi, Indivina, Kliofem, Kliovance, Novofem, Nuvelle Continuous, Tridestra, Trisequens
    conjugated oestrogens only Premarin
    estradiol only Bedol, Climaval, Elleste-Solo, Elleste Solo MX, Estraderm MX, Estradot, Evorel, FemSeven, Oestrogel, Progynova, Progynova TS, Sandrena, Zumenon
    estradiol, estriol and estrone Hormonin
    estriol only Ovestin
    tibolone Livial
    ethinylestradiol Ethinylestradiol
    raloxifene hydrochloride

    Evista

  • Stopping hormone replacement therapy Stopping hormone replacement therapy

    After about one or two years of using HRT, your GP may suggest stopping HRT for a short period of time to see if you still need it. This will also depend on if you have had no symptoms during this time. You may find that some of your symptoms, such as hot flushes and sweats, return for a few months when you stop taking HRT, but they usually go away after a few months. To avoid symptoms returning, your GP may ask you to reduce your HRT dose gradually over a period of time.

    Your GP will advise you about the risks and benefits of stopping HRT.

  • FAQs FAQs

    Will HRT increase my risk of cancer?

    Answer

    Yes, you may increase your risk of developing a number of types of cancer if you take HRT.

    Explanation

    If you take HRT over a long period of time (over five years), it may increase your risk of developing breast cancer. Some studies have suggested that HRT may increase your risk of developing ovarian cancer too but it isn't known for sure yet. If you’re taking oestrogen-only HRT, there is also a slightly increased risk of developing cancer of your womb lining (endometrial cancer).

    Oestrogen stimulates the production of your womb lining (endometrium) and the release of an egg. Progesterone prepares your womb lining to receive a fertilised egg. If this doesn’t happen, the lining breaks down and you have a period. If there is no progesterone to stimulate a period, this can lead to uncontrolled growth of the lining of the womb. This may increase your risk of developing womb cancer. For this reason, oestrogen-only HRT is usually only offered to women who have had a hysterectomy (an operation to remove their womb).

    If you’re taking HRT, there is also a slightly increased risk of developing a blood clot in a vein (deep vein thrombosis). This is less likely if you use HRT patches or gel.

    Taking HRT can also increase your risk of stroke. These risks can also depend on your family history and lifestyle factors, such as your diet, if you smoke and your weight. It’s important to discuss these factors with your GP before you start HRT.

    Will taking hormone replacement therapy (HRT) cause me to put on weight?

    Answer

    No, taking HRT is unlikely to cause you to put on weight.

    Explanation

    There isn’t enough evidence to suggest that there is a link between taking HRT and putting on weight.

    Many women gain weight when they reach the menopause. This is normally because the amount of muscle you have reduces and your basal metabolic rate (BMR) slows down. Your BMR is how many calories your body uses when you’re at rest.

    If you’re going through the menopause, it’s important to exercise regularly and lose any excess weight slowly and steadily. Losing excess weight may help reduce the number and severity of any hot flushes you have. It will also help to reduce your risk of conditions such as cardiovascular disease. Try also to eat a healthy, balanced diet including all of the main food groups listed below.

    • Starchy foods (for example rice or pasta). Base your meals on these as they will fill you up.
    • Fruit and vegetables. Aim for five portions every day.
    • Dairy foods. Aim for two to three servings a day (for example a small pot of yogurt).
    • Meat, fish and other non-dairy sources of protein (such as beans). Aim for two to three servings of protein every day. A typical serving could be 100g of lean boneless meat (red or poultry), 140g of fish or three tablespoons of nuts.
    • Fat and sugar. You should limit the amount of these you have in your diet.

    Are herbal remedies as effective as HRT at reducing the symptoms of the menopause?

    Answer

    It’s not possible to say for sure whether herbal remedies can help reduce menopausal symptoms.

    Explanation

    Many women try herbal remedies, such as phytoestrogens, black cohosh, evening primrose oil, gingko biloba or ginseng to reduce menopause symptoms. However, there isn’t enough information to show whether they work.

    Phytoestrogens are naturally occurring products, similar to oestrogen, that are found in some plants. Some studies have shown that phytoestrogens may help reduce hot flushes but overall there isn’t enough evidence that they work for GPs to prescribe it.

    There is very little information to support taking any other herbal remedy to help with menopausal symptoms. And very little is known about how safe they are.

    You may find herbal remedies helpful but it’s important to remember that natural doesn’t always mean harmless. Herbal remedies can sometimes affect how your medicines work or cause side-effects. However, some people find that herbal remedies work well for them. Do your research and be sure to talk to your pharmacist or GP before trying anything new.

  • Resources Resources

    Further information

    Sources

    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2013
    • Map of Medicine. Menopause. International view. London: Map of Medicine; 2013 (Issue 3)
    • Menopausal hormone replacement therapy. Medscape. www.emedicine.medscape.com, published 21 April 2014
    • Osteoporosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2013
    • Hormone replacement therapy (including risks and benefits). PatientPlus. www.patient.co.uk/patientplus, reviewed 21 October 2013
    • HRT – follow-up assessments. Patientplus. www.patient.co.uk/patientplus, reviewed 21 October 2013
    • Contraception and the mature woman. PatientPlus. www.patient.co.uk/patientplus, reviewed 18 February 2014
    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 11 August 2014
    • Latest research from the million women study. University of Oxford. www.millionwomenstudy.org, published July 2013
    • Menopause. The Merck Manuals. www.merckmanuals.com, published May 2013
    • HRT – initial consultation. PatientPlus. www.patient.co.uk/patientplus, reviewed 21 October 2013
    • Thromboembolism. Medscape. www.emedicine.medscape.com, published 2 May 2014
    • Venous thromboembolism and hormone replacement therapy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published May 2011
    • Understanding VTE. Royal College of Nursing. www.rcn.org.uk, accessed 11 August 2014
    • Strauss JF, Barbieri R. Yen & Jaffe's reproductive endocrinology. 7th ed. Philadelphia: Elsevier, 2013:308–39
    • Menopause. Medscape. www.emedicine.medscape.com, published 21 July 2014
    • Menopause: lifestyle and therapeutic approaches. Royal College of Nursing. www.rcn.org.uk, published 2014
    • Healthy weight loss. British Nutrition Foundation. www.nutrition.org.uk, published 2012
    • Milk and dairy foods. British Nutrition Foundation. www.nutrition.org.uk, published February 2014
    • Protein. British Nutrition Foundation. www.nutrition.org.uk, published October 2012
    • Menopause and its management. PatientPlus. www.patient.co.uk/patientplus, reviewed 21 October 2013
    • Leach MJ, Moore V. Black cohosh (cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews 2012, Issue 9. doi:10.1002/14651858.CD007244.pub2
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