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Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is a treatment used to ease symptoms of the menopause. It tops up, or replaces, low levels of the hormone oestrogen, and sometimes progesterone too.

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Details

  • Decision-making Why would I take hormone replacement therapy (HRT)?

    Your doctor may prescribe HRT if you have severe menopausal symptoms that you can’t ease with self-help measures. These symptoms are caused by your body no longer producing enough oestrogen as you reach the menopause. Your ovaries make the hormones oestrogen and progesterone during your menstrual cycle. But when you get close to the menopause, your body naturally produces less of these hormones.

    Low oestrogen levels can lead to a number of physical and emotional symptoms, including hot flushes, night sweats and mood swings. Around eight in every 10 women notice some of these symptoms around the time of the menopause. You can use HRT to ease many of these symptoms.

    In the years leading up to the menopause, you may notice your periods are no longer regular. This stage of life is called the perimenopause. Once you reach the menopause itself, your ovaries stop releasing eggs and your periods stop completely.

    HRT isn’t a form of contraception. You can still get pregnant during the perimenopause and, depending on your age, for up to two years after your last period. Speak to your GP for advice about contraception while you’re going through the menopause.

  • Types Types of hormone replacement therapy (HRT)

    There are two different types of HRT. Your GP will talk to you about which one is best for you based on your medical history.

    Oestrogen-only HRT

    This form of HRT only contains the hormone oestrogen. It helps to relieve symptoms of the menopause and also strengthens your bones Low levels of oestrogen at the menopause can weaken your bones and make you more likely to break a bone if you fall over.

    Your GP may offer you oestrogen-only HRT if you’ve had a hysterectomy (an operation to remove your uterus (womb)). Brand names of oestrogen-only HRT include Bedolâ, Climavelâ, Elleste-Soloâ, Evorelâ, FemSevenâ, Progynovaâ and Sandrenaâ.

    Combined HRT

    Combined HRT contains the hormones oestrogen and progesterone (in the form of progestogen). If you haven’t had a hysterectomy, you’ll need to take progesterone as well as oestrogen, to protect you from developing uterine cancer (endometrial cancer). Brand names of combined HRT include Angeliqâ, Climagestâ, Climesseâ, Clinoretteâ, Elleste-Duetâ, Evorelâ Conti or Sequi, FemSevenâ Conti, Kliofemâ and Novofemâ. You can take combined HRT in two ways.

    • 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’ll usually have a monthly bleed at the end of each course of progesterone.
    • Continuous combined HRT. This means you take both oestrogen and progesterone every day. You won’t have any monthly bleeding.

    Most women start taking cyclical HRT and then change to continuous combined HRT a year or two later.

    Tibolone

    Tibolone is a synthetic (artificial) version of HRT, which mimics the effects of oestrogen and progesterone. It also has weak androgenic (male hormone) properties. Like combined HRT, you take tibolone every day. Your doctor will only prescribe tibolone if you haven’t had a period for 12 months. The brand name of tibolone is Livialâ.

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

  • Taking the medicine How do I take hormone replacement therapy (HRT)?

    You can take HRT in a number of ways. Your GP will discuss these with you to help you work out which is best for you.

    Tablets

    Tablets are the most popular form of HRT. You take these every day to control your symptoms.

    Patches

    Patches may be best for you if you’re prone to certain medical conditions, such as migraine or blood clots in your legs. You stick a self-adhesive patch on your skin below your waist. This provides a constant flow of hormones. You remove the patch once or twice a week, depending on the product. You replace it with a fresh patch on a different area of your skin each time. You shouldn’t put the patches on or near your breasts or under the waistband of your clothes. Patches may irritate your skin. If a patch falls off in the bath, apply a new one once your skin has cooled down.

    Gels

    You put gels on a clean dry area of skin, such as on your lower back or on your thighs, every day. You shouldn’t apply gels to your breasts or near your vaginal area. Gels are less likely to irritate your skin than patches. Avoid putting that area of skin in contact with the skin of another person, especially male, once you’ve applied the gel. Don’t use other skin products over the gel or wash that area of skin for at least one hour afterwards.

    Vaginal oestrogens

    You can use vaginal tablets, vaginal rings or vaginal creams. These may be recommended for you if you mainly have vaginal dryness or bladder symptoms. You should use the smallest amount of cream possible to ease your symptoms. Some vaginal creams may damage condoms and diaphragms.

    Implants

    You can also have HRT as implants, which your GP inserts under your skin. These gradually release oestrogen over time. However, they can be difficult to remove if you have any side-effects. Because of this (and also because they become less effective over time), implants aren’t used very often now.

  • Can all women take HRT? Can all women take hormone replacement therapy (HRT)?

    Most women can use HRT, but your GP may not prescribe it if you have, or have ever had:

    If you're having menopausal symptoms but aren’t sure if you can take HRT, speak to your GP. Your GP will go through your medical history to see whether HRT is right for you, and discuss what your options are.

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

    HRT can cause several side-effects. These include:

    • tender, and larger, breasts– this may last for four to six months
    • cramp in your legs
    • feeling sick
    • feeling bloated
    • mood swings
    • depression
    • headaches
    • fluid retention – this is when fluid builds up in your ankles or face, which can cause swelling
    • more frequent migraines, if this is something you’re normally prone to

    If you’re taking cyclical HRT, you may notice some vaginal bleeding for the first two to three months. If you’re taking continuous combined HRT, you may notice a tiny amount of blood, called vaginal spotting, for up to six months. These bleeding patterns can be normal for many women when they start taking HRT, but it’s important to mention them to your GP.

    Your GP may recommend that you take HRT for three months at first to see how you get on. Then you’ll have a check up with your GP every six to 12 months. You can make an appointment sooner than this if you notice any problems. Most side-effects get better within a few months. If they don’t improve, your GP may suggest you try a different type of oestrogen or progesterone.

    Always read the patient information leaflet that comes with your medicine.

  • Risks Risks of hormone replacement therapy (HRT)

    HRT is the most effective treatment for the menopause, but it has been associated with increased risk of certain conditions. These are summarised below. Any risks associated with taking HRT are very small, but they can outweigh the benefits in some women. Your GP will discuss any risks that apply to you, so that you can make an informed choice about whether or not to take HRT.

    Breast cancer

    Taking combined HRT may increase your risk of developing breast cancer. This excess risk disappears within 5 years of stopping HRT. Oestrogen-only HRT is associated with little or no change in your risk.

    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, speak to your GP as soon as possible.

    Ovarian cancer

    Using combined HRT or oestrogen-only HRT over a long time is associated with a small increase in risk of ovarian cancer. This disappears within a few years of stopping HRT.

    Endometrial cancer

    Oestrogen-only HRT is associated with an increased risk of endometrial cancer (cancer of the lining of the womb). Because of this, you’ll only be offered oestrogen-only HRT if you don’t have a womb (for instance, you’ve had a hysterectomy).

    Blood clots

    Taking HRT can increase your risk of developing blood clots in your legs (deep vein thrombosis). Very occasionally, some or all of a blood clot can break away and move to your lungs. You’re more likely to have a blood clot if you’re using HRT tablets rather than HRT patches or gel. See your GP if you:

    • have swelling or pain in one of your calves
    • notice the skin on your calf feels hotter than usual
    • notice the skin on your calf looks red or purple
    • have severe chest pain
    • suddenly find it difficult to breathe
    • have a cough – you may cough up bloody mucus

    Heart disease and stroke

    Taking oestrogen-only tablets can increase your risk of stroke. However, oestrogen-only HRT doesn’t affect your risk of heart disease – it may even reduce your risk.

    Combined HRT may slightly increase your risk of heart disease.

    If you’re worried about the risks of HRT, or notice any unusual symptoms while you’re taking it, speak to your GP.

  • Stopping HRT Stopping hormone replacement therapy (HRT)

    Menopausal symptoms last for two to five years in most women. Your doctor won’t usually recommend taking HRT for longer than five years. If you’ve been using HRT for one or two years, your GP may suggest stopping it for a short while to see if you still need it.

    You may find that some of your symptoms, such as hot flushes and sweats, come back for a few months when you stop taking HRT. These usually go away again after a few months. To prevent your symptoms coming back when you stop HRT, your GP may ask you to reduce your HRT dose gradually over three to six months. If your hot flushes and night sweats return and are severe, your GP may suggest that you go back on HRT. Your GP will prescribe the lowest dose possible to control your symptoms.

    Your GP may ask you to stop taking HRT straight away if you have any severe side-effects, such as a blood clot in your leg.

    Your GP will speak to you about the pros and cons of stopping HRT.

  • FAQ: HRT and weight Will taking HRT make me put on weight?

    It’s common to put weight on as you approach the menopause, but there’s no evidence that HRT itself causes this. If you do gain weight, it’s more likely to be due to the menopause itself.

    Many women notice they put on weight at the menopause, particularly around their waistline. Doctors aren’t sure whether this is caused by ageing or hormonal changes. Being overweight at the menopause may make your hot flushes more regular and more severe. It can also make you more prone to heart disease, stroke, type 2 diabetes and breast cancer.

    If you’re going through the menopause, it’s important to exercise regularly and lose any excess weight slowly and steadily. Try to eat a healthy, balanced diet, with at least five portions of fruit and vegetables every day. Eat plenty of starchy foods rich in fibre (for example, cereals, rice or pasta) as these will fill you up. A healthy diet also includes some milk and dairy products (or calcium-rich alternatives) and protein (meat, fish or vegetarian alternatives). Limit how much fat, salt and sugar you eat.

  • FAQ: Herbal remedies Do herbal remedies work as well as HRT?

    Many women try herbal remedies to ease their menopausal symptoms. But there isn’t enough research to show whether or not these work.

    Some research has found that phytoestrogens and the herbs black cohosh and red clover can help to ease menopausal symptoms. Phytoestrogens are naturally occurring products, similar to oestrogen. They are found in plants and foods such as soy beans, nuts, cereals and seeds.

    There are many different herbal products available and these can vary in safety and quality. The actual daily doses are also unclear. This is why herbal remedies aren’t recommended by most doctors.

    If you choose to take herbal remedies, it’s important to remember that natural doesn’t always mean harmless. Herbal remedies aren’t regulated in the same way that medicines are: they may cause side-effects or affect other medicines you may be taking. Always talk to your pharmacist or GP before trying anything new.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Reproductive endocrinology. Oxford handbook of endocrinology and diabetes (online). Oxford Medicine Online. oxfordmedicine.com, published March 2014
    • Female reproductive endocrinology. The MSD Manuals. www.msdmanuals.com, last full review/revision August 2016
    • Menopause. PatientPlus. patient.info/patientplus, last checked February 2016
    • Hormone replacement therapy (including benefits and risks). PatientPlus. patient.info/patientplus, last checked February 2016
    • Hormone replacement therapy. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnfc/current, reviewed January 2017
    • Endometrial cancer. PatientPlus. patient.info/patientplus, last checked December 2015
    • Menopause. Clinical Knowledge Studies. cks.nice.org.uk, last revised October 2015
    • Gynaecology. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Menopause: diagnosis and management. National Institute for Health and Care Excellence (NICE) guideline NG23, 2015. www.nice.org.uk
    • Checking your breasts. Breast Cancer Care. www.breastcancercare.org.uk, last reviewed December 2016
    • Deep Vein Thrombosis. PatientPlus. patient.info/patientplus, last checked July 2015
    • Combined hormonal contraceptive. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnfc/current, reviewed January 2017
    • Karvonen-Gutierrez C, Kim C. Association of mid-life changes in body size, body composition and obesity status with the menopausal transition. Healthcare 2016; 4:42. doi: 10.3390/healthcare4030042
    • Obesity in adults. PatientPlus. patient.info/patientplus, last checked January 2015
    • A quick guide to the government’s healthy eating recommendations. Public Health England. www.gov.uk, published August 2014  
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    Reviewed by Pippa Coulter, Bupa Health Content Team, March 2017
    Expert reviewer, Raj Mathur, Consultant Gynaecologist
    Next review due March 2020

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