Hormone Replacement Therapy (HRT)

H.R.T. is hormone replacement therapy, which is designed to counteract the effects of reduced oestrogen levels, which is the cause of many of the menopausal symptoms. It mainly consists of natural, low dose oestrogen.

What types of HRT are available?

Women who have not had a hysterectomy are given a natural, low dose oestrogen  and a progesterone-like drug as part of the HRT. This is called combined HRT.

For women who are perimenopausal, ie still experiencing erratic menstrual bleeding Sequential combined HRT is given.  They are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which oestrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle.

Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of oestrogen and progesterone.
 
How is HRT taken? 
There are many ways of taking HRT, with the most usual being a daily tablet. Alternatives include skin patches, a small pellet or implant under the skin, a gel applied daily to the skin, a ring inserted into the vagina, or a nasal spray. 
 
What are the side effects of HRT?
The majority of women have no side effects, but the following are fairly common:

Nausea
Breast tenderness
Weight gain
Fluid retention.

These symptoms often settle after the first few months of treatment. If they don't, it's worth consulting your doctor or gynaecologist to adjust the medication. 
 
How effective is HRT? 

HRT is effective at relieving hot flushes and vaginal dryness and many women report an improvement in their general sense of wellbeing. HRT is often taken for a short spell of six months to a year to relieve hot flushes.

What are the risks of using HRT
Women’s Health Initiative (WHI) has helped put into perspective the magnitude of these risks, with some figures from their research studies.

For purposes of comparison, the risks are stated as the number of people affected per 10,000 women-years of observation. This can mean one thousand women observed over 10 years or five thousand women over two years, etc.

The Women’s Health Initiative (WHI) study showed the following risks:

Endeometrial Cancer
Some evidence suggests sequential HRT is associated with a slightly higher risk of endometrial cancer.  Ideally, all women on long-term HRT should move to a continuous type within a year or two of starting HRT. 

Breast cancer
The risk of developing breast cancer in women:
Not taking HRT (on placebo) was 30 per 10,000 women-years.
On HRT the risk was 38 per 10,000 women-years.

The best evidence available at present tells us that breast cancers that occur in women taking HRT are smaller, less advanced and of a more treatable type than breast cancers occurring in women not taking HRT.

Heart disease
The risk of developing heart disease in women:
Not taking HRT had 30 per 10,000 women-years.
Women on HRT had 37 cases per 10,000 women-years.

Stroke
The risk of havuing a stroke in women:
On placebo the risk was 21 per 10,000.
On HRT the risk was 29 per 10,000.

Clots in the veins (venous thrombosis)
The risk of developing clots in the vein in women:
On placebo the risk was 16 per 10,000.
On HRT the risk was 34 per 10,000.

In general experts now feel the balance of risk has swung against HRT given for longer than five years. It is recommended that HRT is only used as a short-term treatment to relieve menopausal symptoms, and that treatment is reviewed at least annually. Any woman considering HRT should discuss the risks and benefits for her individual circumstances with her doctor before making a decision about treatment.

 
Other treatments for the menopause

Tibolone (Livial)
Is a synthetic steroid hormone that has some oestrogen plus some progesterone effects (and has some testosterone-like effects, too). In a way it’s a type of combined continuous HRT in a single tablet, which is largely how it’s used.

It helps flushings and sweats, vaginal dryness and irritation and also protects against osteoporosis. It possibly improves libido.

The benefits of tibolone include much less breast tenderness and little effect on breast tissue density in mammograms density. However, the Million Women study showed that tibolone is associated with a slightly increased risk of breast cancer, of around the same level as that associated with oestrogen-only HRT.

Clonidine
Clonidine is a drug originally developed for use as a blood pressure lowering treatment, but at smaller doses (Dixarit) it can relieve hot flushes.

Oestrogen creams and pessaries
Vaginal dryness can be relieved by short courses of oestrogen creams or pessaries that are inserted into the vagina.

There is also a special vaginal ring containing oestrogen that can be left in the vagina for three months, where it slowly releases oestrogen into the vaginal tissues.

Complementary medicine
A range of ‘complementary’ medical treatments are also widely in use to relieve menopausal symptoms. Click here to read our informed guide to alternative treatments of menopausal symptoms

Although the scientific evidence in favour of complementary medicine is not as good as for conventional treatments, they are generally safe to try.

What help is there to get you through the Menopause?

   
Online information:

Menopause Matters is a very good independent, clinician-led website. They provide easily accessible, up-to-date, accurate information about the menopause, menopausal symptoms and treatment options.

Women's Health Concern provides excellent information on all aspects of women's health including the menopause

The Natural Menopause Advice Centre has some great information

NHS24 is an excellent information resource on the menopause

netdoctor.co.uk has some useful information

As always the BBC website has a wealth of fantastic information. 

 
Useful Reading

 
The New Natural Alternatives to HRT by Marilyn Glenville (Kyle Cathie Limited, 2002)

Cruising Through the Menopause - managing your menopause successfully without HRT by Maryon Stewart (Vermilion, 2000)

Menopause Naturally by Kitty Campion (Newleaf/Gill & Macmillan Ltd, 1998)

Ten Steps to a Natural Menopause by Leslie Kenton (Vermilion, 1999)

The Which? Guide to Complementary Medicine by Barbara Rowlands (Which? Books[Consumer Association], 1997)

Menopause - What you Really Need to Know by Dr Sarah Brewer (Robinson, 2003)

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