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The menopuase and HRT: what every woman needs to know

Fact sheet 2: Hormone Replacement Therapy

What is Hormone Replacement Therapy?

Hormone Replacement Therapy (HRT) replaces the oestrogen, which the ovaries no longer produce after your menopause. HRT returns your oestrogen to a level you had before the menopause.

While the menopause is not an illness, HRT is a useful treatment, which can help to relieve the more immediate and troublesome symptoms such as hot flushes, night sweats & vaginal dryness. HRT will also protect you against heart disease and bone thinning which is why it is worth continuing to take HRT, even though your immediate obvious symptoms may have disappeared.

HRT treatments use oestrogen similar to that which your body produced naturally before the menopause. In women who have not had a hysterectomy HRT will often include a course of another female hormone, progesterone which protects the lining of your womb when you are fertile. Progesterone usually needs to be taken for 12 days per month and causes bleeding similar to your monthly period. The purpose of progesterone is to prevent overgrowth of the womb lining, which if it happens –and this is quite rare - may lead to cancer of the womb.

How do I know HRT is right for me?

Deciding whether or not to take HRT during the menopause is a highly personal decision. The more information you have at this time in your life, the more confident you are likely to feel about making an informed choice. You can easily raise any concern you may have with your family doctor or practice nurse.

There are three important reasons why you might want to consider HRT:

    1.Short term relief from hot flushes, night sweats, vaginal dryness
    2.Reduction in risk of heart disease
    3.Protection from bone disease and fractures.

Different forms of HRT are available and which one you decide upon will be a matter of personal choice. It is helpful if you discuss this with your family doctor or nurse, as there may be other reasons why one type of HRT may suit you better than another.

Which type of HRT shall I take?

HRT can be taken in the form of tablet, patch, cream or gel implant.
Tablet –if you still have your womb, this means taking oestrogen tablet every day as well as progesterone tablet about every 12-14 days towards the end of each month. Because the hormones you are taking as tablets behave in the same way as your normal hormones did, you will have a ‘bleed’ towards the end of each month. This period is only light and tends to last for about 4-5 days and then you start taking your next cause of tablets. Your first few periods may be a little irregular as your body gets used to a monthly cycle again; this is quite normal and will settle down after the first few months. If things do not settle down or you have bleeds in the middle of a cycle, then you should see your doctor.

HRT tablets are available in different strengths so the amount of oestrogen can be altered to suit your body’s needs. Usually your doctor will ask you after the first three months of taking HRT to see how you are getting on. This is an ideal time to raise any concerns or discuss trying a different strength of oestrogen or another type of HRT, which might suit you better.

For those women who have finished their period’s altogether, there is a type of HRT, which combines oestrogen and progesterone in a single tablet. Taken every day, this has the benefit of avoiding monthly bleeds and still protects your womb.

Patches-patches contain the same type of oestrogen as HRT tablets. You stick the patch on your skin, usually the thigh or buttock and the hormone is absorbed through the skin in to the blood stream. If you have not had a hysterectomy then you will either need a pitch contains oestrogen and progesterone or you will need to take a progesterone tablet for the last 12-14 days of each monthly cycle, in which case you will have a monthly bleed.

Until very recently, you had to change your patch every 3-4 days. Now patches have been developed which only have to changed once a week, if applied correctly it will not fall off when swimming or taking a shower. Patches are a convenient method of administering HRT.

In order to ensure that the maximum benefit is received with the minimum of complications when using a patch applied to a dry clean area of skin to avoid the likelihood of it falling off. Also, to avoid the chances of skin irritation try to attach your patch to a different area of skin each time you replace it.

Creams and pessaries-these are most useful for women who experience painful intercourse due to vaginal dryness but who do not experience any other menopausal symptoms. The oestrogen in the creams and pessaries help to restore the moisture to the vagina. However, it is unlikely to relieve other menopausal symptoms and many women tend to find this method messy and inconvenient.

Implants-
these are small pellets of oestrogen which are placed under the skin – usually the stomach or thigh and are replaced every six months. This involves a minor surgical procedure and you will need a local anaesthetic. The advantage of this implant is that you do not have to worry about taking tablets every day or changing your patches. However, if you have a womb you will still need to take progesterone tablets for the last 12-14 days of each month.

Gels-gels are applied to the skin on a daily basis. If you have not had a hysterectomy you will need progesterone tablets for the last 12-14 days of the month.

Are there any side effects from the treatment?

When you start HRT you may experience some side effects. Usually these side effects last no more than a month or two. The most common effects are breast tenderness, nausea and headaches. Some women may experience weight changes but this is likely to be due to fluid retention and like all side effects, settles after a few months.

What can I do if my HRT doesn’t suit me?

It is worth persevering with HRT because it offer you so many health benefits, so:
  • Stick with your existing method for 3-6 months to see if the side effects settle down.
  • Ask to try another form of HRT, which might suit you better: remember you can choose from tablets, patches, creams, gels or implants.
  • Ask if a different dosage or slightly different type of oestrogen/ progesterone combination might solve the problem.
You may feel the side effects are so bad that you want to stop taking HRT immediately. If you experience severe side effects you should speak to your doctor or practice nurse; it may be that you need a lower dose of oestrogen or a different type of progesterone. The important thing is not to stop taking HRT suddenly without first talking through any concerns or anxieties, which you may have. You will only benefit fully from HRT if you take it regularly and as directed by your doctor.

Most importantly, don’t be reluctant to take up the doctors or nurses time by discussing your concerns and queries about HRT. The more you know, the more comfortable you are going to be with HRT and the better you will feel.

Do I still need contraception?

It is important to remember that HRT is not a contraceptive. Until the chance of pregnancy no longer exists, that is, at least one year after your last period if you are over 50 and two years if you are under 50, then you should continue to use contraception.

How long should I take HRT for?

Deciding how long you should take HRT depends on a number of factors:
  • Symptom relief and how long those symptoms last, anything from a few months to a few years.
  • Whether the side effects and return to ‘periods’ is too much to put up with.
  • Reduction of the risk of heart disease.
  • Prevention of bone thinning.

It is worth considering that women who take HRT for a least five years can reduce their risk of heart disease by 40% and bone fractures due to osteoporosis by as much as 50%.
Sadly, despite these obvious long-term benefits, many women give up HRT after a few months because of initial side effects or worries about long-term side effects. It is important to remember that to gain the full protective benefit from HRT you need to take it for at least five years. In fact, many doctors recommend taking it for 10-15 years.

Is there any age limit for HRT?

Even women, who went through the menopause some years ago, can still benefit from HRT. Older women who have never used HRT are likely to need it even more than younger women due to their increased risk of heart disease and osteoporosis. And don’t worry about a return to monthly bleeds- if you have not had a hysterectomy, you can avoid bleeds by taking a combined preparation of oestrogen and progesterone.

What about the risks of breast cancer?

Like most diseases, breast cancer is not caused by a single factor. Some women may be at greater risk overall of breast cancer, regard less of whether they rake HRT. You need to discuss this with your doctor and weigh up the pros and cons of taking HRT in your particular situation.

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