Understanding Menopause: Is Hormone Replacement Therapy (HRT) Right for You?
Menopause Support Services
- HRT Prescription Prepayment Certificate: Since April 2023, a Prescription Prepayment Certificate is available to help with the cost of HRT medication. For further details and to apply, click here.
Menopause Overview
- Symptom Distribution:
- 25% of women experience no menopausal symptoms.
- 25% of women experience severe or debilitating symptoms.
Menopause is a natural stage in aging, typically occurring between ages 45 and 55, triggered by a decline in a woman’s estrogen levels. In the UK, the average age for menopause is 51. The years leading up to menopause, known as perimenopause, can last several years.
You are considered "post-menopausal" when you’ve gone a full year without a period. However, if you're using hormone treatments or contraception that affects your menstrual cycle, identifying your exact stage may be unclear. What matters most is understanding your symptoms and how they affect your quality of life.
When to Consider HRT
HRT may be beneficial when menopausal symptoms interfere with your daily life, including home, work, social, or sexual activities. Symptoms can begin years before your periods stop, so it's not necessary to wait for menopause to begin HRT.
If you’ve had a surgical menopause (ovaries removed), it’s important to replace the hormones that are no longer being produced until you reach the average age of natural menopause (around 51). There’s no increased risk associated with HRT in this situation, as it’s simply replacing the hormones your body would naturally produce.
Early Menopause refers to when menopause occurs before the age of 45, and Primary Ovarian Insufficiency (POI), or premature menopause, happens when periods cease before age 40. This condition affects up to 1 in 100 women and can cause various symptoms and health concerns if untreated. Replacing hormones in these cases is crucial, and there are no increased risks with HRT until you reach the natural age of menopause.
HRT Benefits and Risks
The benefits and risks of HRT have evolved over time, with newer studies showing that while not entirely risk-free, HRT remains the most effective treatment for alleviating menopausal symptoms. Additionally, it can help prevent long-term health issues caused by declining hormone levels. You can explore more about these risks and benefits in the Women's Health Concerns Fact Sheet on HRT.
Benefits of HRT
- Alleviates menopausal symptoms, leading to a better quality of life.
- Helps prevent osteoporosis.
- Reduces heart disease risk in certain age groups. Research shows HRT can decrease heart disease risk by 30-50% if started within 10 years of menopause.
- Some studies suggest HRT may lower the risk of type 2 diabetes, bowel cancer, dementia, and depression.
Risks of HRT
- Breast Cancer: While the risk of breast cancer increases with age, studies show that Obesity and regular alcohol consumption pose a greater risk than HRT. Research also reveals that women taking estrogen-only HRT (for those without a uterus) may have a lower risk of breast cancer. Combination HRT (estrogen and progesterone) slightly raises the risk of breast cancer but does not increase the risk of death from the disease. It's important to note that synthetic progesterones were used in older studies, while newer options like Utrogestan (bioidentical progesterone) show different results.
- Blood Clots: Older forms of oral HRT have been linked to an increased risk of blood clots. However, newer forms of HRT that are administered through the skin (patches, gels, sprays) do not carry this risk. More information on blood clot risks is available through the British Menopause Society.
- Vaginal Dryness & Pelvic Health: Some women may experience vaginal dryness or pelvic floor issues with HRT use.
Menopause and Heart Health
Beyond HRT, other lifestyle factors play a significant role in increasing risks for conditions like breast cancer, stroke, and blood clots. Factors like obesity, smoking, and alcohol consumption should also be managed independently. You can view an infographic comparing lifestyle risks with HRT risks related to breast cancer.
Lifestyle and Dietary Tips
A lower carbohydrate diet can help stabilize blood sugar levels, which may ease menopause symptoms and address obesity, a key risk factor for several health issues. Regular physical activity, mental wellness, and a positive outlook can also significantly impact how you experience menopause. For more resources on a healthy lifestyle, check out our linked pages on health and wellbeing.
Alternatives to HRT
If you're interested in options other than HRT for managing menopause symptoms, we have links to various non-hormonal treatments and alternative therapies.
Natural Alternatives to HRT
Be cautious with "natural" remedies. Just because a substance is natural doesn't mean it's safe. Some herbal products or treatments may have unproven efficacy or safety concerns. It’s important to research thoroughly and discuss these options with your healthcare provider.
What Type of HRT Should I Take?
The type of HRT you need depends on whether you still have a uterus or other reproductive organs, as well as any medical history, such as endometriosis.
- For women without a uterus, estrogen-only HRT is typically prescribed.
- For women with a uterus or cervix, a combination of estrogen and progesterone is needed to prevent uterine lining thickening, which could increase the risk of endometrial cancer.
HRT Regimens: Cyclical vs. Continuous
Depending on your age and the time since your last period, your doctor may recommend a cyclical regimen, where you take estrogen continuously and progesterone for two weeks each month, resulting in a monthly bleed. Alternatively, a continuous regimen involves taking both hormones daily without a break, typically recommended for women who haven’t had periods for some time.
Pills vs. Transdermal Application
Oral HRT pills are associated with a higher risk of blood clots compared to transdermal methods (patches, gels, or sprays). The choice of delivery method depends on personal preference, but transdermal methods are generally preferred for their lower clotting risk. Patches, for example, only need to be changed twice a week and are water-resistant, while gels require daily application.
Common Side Effects of HRT
Many women experience mild side effects in the first few months of HRT, including:
- Breast tenderness
- Acne or skin changes
- Bloating
- Mood swings
Bleeding on HRT
Spotting or bleeding is common in the first few months after starting HRT. However, if bleeding continues beyond 3-6 months, it’s important to consult your doctor to rule out other issues.
Body-Identical vs. Bioidentical HRT
Body-identical HRT is regulated by health authorities, such as the Medicines and Healthcare products Regulatory Agency (MHRA), and is available through the NHS. These treatments have been safety-tested and are available in transdermal forms, such as patches or gels. Bioidentical HRT, marketed as "natural" or "customized," is unregulated, not tested for safety, and is not recommended by the British Menopause Society.
How Long Should You Take HRT?
Menopausal symptoms vary greatly from person to person. For some, symptoms improve over time, while others experience long-term discomfort. As you age, you may need a lower dose of HRT or may decide to stop altogether. The decision to continue HRT should be made based on how well it manages your symptoms and the associated risks, typically reviewed annually.
Stopping HRT
If you decide to stop HRT, you can either taper off gradually or stop abruptly. Both methods are effective, though you may experience temporary symptoms after discontinuing HRT. These should subside over time, usually within a few weeks to months.
Regular Health Screenings
It’s important to continue regular health screenings, including breast and cervical cancer checks. After starting HRT, a follow-up appointment with your GP after three months is recommended, with annual reviews thereafter.
If you experience any new or prolonged bleeding after starting HRT, please consult your doctor for further investigation.
Useful Resources
- Hampshire and Isle of Wight Menopause Page: Offers support, resources, and virtual menopause support groups.
- Women’s Health Concern: Provides trusted information on menopause and other women’s health issues.
- British Menopause Society (BMS): A resource for healthcare professionals, including guidelines on prescribing HRT.