Hormone Replacement Therapy (HRT) is the treatment used for the relief of symptoms of menopause by replacing hormones that are declining near the menopause. It is also used as a preventative therapy to help maintain healthy bones and connective tissues including lining of the vagina and bladder. It is also known to reduce the risk of cardiovascular disease when started between 50 and 59 years of age.

HRT will treat:

  • Hot flushes
  • Night sweats
  • Bladder symptoms
  • Mood changes anxiety
  • Vaginal dryness
  • Reduced sex drive

What is HRT

Hormone Replacement Treatment (HRT) comprises of two main hormones estrogen and progestogen.

Estrogen

This hormone is the main replacement ingredient that is responsible for most of the symptoms of menopause. It also has a key role in preventative therapy such as maintenance of bones and connective tissue. It is used in conjunction with either a synthetic progestogen or natural progesterone in a similar fashion to what nature provides us in our reproductive years.

Progesterone

The main role of this hormone is to protect the lining of the womb from overstimulation by estrogen, and the combination reduces the risk of endometrial cancer. Women who do not have a womb, from having had a hysterectomy for example, may only have estrogen.

HRT Hormones

Estrogen:

  • Estradiol
  • Estriol
  • Estrone

Progestogens

  • Natural or Micronised progesterone
  • Levonorgestrel
  • Dydrogesterone
  • Norethisterone

Testosterone

  • This may not be available on the NHS as it is not yet a licensed product for women in the UK, but it has its role in some women.

Tibolone

  • This is similar in its function to estrogen and progesterone. It also has androgenic properties and can help with reduced libido. Some women however may not find it as effective as estrogen and progesterone.

How to Take HRT

There are different ways to administer Hormone Replacement Treatments, including:

  • HRT Patches – applied to the skin twice a week
  • Gels – applied to skin daily
  • Creams – applied locally to the vagina as directed by your doctor
  • Vaginal pessaries – inserted in the vagina as directed by your doctor
  • Vaginal hormonal ring – inserted in the vagina and changed every 3 months or as directed by your doctor
  • Tablets or capsules – taken daily

Starting Hormone Replacement Treatment (HRT)

All of the above hormones can be prescribed on the National Health Service (NHS). However, there are hormones that are well researched for their benefit but may not be manufactured by the pharmaceutical companies. These can to be prescribed off-label and therefore have to be done by your private specialist.

When it comes to your dosage your doctor will start low and go slow in order for you to experience more benefits and less side effects. It is important to trial HRT for at least 3 months to allow any side effects to settle before changing the dosage. It is important to note that it can sometimes take a few weeks to see the desired results.

You will be able to choose the form of HRT that you think you will be most compliant with
and one that suits your needs. Your doctor will be able to advise you on the best approach
to using hormone therapy that is most natural and identical in chemical structure to your
own hormones. These hormones mimic your body’s hormones and optimize levels and
hence function.

However, there may be patients where HRT may not be used such as some breast cancer
sufferers or those with clotting disorders. Here, other treatment methods may be
recommended.

Whilst we are able to help achieve a healthy balance between science and nature, which
can go a long way towards maintaining hormonal health, it is also extremely important that
at the same time you seriously reflect on your nutrition and lifestyle.

HRT Regimes

Sequential HRT

Whilst you are still experiencing your periods, the Sequential HRT Regime will be prescribed. In your regime you will have doses of estrogen every day and add progesterone for the last 10 to 12 days of the month. This will result in a light period every month. Similar schedule will also apply to women who are within one year of their last period. Sequential HRT can be taken in pill, gel, or patch form.

Continuous Combined HRT

If your last period was over a year ago then a Continuous Combined HRT Regime will be used. Here you take both hormones in a continuous fashion and are less likely to experience a period. You may still spot though initially.

Mirena® IUS

In women who use a Mirena® IUS as the progestogen arm of HRT, only estrogen
replacement needs to be added. This will, in addition, give you the contraceptive benefit
and therefore is a useful way of initiating HRT in perimenopausal women.

The Mirena® IUS is a small device that is inserted into the womb by your doctor and remains
in situ for five years. During this time, it secretes a tiny amount of hormone levonorgestrel,
which has a local action.

This will keep the lining of the womb thin so that it is not affected by any havoc our own
hormones may be causing. It therefore also prevents any chance of overstimulation and the
possibility of endometrial cancer by unopposed estrogen.

The Mirena® IUS will not interfere with your own hormonal balance and allows your ovaries
to function as they are presently. It does not interrupt the conversation between your pituitary gland in the brain and the ovaries. So, whatever your hormonal rhythm, it will be
allowed to continue undisturbed.

It enables us to manage heavy periods that are a common occurrence in the perimenopause
phase, but also allows us to add estrogen replacement using gels or patches. In this way the
smallest dose of progesterone is used for the protection of the lining of the womb whilst
allowing us to titrate the estrogen dose as required.

Topical Vaginal Estrogen Therapy

Other than systemic forms of HRT, i.e. the ones that bring an overall body benefit, there is a
topical vaginal form of estrogen therapy. This can come in the form of vaginal pessaries,
creams or vaginal rings. These are local treatments to help vaginal dryness, tissue fragility,
urinary tract infections and bladder symptoms. They are licensed for indefinite use where
indicated in recommended dosages. They are very mild, but very effective prescribable
treatments. Your doctor may advise these in addition to systemic HRT or as a stand-alone
treatment.