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Menopause - Looking at HRT


What is HRT?


Basically, HRT (Hormone Replacement Therapy) does what it says on the tin - it replaces the hormones lost once your start out on your menopause journey.



Who can have HRT??


Most women can have HRT if they're having symptoms associated with menopause.

But HRT may not be suitable if you:

  • have a history of breast cancer, ovarian cancer or womb cancer

  • have a history of blood clots

  • have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT

  • have liver disease

  • are pregnant – it's still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you're under 50, or for 1 year after the age of 50

In these circumstances, alternatives to HRT may be recommended instead.


How do you use it?


You should talk to your GP regarding the different forms of HRT and which is best for you.


Tablets

Probably the most common form of HRT, and the most convenient - these are usually taken once a day.

Either oestrogen-only tablets or combined tablets are available.

Although the overall risk is small, some of the risks of HRT may be higher with the tablets - talk to your GP.


Skin patches

Another common way of taking HRT, these are simply stuck onto your skin and you replace them every few days.

Again, oestrogen-only and combined HRT patches are available.

The patches may suit some people better and they can reduce side effects like indigestion, which the tablets may cause and they do not increase your risk of blood clots.


Oestrogen gel

Like the skin patches, the gel does not increase your risk of blood clots and is easy to apply.

But if you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.


Implants

Although not widely available on the NHS, HRT also comes as small pellet-like implants, which gradually release oestrogen and last for several months. They are inserted under your skin (usually in the tummy area). This may be convenient if you're not good at remembering to take a tablet every day.

If you still have your womb, you'll need to take progestogen separately too.

If you're taking a different form of oestrogen and need to take progestogen alongside it, another implant option is the intrauterine system (IUS). An IUS releases a progestogen hormone into the womb. It can stay in place for 3 to 5 years and also acts as a contraceptive.


Vaginal oestrogen

To help relieve vaginal dryness associated with menopause, you can get oestrogen as a cream, pessary or ring that is placed inside your vagina; this can also help with hot flushes.

As it does not carry the usual risks of HRT and does not increase your risk of breast cancer, you can use it without taking progestogen, even if you still have a womb.


Testosterone

Whilst not currently licensed for use with women, testosterone is available as a gel that you rub onto your skin. If you are experiencing a loss of libido with menopause, a specialist doctor may be able to prescribe it to you and is used alongside another type of HRT.

Possible side effects of using testosterone include acne and unwanted hair growth.



Side Effects


Like any medicine, the hormones used in hormone replacement therapy (HRT) can cause side effects, although these usually improve over time - speak to your GP if the side effects last longer than 3 months or are severe.

Side effects of oestrogen

The main side effects of taking oestrogen include:

  • bloating

  • breast tenderness or swelling

  • swelling in other parts of the body

  • feeling sick

  • leg cramps

  • headaches

  • indigestion

  • vaginal bleeding

These side effects will often pass after a few weeks. To ease side effects, try:

  • taking your oestrogen dose with food, which may help feelings of sickness and indigestion

  • eating a low-fat, high-carbohydrate diet, which may reduce breast tenderness

  • doing regular exercise and stretching, to help leg cramps

If side effects persist, your GP may recommend switching to a different way of taking oestrogen (for example, changing from a tablet to a patch), changing the medicine you're taking, or lowering your dose.

Side effects of progestogen

The main side effects of taking progestogen include:

  • breast tenderness

  • swelling in other parts of the body

  • headaches or migraines

  • mood swings

  • depression

  • acne

  • tummy (abdominal) pain

  • back pain

  • vaginal bleeding

As with side effects of oestrogen, these will usually pass after a few weeks.

If they persist, a GP may recommend switching to a different way of taking progestogen, changing the medicine you're taking, or lowering your dose.



Are there alternatives?

  • Herbal medicine - a practice based on the use of plants or plant extracts to relieve symptoms, e.g. evening primrose oil or St John’s Wort

  • Alternative medicine - a range of therapies used instead of conventional medicine, such as acupressure, acupuncture and homeopathy

  • Complementary therapy - interventions that tend to be used alongside conventional medicine, e.g. aromatherapy with HRT

  • Non-hormonal medical treatments - treatments prescribed by your doctor, such as antidepressants

  • Bioidentical HRT - these are made from plant sources and are considered similar to human hormones. Although they have been used for over 10 years in the US, in the UK they are not regulated as not enough studies have been done to prove how safe they are.

  • Supplements - take advice from your GP before taking.

  • Diet and Lifestyle - ensure you follow a healthy diet, cut down on caffeine and alcohol, and doing regular exercise can all help alleviate the symptoms of menopause.


Be aware that some supplements are being advertised on social media as ‘a new way to tackle the menopause’. Some of these products, which contain plant-based compounds, 'show little value’ in combating symptoms, according to the British Menopause Society (BMS), the authority for menopause health in the UK.


Taking HRT is a very personal decision which should be made once you have the facts and you have discussed it with your GP.


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