Hormone replacement therapy (HRT) essentially replaces one or more of the hormones oestrogen, progesterone and testosterone and it is the most effective treatment for menopause and perimenopausal symptoms.
These hormones are produced by the ovaries, and changing levels of these hormones in perimenopause, and low levels after menopause, has wide-reaching effects from hot flushes and sweats to joints pains, loss of libido (sex drive) and vaginal dryness.
When could I start taking HRT?
This is a personal choice. There is benefit for other long term health issues (heart disease/osteoporosis) if HRT is started early, certainly within 10 years of menopause.
I’m in perimenopause, can I take HRT?
You do not need to wait for your periods to stop, you can start taking HRT in perimenopause, when you are having symptoms and are still having periods, which may be changing in nature.
Another option which might be possible for some women is to take the combined contraceptive pill, patch or vaginal ring, if it is safe for you to take this. Some of the newer versions of this type of contraceptive contain oestrogen in the form of E2, Estradiol, or E4, Estetrol, instead of the ethinylestradiol, which many combined contraceptive pills contain. This method is usually stopped at 50 years.
If you take HRT there is no arbitrary time limit to using it, providing there is benefit, there is no specific cut-off and women are increasingly choosing to take HRT beyond the age of 60.
In women with Premature ovarian insufficiency, POI, HRT is advised to be taken, if not contraindicated, and continued until menopausal age, after this time it is an individual decision on continuing care.
I am older than 60 or more than 10 years from my menopause, can I take HRT?
This is an individual discussion about benefit and risk to you, and we are very happy to have that conversation with you. HRT may be appropriate and the benefits may outweigh the risks to you.
Certainly vaginal oestrogen is safe to take for almost every woman of any age, we can discuss if this is right for you.
How to take HRT?
Oestrogen
This can be replaced either through the skin as a patch, gel or spray, or in a tablet or implant. Most of these formulations contain oestrogen in a form identical to the oestrogen which women naturally produce called 17 B-estradiol, which is derived from the yam plant. Oestrogen is the key hormone that improves the majority of menopausal and perimenopausal symptoms.
Progestogen
This is needed alongside oestrogen if women have a uterus (womb) as taking oestrogen without progestogen can lead to thickening of the womb lining and an increased risk of womb lining (endometrial) cancer. Women with a uterus should therefore use combined HRT (oestrogen + progestogen). Progesterone, as a bioidentical / body identical hormone, is available in capsule form, as part of HRT, or a synthetic progestogen (similar to progesterone but not exactly the same) can be taken.
There are various ways in which you can take progestogen.
- A patch which contains oestrogen and a progestogen which is absorbed through the skin
- It is available combined with oestrogen in an oral tablet
- As a separate oral tablet or capsule to be used with oestrogen taken as a gel, patch, spray or oral tablet
- A hormone device containing progestogen (Mirena 52mg Levonorgestrel IUD) – up to 5 years at a time and also providing contraception and help to lighten heavy periods
One of the safest ways to take progestogen is as a capsule containing body identical micronised progesterone (Utrogestan or Gepretix), this is usually taken orally but some women use the same preparation and vaginally with advice from their Dr about dose and safety.
Testosterone
This is another key female hormone, although we produce much smaller amounts than men, it has important roles in libido, sexual arousal, metabolism, muscle and bone strength, mood and cognitive function. Some women find that, despite oestrogen being used, symptoms such as low libido, reduced orgasm, fatigue, low mood, brain fog and muscle fatigue are still an issue. In
these women, testosterone therapy (in addition to oestrogen) can be beneficial.
Testosterone is available as a gel or cream which is rubbed into the skin. While there are no specific products licensed for female use in the UK, it is widely used and safe when prescribed by your menopause specialist who will carefully monitor the dose and blood levels during your treatment.
Low dose vaginal oestrogen
This treatment can be added to your HRT, or taken without HRT, to help if you suffer from vaginal and bladder symptoms.
For detail on benefit and risk please see our FAQ in the HRT section.
Bioidentical compounded HRT
The use of compounded bioidentical hormone replacement therapies is not recommended given the issues related to their purity, potency and safety.
There are different ways to take the different hormones in HRT and we will tailor make this for you, depending on your choice, your health conditions and your family history. We will recommend the safest preparation and dose for you. Please do talk with us about your preferences, some women love the gel and others don’t. Some women remember to take a tablet every night for 2 weeks of the month and other’s would never remember that, don’t worry, we’ll work together to find the right HRT for you.
We can discuss which preparation may suit you and your lifestyle best.
For an appointment at Rowena Health please click on the link, we will be delighted to see you.
Dr Carys Sonnenberg Rowena Health July 2024 – this article is written for patients of Rowena Health, to be used alongside a menopause consultation. Please regard this as guidance only, if you have not had a consultation with us.