Hormone replacement therapy made easy

This is a video about perimenopause and menopause, giving simple advice about Hormone replacement therapy, HRT. At Rowena Health Menopause Specialist Clinic we are here to support you in a holistic way with perimenopause, menopause and we also prioritise your general and sexual health.

Levels of estrogen in your body reduce during the perimenopause and menopause, as the ovaries stop working, this causes many of the symptoms we experience with perimenopause and menopause. Many women choose to take HRT to top up the hormones and help control the symptoms. Finding the best HRT for you is individual and subsequently it can take time. We all absorb and respond to hormones differently and what suits one woman may not suit another. Symptoms can fluctuate in perimenopause and it is very common for the dose or type of HRT to be adjusted to manage this.

We now know that HRT is very safe in most women and is the most effective treatment to help with the symptoms of perimenopause and menopause. As well as improving symptoms, HRT can lower your future risk of developing diseases such as osteoporosis, heart disease, type II diabetes and dementia, depending on when it was started in your menopause.

In the perimenopause, when hormone levels fluctuate and decline, the role of HRT treatment is to supply the body with a steady dose of hormones, to avoid the ups and downs. Hormone replacement therapy refers to the replacement of one or more of the hormones estrogen, progesterone and testosterone.

  • Estrogen – the type of estrogen in HRT is 17 beta-oestradiol and it is derived from the root vegetable, the yam. This has an identical biological structure to the estrogen produced in your body. It can be given as a patch, gel or spray delivered across the skin transdermally and it can also be taken as a tablet, orally.
  • Progestogen – if you have a womb and use estrogen replacement you will also need to take a progestogen. If given alone, estrogen causes the lining of the womb to thicken, like a fertiliser on the lawn, with an increased risk of abnormality and cancer. The progestogen keeps the lining of the womb thin, acting like a lawn mower, and prevents the endometrium from becoming abnormal. In the perimenopause the Mirena coil is often a good choice as not only is it an effective contraceptive, but it also releases progestogen into the womb to prevent the lining from thickening and can remain in place for 5 years, then it needs to be changed. As an alternative, natural micronised progesterone (called Utrogestan in the UK) is the safest type of progesterone, and this is taken orally, at bedtime, as a capsule. Utrogestan is also derived from the yam plant.
  • Testosterone – some women continue to experience symptoms of low libido, low arousal and poor sexual satisfaction despite adequate replacement of estrogen. If this affects you then a 6 month trial of testosterone can sometimes help. Currently there are no testosterone products licensed for use in women in the UK, but we can prescribe a gel, off license, but approved by the BMS and NICE, and under supervision.
  • Local vaginal estrogen, symptoms of vaginal dryness, pain on having sex, soreness of the vulva and vagina, recurrent urinary tract infection and urinary frequency improve with treatment with a vaginal estrogen. This can be used alone, or can be used in combination with HRT as a patch, gel or spray or an oral tablet.

For more detailed information on HRT please see my other article Hormone Replacement Therapy.

Please see this article on vaginal and bladder symptoms of the menopause.

Last updated June 2023 Dr Carys Sonnenberg

Are you confused about HRT? In my latest video I explain the four parts of HRT and how you might take these.

Last updated September 2023 Dr Carys Sonnenberg Rowena Health

To book an appointment for individual menopause care, holistically using HRT and lifestyle medicine online if you are in the UK, or in person in Guildford, please visit Rowena Health Menopause Specialist Clinic.

6 thoughts on “Hormone replacement therapy made easy”

  1. Veronica towner

    Hi my name is Veronica I was on oestrogel they have changed to another gel called oestrodose I have noticed that am have swelling on my breasts it’s like I am blotting it’s so uncomfortable even on my operation I had a full hysterectomy on the 6 of August 2021 is there any advice you could give me have been very bad had to up the gel 3 pumps a day the sweats have been really bad not even been able to go out and am on testosterone I little dose a day but still feeling overwhelmed by this all the only symptom I don’t have in the dryness down below any help would would be very appropriated thank you Veronica 💖💖💖💖

    1. Hi Veronica, Thank you for your email. Oestrogen and Oestrodose are made by the same company and have the same active ingredients but oestrodose is made for the European market so there is some question about if it is affected by storage in transit? I’m not certain about this. It is possible to speak with your Dr and ask for another prescription and then ask the pharmacy to ensure that you get oestrogel, if you feel that oestrodose is not suiting you. You could also ask the Dr to do an oestrogen blood test to see what this level is, if your symptoms ate not controlled well at the moment. All the best.

  2. Hi, My name is Tina, I’m 53 and just had a Total Laparoscopic Hysterectomy and Bilateral Salpingo-oophrectomy, I’ve had Gynaecology issues for 2yrs now. Im really worried due to risk of recurrence of my endometriosis coming back!, can you advice which is the best form of HRT to go on for this? I’ve spoke with my doctor to ask if there are any specialist Doctors or Nurses that can advise me the best option that would help me but still no luck so far! Yours sincerely

    1. Dear Tina, Thank you for your message. If you have endometriosis we would usually advise that you take a combined HRT which means taking oestrogen and a progesterone The role of the progesterone, or progestogen, would be to protect the ectopic endometrium. There are various ways you can take this by taking the oestrogen as a gel, spray, patch or tablet and taking the progesterone as a tablet orally. There are other ways of taking progesterone if you are not able to tolerate it orally. I hope that helps.

  3. Hi, My name is Lyndsay I’m 41and I’ve had a bilateral saplingo – oopherectomy with my last operation being in 2017 . I’ve had Gynaecology issues for 25 years after having my son via emergency c section . I have adhesions and endometriosis, I’m currently on Evorl 50 patch but I just bleed for weeks at a time , but if I come out f it I get chronic migraines. I have been back at my GP who has sent another referral to gynaecologist. Would appreciate any advice you could give me please as it’s getting me really down .
    Yours sincerely

    1. Dear Lyndsay, Thank you so much for your message. I’m so sorry but i am unable to give personal advice unless you are one of my patients. I will be starting to see patients privately in 2023, if that is helpful. I understand how this must be affecting you and I hope that your gynaecologist will be able to help.

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