This is a video giving simple advice about Hormone replacement therapy, HRT. Hormone replacement therapy refers to the replacement of one or more of the hormones oestrogen, progesterone and testosterone. HRT can be taken to relieve the symptoms of perimenopause and menopause.
Choosing to take HRT is individual and it can take time to get it right. 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.
- Oestrogen – 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. This is known as bio-identical or body identical. 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 oestrogen replacement you will also need to take a progestogen. If given alone, oestrogen 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 or Gepretix, in the UK) is the safest type of progesterone, and this is taken orally, at bedtime, as a capsule. Micronised progesterone 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 oestrogen. 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 oestrogen, 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 oestrogen. This can be used alone, or can be used in combination with HRT as a patch, gel or spray or an oral tablet.
Last updated August 2024 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.
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
For more information please visit Menopause Matters
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 💖💖💖💖
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.
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
Tina
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.
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
Lyndsay
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.