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.