Hormone Replacement Therapy (H.R.T.)

What is Hormone Replacement Therapy?

Hormone Replacement Therapy (H.R.T.) is a treatment used to help ease and even prevent some of the uncomfortable symptoms women experience around the time of menopause. H.R.T. has been known to generally improve the quality of life of those taking it.

Everyone is individual and some women feel taking H.R.T. isn’t necessary. It is therefore important that you have accurate information about the treatment and the benefits before you decide if H.R.T. is right for you.

Why might I need H.R.T.?

When you reach the menopause your ovaries produce less and less of the hormone oestrogen. The purpose of H.R.T. is to give back your natural levels of oestrogen. By restoring this hormone your body can deal with the problems experienced during the menopause, such as night sweats and hot flushes.

Progestogen, which mimics another female hormone called progesterone, is usually given with oestrogen to protect the lining of the uterus (unless you have had a hysterectomy). Taking progestogen means that you may have a small bleed each month, similar to a period. Taking two hormonestogether is known as a combined form of H.R.T. Your doctor will decide what type suits you best.

Are there different types of H.R.T. available?

H.R.T. is not one medicine, but a variety of combinations, types and dosages. Different women need different forms of H.R.T to suit their individual needs. H.R.T. can be given in the following ways:

• Tablet form – this is the most common type of H.R.T. and needs to be taken daily.
• Patches – are applied to your skin below you waist, for example, on your thigh, bottom, hip or stomach. Oestrogen is gradually released through the skin directly into the blood stream. Patches need to be changed every few days and each time they are applied they may need to have a new location as irritation can occur.
• Implants – these are small pellets of oestrogen that are inserted into the fat under the skin. This process is carried out with a local anaesthetic at your local doctor’s surgery or at your hospital outpatients department. These implants last about 6 months and they are very effective for those with a busy life style and may find remembering regular medication a problem.
• Gels – which contain oestrogen can be applied to the skin usually once or twice daily. After applying the gel to your skin, oestrogen is absorbed into the blood stream.
• Vaginal treatments – these come as pessaries (tablets inserted into the vagina) or creams which help to ease vaginal discomfort. There is also a vaginal ring available, which contains oestrogen and can be left in the vagina for 3 months, where it slowly releases oestrogen into the vaginal tissues.
• Nasal spray, this is a new form and allows oestrogen to be absorbed through the soft tissues in the nose into the bloodstream. It will need to be sprayed into each nostril daily.

What are the benefits of H.R.T.?

H.R.T. can help :

• Stop hot flushes.
• Restore the vagina’s elasticity and natural lubrication.
• Stop night sweats.
• Ease depression.
• Prevent headaches or migraines
• You feel better in yourself.

H.R.T. can also help protect against osteoporosis and long term use will also reduce the risk of fractures. Research has suggested that women taking H.R.T. are also living longer. In women who don’t smoke, H.R.T. can also provide some protection against heart disease and strokes, if taken over a long period. Recent research also suggests that taking H.R.T. may lower the risk of getting Alzheimer’s disease and bowel cancer.

How long should I use H.R.T.?

To relieve the short term symptoms such as hot flushes and night sweats, treatment for 1-2 years may be enough. However, to help gain protection against osteoporosis and heart disease, H.R.T. needs to be taken long term (approximately 5 years).

What are the risks?

Like all medicines H.R.T. has its disadvantages and recent evidence shows that when H.R.T. is taken for a long period of time (5-10 years or more) there may be an increased risk of breast cancer and blood clotting, also referred to as Deep Vein Thrombosis (D.V.T.). If you are already at risk of blood clotting then H.R.T. may not be for you and you may need special blood tests before you start on H.R.T.

All women who take H.R.T. should attend for breast screening and check their own breasts for any lumps or abnormalities. Those people who have more than one close blood relative with breast cancer can still take H.R.T. as the benefits of H.R.T. outweigh the extra risk of breast cancer, however, they should ensure they have yearly mammograms.
For more information on breast cancer and how to check your breasts click here.

As H.R.T. is only available on prescription your doctor will help you weigh up all risks and benefits before you begin treatment and you can discuss any concerns you have. If you are already taking H.R.T. and you wish to stop you should ask your doctor for advice.

Are there any side effects?

Oestrogen replacement has been prescribed since the 1940’s and is used today by thousands of women all over the world. Each individual may experience some side effects, some types may cause the return of your monthly period, though there are period-free medications available. There are several types and different doses of H.R.T. so it may take a while to find the best one for you.

Possible side effects include:

• Breast tenderness
• Bloating, due to fluid retention
• Headaches
• Nausea

There are over 40 different combinations available, so if one doesn’t work well for you there will be other options. You should try each method of treatment for 3 months before deciding if it’s suitable for you.

As with many treatments, H.R.T. is unsuitable for some women with certain medical problems. Any questions or worries should be referred to your G.P. or practice nurse.