Hormone Replacement Therapy (HRT) is a treatment given to women at the time of menopause that helps to ease or even prevent some of the difficult symptoms experienced by women during this phase. HRT is considered very beneficial to those taking it and is known to make things a lot easier for them. However, it is important to be informed about the treatment and to know the exact nature of its benefits, side effects and possible risks while considering it.
Why Is Hormone Replacement Therapy Needed?
When women reach menopause, their ovaries stop producing the hormone oestrogen in the right quantities. What HRT does is to get the ovaries to produce oestrogen at the same level as before. By restoring oestrogen production to its natural levels, HRT helps the body deal with various pertinent issues experienced during the menopause such as hot flushes and night sweats.
Progestogen is a hormone that has the same effect as the female hormone progesterone. During HRT, progestogen is given along with oestrogen to protect the lining of the uterus. This ensures that the patient has a small bleed each month, just like a period. Giving both the hormones together is called a combined form of HRT. Typically, at this stage, the doctors decide the right treatment to be given to a patient.
Hormone replacement therapy may also be needed for women who have had their ovaries removed or those who have had premature menopause. In addition to managing symptoms of menopause, HRT can also help prevent bone loss and reduce the risk of osteoporosis. It has also been shown to reduce the risk of colorectal cancer and improve cardiovascular health.
However, HRT is not suitable for everyone, and the decision to undergo this treatment should be made after careful consideration and consultation with a healthcare professional. Women with a history of breast cancer, blood clots, liver disease, or a family history of certain cancers may not be suitable candidates for HRT.
It is important to note that HRT is not a one-size-fits-all approach and the dosage and duration of treatment will vary depending on the individual. Women on HRT should also have regular check-ups with their doctor to monitor their health and discuss any concerns or side effects they may be experiencing.
Types of Hormone Replacement Therapies
Any HRT involves a variety of treatments, combinations, and dosages. Different patients need different forms of HRT to be administered to them depending on their needs. This could involve any of the following…
Implants are small pellets of oestrogen. Implants are inserted into the fat under the skin through a process that involves the administration of an anaesthetic at the doctor’s clinic. Implants, once administered, can last six months. They are usually administered to those who have busy jobs and may forget getting medication on time.
Tablets are the most common types of HRT. They have to be taken on a daily basis.
Patches are usually applied to the skin below the waist, on the hips, stomach, bottom or thigh. Oestrogen is then slowly released through the skin into the bloodstream through the patches. The patches need to be changed after a few days and when reapplied, they should be given a new location. Applying them on the same location could lead to irritation.
Nasal sprays are new forms of HRT that ensure that the oestrogen gets absorbed into the bloodstream through the soft tissues in the nose. They have to be sprayed into each nostril on a daily basis.
Gels containing oestrogen are applied to the skin once or twice a day. On applying the gel to the skin, the oestrogen gets absorbed into the bloodstream.
Vaginal treatments involve the administration of pessaries or tablets that are inserted into the vagina. Some treatments involve the use of vaginal rings, which contain oestrogen and are left in the vagina for three months or so. These rings gradually release oestrogen into the vaginal tissue.
Benefits of Hormone Replacement Therapy
HRT has the following benefits…
• Restores the elasticity of the vagina and its natural lubrication.
• Stops night sweats.
• Stops hot flushes.
• Make the patient feel better about their overall condition
• Prevents depression.
• Stops headaches and migraines
HRT has other benefits as well. It is believed that women who undergo HRT live longer. HRT prevents osteoporosis, a dreaded condition that threatens most people, especially women, as they get older. Taking the treatment for the long term protects you from suffering a fracture. HRT also protects women against heart disease and strokes, if taken over a long time and provided they don’t smoke. There are studies that suggest that HRT lowers the risk of getting Alzheimer’s disease and bowel cancer.
How Long Should the Treatment Be?
HRT should be taken for 1 to 2 years to relieve short term symptoms such as hot flushes and night sweats. When used to treat osteoporosis and heart disease, HRT needs to be taken for a longer term — at least 5 years.
What Are the Possible Risks of Hormone Replacement Therapy?
HRT is not entirely risk free. Research shows that taking HRT for a particularly long time, 10 years or so, increases the risk of breast cancer and blood clotting — also called Deep Vein Thrombosis (DVT). So whether HRT is suitable for an individual or not is decided by their doctors on the basis of blood tests conducted before getting started with the therapy.
Before taking HRT, it is important for a patient to attend breast screening and get their breasts checked for any lumps or abnormalities. Women who have one or more close relative who has had breast cancer can still take HRT after getting all the checks done because the benefits of HRT outweigh the risks of a possible breast cancer — as long as they get mammograms done on a regular basis.
What About the Side Effects of Hormone Replacement Therapy?
Doctors have been prescribing Hormone Replacement Therapy for women since the 1940s. Hundreds of thousands of women across the world have benefited from it. However, HRT may not be unsuitable for some women with certain medical problems. It is possible that some individuals may suffer from certain side effects, such as a return of their monthly period. It is important for patients to take the right form of HRT and in the right dosage, depending on their condition.
The possible side effects of HRT are: Bloating due to fluid retention, breast tenderness, headaches and nausea. There are 40 different combinations of HRT, you should choose the option that is best for you and give up those that make you uncomfortable. Try each new treatment for 3 months before deciding whether to continue it for the long term or not.
If you’re interested in HRT, then you don’t have to worry about the risks as your doctor will have you checked for all possible side effects and recommend HRT only after evaluating your condition thoroughly. If you’re taking HRT already and wish to stop, do consult with your doctor before doing so. If you have any questions or are worried about something, be sure to talk to your doctor about it.
Recent Perspectives on HRT
While HRT has many recognised benefits, some medical professionals caution against viewing it as a universal solution for menopausal symptoms. Dr Sue Mann, the NHS national clinical director for women’s health, recently emphasised that HRT should not be automatically prescribed to all menopausal women.
Dr Mann suggests that menopausal symptoms might be part of a “complex difficult life” that “maybe a medication won’t solve.” She advocates for a more nuanced approach, stating, “Being very linear about it and saying, ‘Oh, we’ll just give you some HRT’…I don’t think that’s very empowering for women.”
While acknowledging that HRT can be “brilliant” for managing physical symptoms, Dr Mann advises against automatically prescribing it for issues like anxiety. She recommends considering HRT as “one raft of options” and exploring other treatments such as talking therapies when appropriate.
This perspective aligns with recent arguments from some experts that menopause is not a disease and may be “over-medicalised” in high-income countries. They point out that globally, most women navigate menopause without medical treatments.
It’s important to note that these views don’t negate the benefits of HRT for many women. Rather, they encourage a more personalised approach to menopause management, considering each woman’s unique circumstances and preferences.
Photo Credit: Zoom Health
Zoom Health is a leading UK supplier of Home Health Tests and Earplugs
This post was originally published in November 2015. Last updated in August 2024.
