Menopause, when a woman’s periods stop due to decreasing hormone levels, can often be a challenging stage of life.
Women can experience erratic periods, night sweats, vaginal dryness, hot flushes and mood swings during this time. These symptoms can vary in severity, ranging from unpleasant to having a significant impact on your day-to-day life. Managing the symptoms of menopause can make the whole process easier and enable you to continue with daily life more comfortably.
The most common treatment offered to help manage menopause symptoms is hormone replacement therapy (HRT). In this blog post, we are going to look at what HRT is, the types that are available and if it can truly help manage the symptoms of menopause.
Understanding hormone replacement therapy
Hormone replacement therapy aims to improve the symptoms of menopause by replenishing depleted hormones such as oestrogen and progesterone.
During menopause, dips in oestrogen levels trigger symptoms such as hot flushes, vaginal dryness and potentially osteoporosis. This is why oestrogen is present in HRT treatments. Progesterone itself does not cause most of the physical symptoms associated with the menopause, but in most cases, is taken as well to help reduce the risk of developing endometrial cancer.
Some women might think that they are too young for HRT, however, this is not the case. Women of any age who are experiencing menopause can be offered HRT to help manage their symptoms. HRT can also help with mild menopause symptoms too — they do not have to be severe before seeking help.
Types of hormone replacement therapy
Different types of HRT are available, so it is crucial to speak with a doctor to ensure you receive the right type of treatment.
Combined HRT contains both oestrogen and progesterone to help manage menopause symptoms.
There are a few different types of combined HRT:
- Cyclical (sequential) HRT: Cyclical HRT is recommended if you still have some form of menstrual cycle but are experiencing menopause symptoms. Monthly cyclical HRT is where oestrogen is taken every day, as well as progestogen taken alongside it for the last 14 days of your menstrual cycle.
- Continuous combined HRT is for women who are postmenopausal — which means that they have not had a period for one year. This type of HRT is taken every day, without a break and uses both hormones in one tablet.
Oestrogen-only HRT is only recommended when someone has had a hysterectomy. This is because taking oestrogen on its own increases the risk of developing cancer of the womb or uterus. However, if you've had a hysterectomy (surgery to remove the womb), you can take oestrogen-only HRT.
Forms of HRT
HRT can be taken in a variety of ways and is available as tablets, implants, patches and creams. Some women prefer to take tablets so that they know they have taken the correct dose of HRT each day. Other women may prefer to use creams or patches so they don’t have to worry about remembering tablets.
Implants slowly release oestrogen into the body and will last several months before needing to be replaced, making them an easy way to take HRT.
Your doctor will be able to let you know what options are available for you and will help you make the right choice for your needs.
Dosage
When you first start taking HRT, you will be offered a lower dose so that your body can adapt to the increased levels of hormones again. It can take a few weeks for the benefits of HRT to be felt. If the first lower dose does not improve menopause symptoms, then the dosage can be increased over time.
Typically, it is recommended that you try one type of HRT for three months before deciding to increase the dose or change to a different one.
Effectiveness of hormone replacement therapy
HRT is the most effective treatment for managing the symptoms of menopause. This is because it gets to the root cause of the symptoms — depleted levels of oestrogen and progesterone.
HRT has many benefits, including:
- Reducing hot flushes and night sweats
- Stopping vaginal dryness caused by low oestrogen levels
- Lowering the risk of stroke in women who go through early menopause
- Regulating mood swings
- Boosting libido
Low levels of oestrogen are associated with an increased risk of developing osteoporosis. However, taking HRT, combined or oestrogen only, could decrease this risk and help strengthen your bones and joints.
Women who are going through early menopause are at a higher risk of coronary heart disease. But with treatment from HRT, this risk can be lowered and help maintain a healthier heart for longer. Ageing and menopause can impact your cognitive function too. Women find that once they start on HRT their symptoms of brain fog reduce and their memory and ability to think improves.
It is important to remember that each woman will have a different response to HRT and it may take some trial and error before finding the right type for their body. Some women may need much higher doses of HRT, while others find that low doses manage their symptoms effectively.
Risks and side effects of hormone replacement therapy
While the risks associated with HRT are relatively low, they still need to be monitored.
Certain types of HRT may have more risks than others. For instance, oestrogen-only HRT does not increase the risk of breast cancer. But combined HRT can increase the risk slightly. Similarly, taking HRT tablets can slightly increase the risk of developing blood clots, but using HRT patches does not.
If you are concerned about any risks associated with HRT, let your doctor know and they will be able to advise you on which type is best for you.
When taking HRT, it is important that you have regular reviews to monitor how your body is reacting to the HRT and if any side effects are occurring. Your blood pressure will also be checked to make sure that it is still within the healthy range.
Side effects of HRT can include:
- Breast tenderness and swelling
- Bloating
- Nausea
- Headaches
- Indigestion
- Vaginal bleeding
If these side effects do not go away after a few weeks or get worse, then your doctor may recommend a different type of HRT to minimise them.
Natural alternatives to hormone replacement therapy
Some women may not want to take HRT right away and may want to try natural alternatives first.
Herbal remedies like evening primrose oil, St John's wort, dong quai (also known as ‘female ginseng’), black cohosh and chaste tree are all said to regulate hormones. However, there is limited evidence that these work. Natural alternatives can interact with other medications too, so they are not always safe to take. Make sure that you speak with your doctor before taking any natural remedies for menopause.
Making some lifestyle modifications can make a big difference to menopause symptoms. Lifestyle changes can include:
- Wearing loose clothing to stay cool
- Keeping rooms well ventilated to reduce hot flushes
- Using a vaginal moisturiser
- Stopping smoking
- Practising meditation
- Exercising regularly
- Eating a well-balanced diet
All of these things will not only help manage menopause symptoms, but they can also improve overall health.
Diet can play a big role in menopause symptoms, so changing how and what you eat can make a difference. Cut down on stimulants like caffeine and alcohol and try to up your calcium and vitamin D intake. Stimulants can disrupt hormone levels and increased calcium and vitamin D can strengthen weakened bones.
Frequently asked questions (FAQs) about hormone replacement therapy
Is HRT suitable for every woman going through menopause?
Most women are suitable for HRT when going through menopause. However, a family history of ovarian, breast, or womb cancer or a family history of blood clots can make it unsuitable. The best way to know if HRT is suitable for you is to speak with your doctor.
Can HRT alleviate hot flushes and night sweats?
Yes, HRT can help alleviate hot flushes and night sweats. It can take a few weeks for these benefits to be seen.
How long should you stay on HRT?
Most women will stay on HRT until their menopause symptoms have completely gone and menopause has ended. This means that you may typically be on HRT for two to five years, but it can be longer if you have had a hysterectomy.
Book a consultation at The McIndoe Centre
If you are currently going through menopause and are experiencing discomfort with your symptoms, get in touch with The McIndoe Centre. We offer women’s health services so that you can manage your symptoms of menopause with ease.
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