Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) can be the most effective way of managing menopause symptoms while transforming how a woman* feels. It also provides long-term health benefits for many women and reduces the risk of osteoporosis, fractures and heart disease. Additionally, if HRT is started before the age of 60 or within ten years of the menopause transition, it reduces the number of early deaths in women.

Many women are anxious about taking HRT – often because of how the small risks are reported. Because we believe knowledge is power, this article contains a balanced and evidence-based review of the benefits and risks.

How does HRT work?

Before the menopause, your ovaries produce three main types of hormones:

• Oestrogens (for example oestradiol)
• Progestogens (for example progesterone)
• Androgens (for example testosterone)

It’s the loss of oestrogens that results in most menopause symptoms. And while all women’s testosterone levels gradually decline from our 30s, this has an impact on some of us and not on others. You can find out more about testosterone here.

Put simply, HRT aims to replace the declining levels of oestrogen that your ovaries used to make and this, in turn, helps to reduce your menopause symptoms. It also has long-term health benefits, more crucial than ever as women’s life expectancy is increasing.

The types of HRT

For most women, HRT consists of two hormones – oestrogen and a progestogen. Testosterone can also be an option.

Oestrogen is needed to manage most menopause symptoms. If you still have a womb (you have not had a hysterectomy) and take oestrogen by itself, this can thicken the lining of your womb, increasing your risk of womb cancer. The progestogen hormone is there to protect the lining of the womb.

When considering hormones, there are two types of this HRT:

• Combined HRT contains oestrogen and a progestogen. This can be sequential or continuous. 
• Oestrogen-only HRT.

If it’s less than 6-12 months since your last period, you’ll need to take sequential HRT. This means you’ll continue to have a (usually) monthly bleed. Most women take this type of HRT for around four years, or until they reach 55 (whichever comes first). By 55, most women’s periods have stopped.

If it’s around 12 months since your last period, you can start continuous combined HRT – with no bleed. With this version of HRT, you take oestrogen and a progestogen every day.

If you have had a hysterectomy, you can take oestrogen-only HRT.

The benefits of HRT

HRT is a suitable option for the vast majority of women and many who start HRT say that their life has been changed for the better. 

The small risks of HRT are generally far outweighed by the benefits and it can make all the difference in that it is an effective way of managing a wide range of menopause symptoms.

HRT can help alleviate the following common menopause symptoms:

• Hot flushes and night sweats
• Low mood and anxiety
• Brain fog and memory issues
• Vaginal dryness
• Painful sex
• Loss of libido/sex drive
• Bladder issues
• Skin and tissue quality
• Joint and muscle aches and pains.

The risks associated with HRT

The risks of HRT vary from woman to woman and the type they take. The following factors can affect long-term health and may affect the risks of HRT:

• Your age
• Your weight
• Whether you smoke
• How much alcohol you drink
• Other existing medical conditions
• Your family history.

It’s essential that HRT is tailored to suit you by an experienced healthcare professional, as menopause management is not one-size-fits-all. A healthy diet and regular exercise will help you to reduce the risks and reap the maximum benefit from HRT.

*women, trans men, people who are non-binary who were assigned female at birth, and cis gender women.