Hormone Replacement Therapy

What is Hormone Replacement Therapy?

Hormone Replacement Therapy, commonly known as HRT, is taken by women whose levels of hormones, namely oestrogen and progesterone, decrease substantially due to the menopause. HRT literally replaces the deficiency in the levels of these hormones.

Can I get HRT online?

The Online Clinic can prescribe HRT online in certain situations. Please complete a short consultation form so that we can make an assessment. Next day delivery of your treatment is available.

What is the menopause?

The menopause, also referred to as the ‘change of life’, usually begins in women in their 50s (average age 51 years in the UK) but it can start at a younger age. The menopause actually occurs when a woman has her final menstrual period; she is post-menopausal one year later.

Normally, oestrogen regulates the release of eggs from the ovary and menstruation (‘periods’) in a monthly cycle. As a women ages, her oestrogen level declines and her monthly periods occur less frequently until they stop. Thus, her ovaries gradually stop producing and releasing an egg every month (ovulation), and she can no longer conceive in the natural way. Progesterone prepares a woman’s womb (uterus) to receive the egg for pregnancy and protects the womb lining (endometrium). This hormone is produced on ovulation. It also declines with age, as the number of eggs released decreases.

What are the effects of the menopause (oestrogen and progesterone deficiency)?

The reduction in oestrogen levels results in many of the characteristic symptoms of the menopause. Short-term symptoms that may continue for 2 to 5 years include hot flushes/flashes, night sweats, emotional disturbances (e.g., mood swings, irritability, depression, and anxiety), loss of libido (sex drive), insomnia/disturbed sleep, headaches, and tiredness. Over the longer term, oestrogen deficiency results in skin and hair to become drier and thinner, including that of the vagina which makes intercourse painful. It also causes more frequent urinary infections and need to pass urine; urinary incontinence; bones to become thinner (osteoporosis); and an increased risk of heart and blood vessel disease. Low levels of progesterone are similar to those of oestrogen deficiency. They include infertility, dry skin, emotional disturbances, low libido, tiredness, headaches, and weight gain.

How is the menopause diagnosed?

Menopausal symptoms alone will indicate to your doctor the requirement for HRT. A blood test may be necessary if you are younger than 50 years, have atypical menopausal symptoms, or have had a hysterectomy.

Hormone Replacement Therapy and the treatment of menopausal symptoms

Short-term symptoms of the menopause can be treated with HRT. Most symptoms disappear over time, although they may continue for longer if left untreated. Lack of moisture in the vagina, urinary incontinence, and osteoporosis may persist or worsen if not treated.

How is Hormone Replacement Therapy taken?

HRT is usually a combination of oestrogen and synthetic progesterone (progestin). The preparation and type of HRT suitable for any individual woman will depend on their preference and circumstance. All HRT provides an oestrogen dose into the bloodstream. However, oestrogen is usually given with progesterone to prevent an increase in the womb lining, which increases the risk of womb (endometrial) cancer.

HRT is available in many preparations such as tablets, skin patches, implants, sprays or in a specific vaginal preparation (vaginal creams, pessaries or rings). There are also different types of HRT, including oestrogen only HRT (for women without a uterus following hysterectomy), cyclical or sequential HRT (for women who still menstruate) or continuous combined HRT (for postmenopausal women).

The lowest effective oestrogen dose is usually taken at the start of treatment, and can be increased or the HRT type changed at a later date if ineffective. Long-term use (over 5 years) is generally not recommended. Stopping HRT after 2 to 5 years is appropriate once the menopausal symptoms have subsided. A gradual reduction in dose to prevent a recurrence of symptoms may be advised. Long-term symptoms of oestrogen deficiency such as vaginal dryness and osteoporosis may need continuing treatment with oestrogens or other therapies.

Who can use Hormone Replacement Therapy?

Not all women have problems during the menopause; others suffer considerable discomfort. HRT is suitable for women experiencing symptoms of the menopause, particularly women with hot flushes. It may not be appropriate for women who are pregnant, or who have a history of breast, ovarian or uterine cancer, abnormal periods, blood clots, stroke, heart disease, liver disease, or have uncontrolled (untreated) high blood pressure.

Hormone Replacement Therapy side effects

The most common side effects of HRT include fluid retention, bloating, breast tenderness and swelling, headaches, nausea and digestive disturbances, mood swings and depression. Weight gain may occur in women during the menopause, regardless of whether HRT is taken or not.

While HRT can reduce the risk of osteoporosis, and colon and rectal cancer, its use long term can increase the risk of breast and uterine (endometrial) cancer, stroke, and blood clots in blood vessels of the legs (deep vein thrombosis) and lungs (pulmonary embolism).

When should a doctor be contacted?

If your menopausal symptoms are troublesome, seek advice from your doctor. Women who take HRT should have a yearly check-up including a mammogram.

The Online Clinic can prescribe HRT online for next day delivery.