Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is used to treat symptoms of menopause, and is also prescribed for women with premature ovarian insufficiency (POI). It is important to note that the risks of HRT discussed here do not apply to women with POI.

What are the benefits of HRT?

These include:

• Reduction in hot flushes, mood swings, depressive symptoms  
• Improved vaginal and bladder symptoms
• Improved quality of life 
• Reduced risk of osteoporosis
• Reduced risk of heart disease 
• Reduced risk of colon cancer 
• Reduced risk of Alzheimer’s dementia  

What are the risks of HRT?

These include:

• Thromboembolic events: abnormal blood clot formation e.g. in legs
• Increased risk of stroke 
• Increased risks of breast cancer (1 extra case per 1000 women per year)
• Increased risk of endometrial cancer (if taking estrogen-only HRT)

What are the types of HRT?

HRT can be cyclical (you will still bleed monthly) or continuous (you will not have any periods). There are many routes (which may be used in combination) including:

• Oral
• Skin patches
• Skin creams
• intrauterine i.e. Mirena IUD
• intravaginal i.e. vaginal estrogen ring or estrogen creams

In general, skin preparations come with less side effects and risks.

What should I expect when starting HRT?

It is common to have erratic bleeding for the first 3-6 months; if this persists, you will need to see your gynaecologist for further checks.

The estrogen component of your HRT may cause side effects such as breast tenderness, headaches, nausea, bloatedness. The progesterone component of your HRT may cause side effects such as water retention, weight gain or mood swings; there are different types of progesterone and your dose can be adjusted if this is so.

In general, the risks of HRT are higher if you start it at an older age and further away from menopause. If you are over the age of 60, HRT is not recommended at all. There are ways to reduce the risks of HRT by changing the dose and route of HRT e.g. using skin preparations and taking both estrogen and progesterone if you have a uterus (rather than estrogen alone).

Remember that the aim of HRT is to achieve relief of your symptoms with the lowest dose and shortest duration possible, and you should discuss this with your gynaecologist.