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Hormone replacement therapy (HRT)

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Hormone replacement therapy (HRT) is medicine used to treat menopausal symptoms. If you have any questions or concerns about HRT, please speak to the doctor or nurse caring for you.

The information on this page is for people who have been prescribed HRT medicine. It should be read alongside the patient information leaflet provided by the manufacturer of your medicine. 

There is information on this page about:

What is hormone replacement therapy (HRT)?

HRT is medicine that aims to help with the symptoms that happen during the menopause, also known as the change of life. Symptoms of menopause include:

  • hot flushes
  • night sweats
  • vaginal dryness
  • tiredness and irritability
  • and decreased sex drive

Your body stops making a hormone called oestrogen when you go through the menopause, or if you have surgery to remove your ovaries. HRT replaces the oestrogen to help with the symptoms of menopause. It can also be given if menopause is caused by medical treatment (a medical menopause).

If HRT is used long-term it can help to lower the risk of thinning of the bones (osteoporosis) and bowel cancer. However, there are known risks of HRT (for example, an increased risk of some types of cancer). Your doctor or nurse will talk to you about your age, symptoms and medical conditions before looking at the risks and benefits of HRT which are specific to you. Find out more about the risks of HRT

For some people, taking HRT is not an option. This is usually the case if someone has had a cancer caused by hormones, or if they have had a blood clot.

You may have heard of bioidentical or 'natural' hormones as an alternative to HRT. These are not used in treatment as they have not been approved by organisations that regulate medicines. They have not been researched and proved safe to use. Always talk to your doctor if you are thinking about trying alternatives to HRT.

Types of HRT

There are 2 types of HRT. The type you take will depend on where you are in the menopause, and if your periods have stopped completely for a year.

Oestrogen only (no progestogen)

Oestrogen only HRT is used if you have had surgery to remove your womb (a hysterectomy), or you are using an IUS (intra uterine system) such as Mirena®. Oestrogen only HRT does not contain progestogen to protect the lining of the womb.

Combined HRT (oestrogen and progestogen)

Combined HRT is used if you still have your womb. It can be given in 2 ways.

  • Continuous combined HRT. Oestrogen and progesterone are taken together once a day for 28 days. This means that there will be no withdrawal bleeds.
  • Sequential HRT. Oestrogen only for the first 14 days, then both oestrogen and progesterone for the next 14 days. This usually results in monthly withdrawal bleeds. 

Taking HRT

How you take HRT will depend on the type you are taking. HRT is often taken as tablets, but there are also other ways (known as preparations) to take HRT. For example, a patch or a gel. 

Everyone reacts differently to HRT, there is no preparation that is better than any of the others. It is often a personal choice as to which you will try first.

  • Tablets

     

    Tablets are taken once a day. They help with both the short-term symptoms of menopause and, if taken for longer, the long-term complications of the menopause. There are different tablets available.

  • Patches

     

    HRT patches are applied once or twice a week to any area below the waist. They help with both the short-term symptoms of menopause and, if taken for longer, the long-term complications of the menopause.

  • Gel

     

    Oestrogen is available as a gel that is put on once a day. The gel is put on to a clean, dry, unbroken area of skin. It is usually put on the upper arm, shoulder or inner thigh. It is rubbed in and takes a few minutes to dry. The gel is clear and non-greasy.

    If you have a womb then you will also need to have progesterone to protect the womb lining. This may be as tablets or an IUS (intra uterine System), such as Mirena®. Your doctor or nurse can give you more information about an IUS.

  • Vaginal oestrogen (local HRT)

     

    Vaginal creams, vaginal tablets, vaginal rings or vaginal pessaries contain a small amount of oestrogen. This form of HRT only works for specific symptoms in the area they are applied, for example vaginal dryness and urinary symptoms. Local HRT will not help other symptoms, such as hot flushes, or protect against the longer term effects of the menopause such as osteoporosis. Local HRT does not have the same increased risks as other types of HRT, so it can be used by most people.

 

How long does HRT take to work?

It usually takes a few weeks before you will feel the benefits of HRT. It can take up to 3 months to feel the full effects. If you have not felt the benefit of HRT after 4 to 6 months it may help to try a different type.

It may also take your body time to get used to HRT. When you start HRT you may have side effects such as tender breasts, feeling sick (nausea) and leg cramps. These side effects usually disappear within 6 to 8 weeks. Read more about the side effects of HRT.

What should I do if I forget to take the medicine?

If you forget to take your HRT medicine do not take the doses that you have forgotten, just take the next dose when you remember.

How long is HRT taken for?

If HRT is being taken to help with menopausal symptoms, it should be taken for 2 to 3 years. To get the best benefit in reducing the risk of osteoporosis, HRT needs to be taken for at least 5 years. If you have had an early menopause or surgery to remove your ovaries, the time is not counted until you have reached the age of 50 (the average age of the menopause). 

All discussions about stopping or lowering the amount of HRT you take should be had with your doctor. Each year you and your doctor will review the benefits and risks of continuing to take HRT. 

Side effects of HRT

It is common to have side effects in the first few months of taking HRT. These usually settle on their own within 6 to 8 weeks. If you still have side effects after 3 months of treatment then the type (preparation) of HRT or dose you take may need to be changed. Your doctor or nurse will talk to you about this.

Side effects of HRT include weight gain, irregular bleeding, feeling sick (nausea) and skin irritation. They can also include:

  • tender and enlarged breasts
  • leg cramps
  • bloating
  • headache
  • pre-menstrual symptoms
  • lower tummy (abdominal) pain
  • backache
  • a depressed mood
  • acne or greasy skin

 

Read more about

  • Weight gain

     

    It has been proven that menopause leads to weight gain, so any weight gain may not be a result of taking HRT. Your body’s fat distribution also changes during menopause, with an increase in fat around the waist and less around the hips and buttocks. You can experience water retention when taking HRT. If this happens then it may be worth trying a different preparation of HRT.

  • Blood pressure

     

    There is no evidence that blood pressure increases with taking HRT. You should have your blood pressure checked and treated in the usual way.

  • Irregular bleeding

     

    Irregular bleeding in the first few months of taking HRT is quite common. This usually settles on its own. Any bleeding after the first 6 months will need to be looked into with an ultrasound scan. In some cases, you may have a hysteroscopy. A hysteroscopy is a test that looks inside the womb, through the vagina, using a small telescope at the end of a narrow tube.

  • Feeling sick (nausea)

     

    You may feel sick when having HRT. Taking the HRT tablet at night with food instead of in the morning can help with this. Changing from tablets to another preparation of HRT may also help.

 

Risks of HRT

Risks of HRT include breast cancer, cardiovascular disease, stroke or a blood clot. Your doctor or nurse will talk to you about these risks and how they may affect you.

The information leaflet that comes with your HRT medicine may just talk about risks for people over the age of the natural menopause (around 50 years old). If you are younger and are given HRT after surgery to remove your womb (a hysterectomy) or because of an early menopause there may be more benefits to taking HRT than in those that are older. 

The benefits and risks of HRT explained here are taken from National Institute of Clinical Excellence (NICE) guidelines

Breast cancer

If you are under the age of 50 and taking HRT there is no additional risk of breast cancer. You will still have the same risk of breast cancer as the rest of the population.

There is an increased risk for people over 50 who take combined HRT. Research suggests that for every 1,000 people that take combined HRT for between 7 and 8 years, there will be between 5 and 17 more cases of breast cancer than in those not taking HRT. The risk of breast cancer increases the longer you are on HRT, and lowers once you have stopped HRT. 

The latest research shows that breast cancers found in people who take HRT are easier to treat. 

Cardiovascular disease and stroke

There is a slightly increased risk of cardiovascular disease and stroke for women over 60. This is more likely if HRT was started late into the menopause and if combined HRT is used. The risk can depend on the dose of HRT and how it is given. The risk is lower if the dose of HRT is lower, or if you are using a HRT gel or patch.

Blood clot (deep vein thrombosis or DVT)

There is a risk of developing a blood clot if you are taking HRT. This depends on other risk factors, for example if you smoke, your weight, your age and the way that HRT is taken. It is thought that there is less risk if you are using skin patches or a gel. There is a slight increase in risk in the first year of treatment. 

The risk of a blood clot is a lot lower than taking the contraceptive pill, or the risk of blood clots during pregnancy.

Cost of HRT

HRT is only available on prescription. The cost of HRT will be the current prescription charge. Sometimes your HRT will involve 2 medicines and you may need to pay 2 prescription charges.

Getting a repeat prescription

You can get a repeat prescription from your GP.

Useful sources of information

Daisy Network is a charity supporting those affected by premature menopause. 

Women’s Health Concern is a charity providing advice and information for women.

NHS website has more information about HRT.

Menopause Matters has information on the menopause.

National Institute for Health and Care Excellence (NICE)

 

 

Ref number: 3530/VER3

Date published: July 2019 | Review date: July 2022

© 2019 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request


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 Contact us

For any questions, please contact the gynaecology nurse consultant 

Phone: 020 7188 8032
(Monday to Friday, 9am to 5pm).

Email: gynaecologyresults@
gstt.nhs.uk

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