Hormone replacement therapy (HRT) 

Introduction 

Menopause

The menopause is marked by the ending of menstruation (when a woman's periods stop), and changes in the hormones. As a result of these hormonal changes, many women have physical and emotional symptoms, such as hot flushes, night sweats and irritability. In this video, family doctor Dawn Harper talks about how to ease the symptoms of the menopause, whether to take HRT, and more.

Media last reviewed: 06/08/2014

Next review due: 06/08/2016

Menopause: self-help tips

Five simple ways to help you cope with menopause symptoms

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces female hormones that are at a lower level as you approach the menopause.

The menopause, sometimes referred to as the "change of life", is when a woman's ovaries stop producing an egg every four weeks. This means she will no longer have monthly periods or be able to have children naturally.

The menopause usually occurs when a woman is in her 50s (the average age is 51 in the UK), but some women experience the menopause in their 30s or 40s.

Read more about the menopause.

Oestrogen and progesterone (see below) are female hormones that play important roles in a woman’s body. Falling levels cause a range of physical and emotional symptoms, including hot flushes, mood swings and vaginal dryness.

The aim of HRT is to restore female hormone levels, allowing the body to function normally again.

Oestrogen

Oestrogen helps to release eggs from the ovaries. It also regulates a woman’s periods and helps her to conceive.

Oestrogen also plays a part in controlling other functions, including bone density, skin temperature and keeping the vagina moist. It is a reduction in oestrogen that causes most symptoms associated with the menopause, including:

Most symptoms will pass within two to five years, although vaginal dryness is likely to get worse if not treated. Stress incontinence may also persist and the risk of osteoporosis will increase with age.

Progesterone

The main role of progesterone is to prepare the womb for pregnancy. It also helps to protect the lining of the womb, known as the endometrium.

A decrease in the level of progesterone does not affect your body in the same way as falling levels of oestrogen. However, taking oestrogen as HRT on is own when you have a womb increases the risk of womb (uterus) cancer, sometimes called endometrial cancer.

Progesterone is therefore usually used in combination with oestrogen in HRT.

However, if you have had a hysterectomy (an operation to remove your womb), you do not need progesterone and can take oestrogen-only HRT.

Read more about the different types of HRT.

How systemic HRT is taken

Tablets, patches or implants are only needed if you have menopausal symptoms, such as hot flushes, and have weighed up the benefits and risks of treatment.

There are many different combinations of HRT, so deciding which type to use can be difficult. Your GP will be able to advise you.

There are several ways HRT can be taken, including:

  • tablets – which can be taken by mouth
  • a patch that you stick on your skin
  • an implant – under local anaesthetic, small pellets of oestrogen are inserted under the skin of your tummy, buttock or thigh 
  • oestrogen gel  which is applied to the skin and absorbed

Local oestrogen for vaginal dryness

If you are only experiencing vaginal dryness, you will probably be recommended oestrogen preparations that can be applied directly to your vagina.

As the dose of oestrogen is so low, you do not require the protective effect of the progestogen. Local oestrogens do not carry the same risks associated with systemic combined HRT.

Local oestrogens can be in the form of:

  • pessaries placed directly into the vagina
  • a vaginal ring
  • vaginal creams

When to stop taking HRT

Most women are able to stop taking HRT after their menopausal symptoms finish, which is usually two to five years after they start.

Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may have a relapse of menopausal symptoms after you stop HRT, but these should pass within a few months.

If you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms, contact your GP because treatment may need to be restarted, usually at a lower dose.

After you have stopped HRT, you may need additional treatment for vaginal dryness and to prevent osteoporosis (brittle bones). Read about the best ways to prevent osteoporosis

Creams and lubricants are available for vaginal dryness, as are local oestrogen preparations (see above).

Who can use HRT?

You can start HRT as soon as you begin to experience menopausal symptoms. However, HRT may not be suitable if you are pregnant or have:

If you have irregular periods, this will also need to be diagnosed before HRT is used.

Read more about who can use HRT.

If you are unable to have HRT, different medication may be prescribed to help control your menopausal symptoms.

Read more about alternatives to HRT.

Side effects of HRT

Hormones used in HRT can have associated side effects, including:

Read more about possible side effects of HRT and how to ease them.

Benefits and risks

Over the years, many studies examining the benefits and risks of HRT have been carried out.

The main benefit is that it is a very effective method of controlling menopausal symptoms, and it can make a significant difference to a woman’s quality of life and wellbeing.

HRT can also reduce a woman’s risk of developing osteoporosis and cancer of the colon and rectum. However, long-term use is rarely recommended, and bone density will decrease rapidly after HRT is stopped.

Combined HRT slightly increases the risk of developing breast cancer, womb cancer, ovarian cancer and stroke. Systemic HRT also increases your risks of deep vein thrombosis (DVT) and pulmonary embolism (blockage in the pulmonary artery). Other medicines are available to treat osteoporosis that do not carry the same level of associated risk.

Most experts agree that if HRT is used on a short-term basis (no more than five years), the benefits outweigh the risks.

If HRT is taken for longer, particularly for more than 10 years, you should discuss your individual risks with your GP and review them on an annual basis.

Read more about the risks of HRT.




Page last reviewed: 18/08/2014

Next review due: 18/08/2016

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Comments

The 27 comments posted are personal views. Any information they give has not been checked and may not be accurate.

MiseryGuts said on 28 October 2014

I have recently returned to the Uk and was advised by my new doc here to stop taking HRT at the age of 59 having been on it for 7 years. I started originally due to Hot Spells ( not flashes as they would last for hours), pains in hips and legs and bad temper ! HRT has been a blessing and I was an active 5 day a week exerciser. It removed all of these things.Since I have come off it I have had the worst leg pains - sometimes in the hips, sometimes fronts of legs, sometimes sides of thighs and when I have been sitting for a while am - at times - practically unable to walk. I am woken in the night and morning by hip pain.It seems like my ankles don't want to work and support me! This goes within maybe a minute or so. I have headaches every day- wake with them and spend hours of my day feeling hot! I can walk out in a t shirt and still be hot. It has now been 3 months since i came off HRT and it is just getting worse. I can't exercise as much and it really gets you down. I have put on weight. Today I saw a doctor and he asked me - are you sure that it is not pain from exercise you are feeling? Really? Is that the best they can do? He seems to think that menopause consists of hot sweats and bad temper and that's it. He didn't seem to hear that I said I live on pain killers... Really this is appalling. Can I add this was not my usual doc as he is on holiday and I yet have to have the discussion about going back on to HRT which seemingly this doctor doesn't like people to use! How can doctors be so ill informed about the menopause ?

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Belle2 said on 27 September 2014

I am 44 and have had hot flushes for 2 yrs but had been told not going through menopause I have not had a period for two years but have put on nearly 3 stone even though I have been dieting nothing works so had two more blood tests to be told still not going through menopause but my estrogen level is unbalanced I have an appointment to see a specialist at the end of October but 1 week ago I noticed my hair falling out and ii have lost a Good 30% of my hair I rung my doctor quite distressed and he give me a perscription for HRT patches even though he said 3 weeks ago he didn't want me to have them I am really confused I don't know weather to put the patch on or wait till end of October but my hair notices and is still coming out please help me is there anything I can do to stop my hair falling out

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Martine Davis said on 07 September 2014

I am not ovulating every month and have irregular cycle so am very interested in my menopause which is on it's way. I am reading Passage To Power by Leslie Kenton as she is a great author and researcher of womens health. Plus my mum gave me the book. But it was written in 1995!!
So I found this site. I am amazed by the NHS article above and more so by the comments below. Please don't start HRT without trying a natural approach. The menopause is a natural hormonal change which doesn't need to involve pharmaceutical intervention. There is no chance that I will be asking a GP for help with my menopause because I don't believe a single word of the marketing blurb about how oestrogen can protect me from osteoporosis or heart disease!

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brigg said on 05 September 2014

Hi,I was given oestrogen ony for the past year,and NO progestone! My health has declined terribly,i felt unwell.Im 57.Been through menopause,still have womb ect.Last month I sarted heavy bleeding with clots.I put up with it for 9 days,until I was admitted to hospital.And doctor found I should have been given progestone as well for past year.So tests showed from a biopsy,my womb lining is 1 inch thick.Now im on progestone,a year too late!And waiting on hysterectomy,because of GP negligence.The hospital say the ibopsy showed pre cancer,but I now know from my research,that that doesn't show whats going on in the rest of the womb?I didn't know till last month I should have been on progestone too.So tomorrow im going to GP for breast check.Im so ANGRY about this.

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Alicexxx said on 14 May 2014

Hi Nikki and Resolutely Vital,

No further updates apart from handing my Doctor a full report on the benefits of HRT. Luckily, I have three moth's supply left. I believe I can still carry on if a consultant prescribes it privately.

However, I am very aware that most people (including myself) find this unacceptable. I feel it is my right and my decision (on guidance from my GP) whether I continue on HRT.

No-one has yet advised me fully on the risks of stopping HRT….although I am fully aware.

I suppose another option is to find an HRT "friendly" Practice..although this seems an easy option…and I don't usually do easy:-)

I feel, maybe the practice has had a "claim" against them and therefore taken this decision!

I will update if and when I have further news.

Good luck Rv…keep fighting and demanding.

Alicexxx

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Resolutely vital said on 12 May 2014

I was interested to read about Alicexxx having experienced something similar myself. I am just coming up for my 60th birthday and have been warned that I will have to come off my Femistron HRT which I have been taking for 10 years by my 60th birthday. I too am healthy, I'm told I look great for my age, I cycle and run and work out and feel great. I hold down a pressurised job and have a very satisfying sex life.

To be honest I am panicking a bit - I know if I don't take my HRT for a couple of days I find it difficult to cope and seem to lose my energy. My mother suffered terrible depression during her menopause without the assistance of HRT. I want to take the advice of my GP but they just don't seem to look for viable alternatives e.g possibly patches rather and pills to reduce risk of stroke. At the moment I am getting one months supply at a time! What makes it worse is that I am now so panic stricken fearing they will stop prescribing that my blood pressure goes up and that makes them even more reluctant to renew my prescription. I had to wear a monitor for 24 hours and the BP was good but it's still high I when I get my check ups.

I have thought about trying to get HRT on line or going to see a private consultant . Sorry if this sounds like a rant and not very helpful to anyone but seems I'm not alone and that's a comfort. I must confess I really don't understand this blanket policy of getting older women off HRT come what may but it's starting to feel like a medical profession mantra.

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Nikki howard said on 28 April 2014

Alice

Sorry to hear of your dilemma. Personally, I would ask for an assessment by an Endocrinologist who should carry out blood tests and, possibly arrange for a DXA scan.

HRT has many advantages along with the disadvantages. I was threatened by my Endo that if I did not stop my two cigs a day, he would stop my HRT. I asked him if he would really put me through the screaming horrors of menopause. Yes, I can get it, even being transgender. I know from my own stuation, I'm on HRT for life, mainly to protect the bone density and organs. I have been on high doses of Premarin and now Progynova.

I think your GP is being over cautious, and you should have a review by way of Endocrine.

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Nikki howard said on 28 April 2014

In response to:

Anonymous said on 08 July 2013

hiya im a 27 year old male that wants to be a woman is this the right treatment that i should go with?

Are you still of the same opinion and, do you still need advice? Also are you a UK resident?

I have undergone GRS and been on high dose HRT for 34 yrs. I started on Premarin @ 7.5mg daily, then several years post GRS reduced to 2.5mg, then 1.25mg. Last year I went back up to 5mg for personal reasons, and in March this year, changed to Progynova 6mg daily, reducing under direction of my Endocrinologist and repeat blood tests,

If you are suffering from Gender Dysphoria, you will need expert medical assessment and, live a Real Life Experience (RLE).

Be aware, this operation cannot be reversed. Make a mistake or lie your way through, you will have to live with the consequences.

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Alicexxx said on 19 March 2014

I have recently been told by my surgery that they are not going to continue to supply me with my HRT medication as they have been "advised" by the BMA that they are legally responsible by signing the prescriptions. I have offered to write a disclaimer but it would not change the "practice policy"

I am now trying to present a case showing that the benefits outweigh the slight risks and that it is for each individual case to be accessed.

I have been on Oestrogen only patches for 17 years (after a full hysterectomy) and was told at the time that I could stay on them "forever".

Now in my early 60's (fit and healthy) I am shocked and disappointed to hear that I may lose, what I feel, keeps me human and safe from various other medical conditions.

Any thoughts and tips (as I have found below) would be extremely helpful.

Thanking you in advance.

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Cazxxx said on 01 February 2014

I have been on HRT since I was 41, I am now 70 in a few days time. After 3 months of taking HRT my life changed dramatically with no more flooding, migraines and mood swings. I am still feeling wonderful and my libido is excellent and my husband and I have a very loving and enjoyable relationship.

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KarensMum said on 18 October 2013

Following a total hysterectomy 22 years ago I went onto HRT at the age of 40 and believe it saved my sanity (and marriage). I took Premarin after trialling other combinations inc Testosterone (put on heaps of weight) etc and find this works for me - I'm currently trying to take it on alternate days as I've reduced hours at work and have less stress with kids etc.

I'm sure it tempers my moods and helps concentration for me anyway and my husband used to know within one day if I'd forgotten to take it! My blood pressure is checked annually and I have mammograms when requested and keep my fingers crossed to be honest that all will be well. The GP hasn't suggested coming off it and I don't raise any concerns but if I could do without any drugs I'd love to.

Due to osteo arthritis I take lots of ibuprofen and diclofenac long term to make day to day life more bearable and think of HRT in the same vein really.

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DJMAEALA said on 07 October 2013

I find the video from the female GP very patronising, and out of date with current thinking on HRT. I see the video isn't for review until 2014, however I think it should be updated as soon as possible to reflect the recommendations of the British Menopause Society.
The article ' The 2013 British Menopause Society & women's Health Concern recommendations on hormone replacement therapy' first published on May 24th 2013 is vital reading for anyone considering / or on HRT.

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EAma said on 02 October 2013

As a training female GP, I find the below comments very disconcerting I would like to dispell any rumours that reluctance to continue precribing HRT for prolonged periods is due to an 'inside job'. The fact is, we are trained to be wary of the increased risks of stroke, cardiovascular disease, breast cancer and DVT that may result from prolonged use of HRT. This is especially important in a time where medics are practicing in constant fear of lawsuits. Reluctance to prescribe medications considered to be higher risk is due to what we call 'defensive practice' in the trade. The only way to stop this would be for the number of poorly founded medical negligence cases to reduce, but that is impossible to ask in a day and age of medical entitlement and frankly a lot of people looking to make a quick buck.

Having said that, if as a patient you explicitly state that you take on board the increased risks, your GP's really should be allowing you to continue as there is no hard and fast rule to state that to do so would be negligent.

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Delphinia said on 10 September 2013

Hi all no matter where you are I agree with lots of comments added ,I wrote previously that I had been on HRT since the 80s I am now 69 never fitter my Doctor would never have agreed to being on it but she too said I can stay on it forever as its got more pluses than against no matter what others say!! As long as you go for your mammograms & I now have to ask for those as they stop calling you at 70 ! for some unknown reason! I lead a very healthy life style and eat no red meat at all, but other than that am careful with food also never smoked .I too think that lots have hidden agendas about women being on HRT for any length of time , but I still listen to my previous Doctor & trust what she said.

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Anonymous said on 08 July 2013

hiya im a 27 year old male that wants to be a woman is this the right treatment that i should go with?

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grady said on 05 January 2013

I have just been told by my doctor that anti depressants are sometime used instead of hrt..I am horrified as this shows how little gps understand hormonial problems.
Hormones saved my life many years ago.Anti depressants however totally destroyed my teenage years.
I am now nearly 65 and have been told that i can no longer have hrt but can have antidepressants.instead.
Why do doctors not learn from case historys.and provide patients with the correct medication.
I fully understand cyclerider who says that she has had to turn to the internet for hrt. but why should we have to do this when we have paid into the nhs all of our lives

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PamelaB said on 15 August 2012

I live in South Africa and seem to be having the opposite problem to readers comments who want to continue HRT. I visited my gynaecologist recently to discuss stopping using HRT as I am 61 and have been on HRT for 11 years. I did take myself off HRT about 5 years ago and only last six months as I couldn't manage the hourly hot flushes, sleepless nights, night sweats. I thought maybe now my symptoms wouldn't be so severe. My gynae cannot understand why I want to stop taking HRT. He believes if you are not in a high risk group you can take it "forever". I left the surgery totally confused and with a repeat prescription in my hand! Any advice out there.

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lubyj said on 10 August 2012

I am having the same problem as the 59 year olds. I'm 57 and been on HRT for coming up to 2 years. I had a hysterectomy in 2006 but had my overies left so menopause didn't hit me until 2 years ago. I have been told that as I had a 'late onset' menopause I can only be on HRT for 2 years!! To say I am distraught is an understatement. I was told that the menopause wouldn't kill me but HRT might. As I am fit and healthy with no family history I cannot understand this. Oh, and yes my GP is a woman. I have therefore made a private appointment with the consultant who looked after me and did my operation to get a second opion. I'm sorry others are having similar problems but its nice to know I'm not the only one. I will post again in Sept when I get his verdict!!!

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Vicki01 said on 24 June 2012

HI Jennyann,

I haven't got direct knowledge of this, but I've been told that Nick Panay's NHS clinic is using the imported implants.

http://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause

Also, I know a woman who has got one privately.

Would that be an option for you - to get one privately?


Good luck,

Vicki :)

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jennyann said on 16 June 2012

I am 63 years old and for a number of years I was given an estrogen implant in my buttocks not for menopausal symptoms but was told by a doctor at the now defunct Soho Hospital for Women that I had a very bad estrogen deficiency. This was first given to me in my late 30's after years of suffering with very heavy periods and terrible pms. At the age of 41 I opted to have a hysterectomy because of the heavy periods and pain I was suffering every month. I used to visit first the Soho Hospital, then the Elizabeth Garrett Anderson in Euston and then the UCH, after this I my own gp carried it out and then Basildon Hospital in Essex every 6 months. I moved to Shropshire in 2008 and my gp here would not give me an implant so I had patches which weren't effective, I then went to another gp in the practice and he gave me the implant on 2 consecutive visits, the last one being November 2010. In july 2011 I had my hormone level blood test at my gp's surgery and it was very low so I went to see the gp for another implant but he said he could not get hold of the pellets from the normal supplier and if I could get the pellets he would do it for me. In fact, whilst I was in the surgery he telephoned the Shrewsbury Hospital and the supplier and they both said they cannot get hold of the pellets. He gave me patches which do not have the same effect and I feel like nothing on earth. Night sweats, headaches, loss of libido, the lot. I have tried without success to telephone a number of suppliers and also tried the internet but they all say that the pellets were discontinued in the UK in June/July 2011. I read that they are still doing them in some places and also it is stated in this website that it is still normal practice. Please for the sake of my sanity and my health and my marriage if anyone knows of where I can obtain these pellets I would be most gratefuly.

Thankyou jennyann.

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cyclerider said on 17 May 2012

I think there must be some sort of conspiracy in the NHS to get women of 60 and over off HRT. At 58 I was on Tridestra, a combined HRT pill which gave me a "period" every few months. At 59 I asked my doctor if it would be a good idea to try a lower dosage pill, which she did. It was a continuous combined pill which I was very happy. Things were going swimmingly - or so I thought. When I returned to see my doctor shortly before my 60th birthday, despite my assurances that I was prepared to accept the small increased risk of breast cancer , she grudgingly gave me a prescription for six months supply, saying that it was no use continuing to take it after this had run out as it was doing me no good!

Well, to tell the truth I have become so traumatised at the thought of returning to my GP to ask for more HRT (I am nearly 61 now) that I have ordered some off the internet! All you ladies out there, please don't think that going to a female GP means that you will get sympathy or understanding, and don't go at all unless you are prepared to get on your hands and knees to beg for the stuff. Actually, don't do that because if you do they will give you a prescription for antidepressants.

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BGW said on 11 April 2012

For the last 10 or so years I have been going to an excellent menopause clinic at the John Radcliffe Hospital (Women's Centre). I have had an early menopause and have been using HRT for about 10 years.
i know someone who still has terrible hot flushes in her early 70's - about 25 years after starting the menopause - so to say that symptoms only last 2 - 5 years is not true for everyone.
And to call them 'hot flushes' is such an understatement! For me, they were more like complete hot sweats that took over my whole body about once an hour and stopped me in my tracks for a minute or so. Thank goodness for HRT which stopped this symptom and helped me feel normal again.

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macky53 said on 29 March 2012

I have just read hrtfan's letter and wondered when I wrote this! I am going through the same carry on with my new gp and it was the same with my previous gp. I am 59 and in a new relationship and all I ask for is to be able to feel like a woman..not a hot, sweaty, irrational cow with dry skin and thinning hair. I have told my gp I will sign a disclaimer so that if I am affected by the side effects it is my own fault but no...the doctors know better how I should endure my life. They have offered to up my antidepressants though! If men had this problem we would see a different attittude. As to the symptoms lasting only a few years...my mother is 83 and has suffered hot flushes, night sweats and virginal dryness ( to the point of split skin) for 33 years!Why can we not have a dedicated clinic for HRT?

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silveriver said on 08 August 2011

Spritey

this is a misconception.
Bio identical progesterone (as opposed to artificial/synthetic progesteron) is available for HRT on the NHS.

The problem here is that Gps are very ignorant in these women's matters.
My (female) gp hadn't even heard of the term "bio identical" and learned it from me showing her a magazine.

I suspect all gps will give you the same answer.

it is a dire state of affairs when you get more information from women's magazines and internet chats than your doctor.

The only doctor knowledgeable about bioidentical hormones in the Uk is the menopause expert , founder of the journal "the climacteric" Nick Panay in london.

He has recently written a medical article entitled "Bio identicals: why the hype?" however to read his conclusions you have to subscribe.
ask your gp about it.
It is your responsibility to push for complete info regarding your health inho.Noone but you will really care.

in his book "what your doctor don't tell you about the pre-menopause" Dr John Lee recommends taking bioidentical progesterone in low doses through the skin.
So administration and dosages are still experimental.

But we should still be given the option to try it

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spritey said on 06 March 2011

@jeani - Unless the NHS has made it to the US you should read the comments in context - this site is advice for people under the UK NHS system.

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hrtfan said on 30 December 2010

Excellent advice and I have made an appointment to see a female gp. Sadly I got negative response from receptionist when I said to discuss HRT. I think my practice is anti it and that is astonishing having just watched the video from NHS. We all have the right to make choices about our lives and balance risk versus gains. It should be possible for someone like me to go to an NHS gynaecologist direct and I should not be made to jump through hoops at my gp practice.Lets see what happens next...my sex life is suffering my sleep is deprived my weight is soaring and my well being is on the floor...vaginal dryness and incontinence due to oestrogen loss is affecting evry waking minute of my life. Dont write off older women as not requiring help. I have only been married 3 years and have an active sex life thats going down the pan at a rate of knots ..

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jeani said on 26 August 2010

This is not accurate. You say that HRT has progesterone in it and what is in it is a progesterone substitute - progestogen in England, progestin in the US. This is only because the manufacturers want to patent and exploit the hormone financially. Natural progesterone is harmless, modern HRT can have very bad side effects.

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