Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of menopause. It replaces the female hormones no longer produced after 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 that she will no longer have monthly periods or be able to have children. The menopause usually occurs when a woman is in her fifties (the average age is 52).
Read more about the menopause.
Oestrogen and progesterone (see below) are female hormones that play important roles in a woman’s body. When levels fall, it causes a range of physical and emotional symptoms, including hot flushes, mood swings and vaginal dryness.
HRT helps 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 a number of other functions, including bone density, skin temperature and keeping the vagina moist. It is a reduction in oestrogen that causes most symptoms associated with menopause including:
- hot flushes
- night sweats
- vaginal dryness
- loss of sex drive (libido)
- stress incontinence - leaking urine when you cough or sneeze
- thinning of the bones - which can lead to brittle bones (osteoporosis)
Most symptoms will pass within 2-5 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, which is 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, but it does increase your risk of developing womb cancer (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 HRT is taken
There are several different ways HRT can be taken including:
- as a cream or gel - which can be applied to the skin or directly into the vagina if you are experiencing vaginal dryness
- tablets - which can be taken by mouth or placed directly into your vagina to treat dryness
- 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
If you are only experiencing vaginal dryness, a type of HRT that can be applied directly to your vagina will probably be recommended.
Tablets, patches or implants are only needed if you have other menopausal symptoms, such as hot flushes.
There are many different combinations of HRT, so deciding which type to use can be difficult. Your GP will be able to advise.
Read more about how HRT is taken.
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:
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 a number of associated side effects including:
Read more about possible side effects of HRT and how to alleviate them.
Benefits and risks
Over the years, many studies have been carried out looking at the benefits and risks of HRT.
The main benefit of HRT is that it is a very effective method of controlling symptoms of the menopause. 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 of HRT to prevent osteoporosis is not usually recommended, and bone density will fall rapidly after HRT is stopped.
This is because HRT slightly increases the risk of developing breast cancer, endometrial cancer, ovarian cancer and stroke, and other medicines are available for osteoporosis that do not carry the same level of associated risk.
Most experts agree if HRT is used on a short-term basis (no more than five years), benefits outweigh associated 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.
