All types of hormone replacement therapy (HRT) contain an oestrogen hormone. Taking HRT replaces the oestrogen that your ovaries no longer make in the same quantities as when you were younger.
Without treatment in the form of hormones, there is a greater risk of conditions such as osteoporosis and heart disease in younger menopausal women. It is very important that if you are diagnosed with POI or early menopause then you receive hormones (HRT or the contraceptive pill) up to the natural age of menopause (51 years) to replace the hormones that your body would otherwise be producing.
HRT is the most effective treatment available to relieve symptoms caused by the menopause such as hot flushes, night sweats, mood swings and bladder symptoms. HRT is recommended for young women to take following an early menopause and those women with POI and they need to take it until they are at least 51 years.
HRT is not a contraception. If you still require contraception, then you should talk to your doctor about the options available to you.
Types of HRT
HRT is available as tablets, skin patches or gel. The patches are usually changed twice a week and the gel is applied to your skin daily. The tablets are usually taken daily.
If you still have a womb (uterus) it is important that a progestogen is combined with the oestrogen. When you take oestrogen the lining of your womb can build up which can increase your risk of cancer. However, taking progestogen completely reverses this risk.
If you are still having regular periods, then you will be given a type of HRT that still gives you a monthly period (technically a withdrawal bleed). This type of HRT needs to be taken for around a year.
If you have not had a period for one year or if you have taken HRT for one year then it is likely you will be given a type of HRT which does not give you a period. It can be common and completely normal to have some light bleeding or spotting in the first few months of using this type of HRT. However, if you experience heavy or prolonged vaginal bleeding then you need to inform your doctor.
If you have a history of a clot, migraine, diabetes or liver disease then you can still take HRT but it is likely that you will be recommended to use a patch or gel rather than a tablet. This is a safer and associated with less risks compared to having the tablet form of oestrogen. The progestogen is usually still given as a tablet.
There are many different preparations of HRT and if one type does not suit you then it is very likely that another type will suit you.
Your symptoms will improve
Many women find that any symptoms of the menopause that they were experiencing improve within a few months of taking HRT and feel that they have their “old life” back again. They often notice that their sleep improves, their mood improves and their concentration recovers. They also often notice that their energy is much greater than it was before they started taking HRT.
HRT usually works to stop hot flushes and night sweats within a few weeks. In addition, HRT will reverse many of the changes around your vagina and vulva usually within 1-3 months. However, it can take up to a year of treatment in some cases. This means that HRT can improve symptoms of vaginal dryness, improve discomfort during sexual intercourse, help to reduce recurrent urine infections and also improve any increased frequency of passing urine.
You may find that any aches or pains in your joints improve and also that the texture of your hair and skin improves when taking HRT.
If you are still experiencing menopausal symptoms on HRT then your dose of HRT will probably be increased. Younger women usually need higher doses of HRT compared to older women.
Your cardiovascular disease risk will reduce
There is evidence that taking HRT, especially HRT with oestrogen alone, reduces your risk of developing cardiovascular disease (meaning heart attacks and strokes) in women. HRT can also lower your cholesterol levels which is beneficial for your heart and body.
Your risk of developing osteoporosis will reduce
Taking HRT can prevent and reverse the bone loss that occurs. This means that taking HRT reduces your risk of having a fracture due to osteoporosis. This benefit is maintained during treatment but does reduce when you stop taking HRT.
Other possible benefits
Some studies have shown a reduced risk of Alzheimer’s disease and other types of dementia in women who take HRT. However, other studies have not shown this, so more work needs to be done in this area. In addition, some studies have also shown a reduction in risk of bowel cancer in women who take HRT. However, the evidence for this is still not completely clear.
There is no increased risk of breast cancer if you are taking HRT when you are young. Any risks that people may talk about regarding HRT are only relevant to those women who take HRT after the age of the natural menopause, which is around 51 years. So taking HRT when you are less than 51 years gives your body all the benefits of HRT without having any risks.
Clots in the veins (venous thromboembolism)
This is a blood clot that can cause a deep vein thrombosis (DVT). In some women this clot may travel to your lung and cause a pulmonary embolism (PE). Together, DVT and PE are known as venous thromboembolism. Women who take combined HRT as tablets have an increased risk of developing a clot. You are more likely to develop a clot if you have other risk factors for a clot. These include being obese, having a clot in the past and being a smoker.
However, this risk of clot is not present if you use patches or gel rather than take tablets of HRT.
Some studies have shown that there is a small increased risk of stroke in women taking either oestrogen-only or combined HRT. However, there is no increased risk of stroke in women who use the patch (or gel) rather than tablets. In addition, oral HRT containing lower doses of oestrogen seems to be associated with a lower risk of stroke compared to those containing higher doses. Most women under the age of 51 years have a very low risk of stroke.
Side Effects of HRT
Side-effects with HRT are more likely to occur when you first start taking HRT and then they usually settle with time. The most common side effects you may experience in the first few weeks of taking HRT are a feeling of sickness (nausea), some breast discomfort or leg cramps. These tend to go within a few months if you continue to use HRT.
Some women find that certain makes of HRT skin patches cause irritation of their skin. A change to a different brand or type of HRT may help if side-effects occur. Various oestrogens and progestogens are used in the different brands. If you have a side-effect with one brand, it may not occur with a different one. Changing the delivery method of HRT (for example, from a tablet to a patch) may also really help if you develop any side-effects.
Testosterone is another one of the sex hormones that you produce. Many people think of it as the “male” hormone, which is correct, but women need to have testosterone too. In fact, women produce three times as much testosterone than oestrogen before the menopause! Testosterone is made in your ovaries and also your adrenal glands, which are small glands near your kidneys. Many women have low levels of testosterone as they go through the menopause.
Testosterone can be beneficial at improving your mood, energy, concentration and also sex drive (or libido). Low levels in your body are usually diagnosed by a blood test. Testosterone is usually given as a gel on your skin or sometimes an implant. The dose of testosterone is very low so it will not cause facial hair growth. Testosterone is usually given by a doctor who specialises in the menopause.
Last updated: February 2018