Hormone Replacement Therapy or HRT is the most effective treatment for managing the symptoms of the menopause, which can often have a debilitating effect on quality of life. The menopause is caused by declining levels of sex hormones, including oestrogen, testosterone and progesterone. HRT works by replacing these hormones that your body can no longer produce, alleviating many associated symptoms.
The first step is always diagnosis, as other medical issues can cause similar symptoms. For example, thyroid issues can cause fatigue, lethargy, weight gain, hot flushes, night sweats, mood changes and insomnia, and a blood test for thyroid function can rule this out.
Although menopausal symptoms are broadly due to changes in hormone production, factors like lifestyle and mental health can also contribute.
Treating or managing other underlying medical conditions and making positive lifestyle changes can significantly impact your quality of life and how you manage menopausal symptoms. However, if quality of life is significantly impacted and everyday activities are disrupted, HRT can be a helpful intervention.
Genitourinary symptoms of the menopause (GSM), which present as vaginal dryness, discomfort during sex, bladder changes and urinary symptoms, may need further and ongoing medical intervention. Vaginal oestrogen creams, gels or pessaries may be required. Topical HRT to treat GSM symptoms can be used for many years after other symptoms have disappeared.
Am I suitable for HRT?
For most women, using HRT is a personal choice, and we discuss the potential benefits and risks with you in your initial consultation. Some pre-existing conditions may increase the risk of complications, including:
• Any breast cancer (past, present or suspected)
• Any known or suspected oestrogen-dependent cancers
• Vaginal bleeding with no known cause
• Certain types of blood clots (past or present)
• Certain types of arterial disease (past or present)
What are the risks of HRT?
In the early 2000s, a large-scale study into the safety of HRT pointed to an increased risk of breast cancer and coronary heart disease. This was reported in the media, causing much controversy and concern, and many women stopped taking HRT. Since then, it has become clear that the study’s design meant it did not give a clear indication of the possible risk.
Since then, further studies have given us a clearer picture of the potential risks, and we can discuss these with you during your initial consultation.
What are the benefits of HRT?
As well as alleviating menopausal symptoms such as hot flushes, night sweats, sleep issues and mood changes, there is evidence that HRT protects your bone density and prevents the development of osteoporosis. There is some evidence that HRT may benefit heart health by reducing the risk of coronary heart disease.
When will I see the benefits of HRT?
It can take up to three months for the body to start reacting to increased hormonal levels and for any associated symptoms to improve. You may also experience some side effects initially. These can include bloating, breast tenderness, nausea, headaches, indigestion and vaginal bleeding.
At GP at London W1, we will see you for a follow-up appointment at the three-month stage so we can review your progress. If you’ve not seen any significant change to your symptoms or you are continuing to experience side effects, we may recommend switching to another method of taking oestrogen or changing your dose.