Everything you need to know about HRT

Many women have questions about hormone replacement therapy, or HRT. The decision to use HRT is a highly personal one, and one that should be made in discussion with consultants that are fully aware of their health and family medical history, age, where they are in the menopausal transition, the severity of their menopause symptoms and the effectiveness for them of non-hormonal therapies in relieving those symptoms.

Below we’ll talk about what the benefits and risks of HRT as well as what it is, and the different therapies available.

Given the amount of misinformation and confusion that exists, our Consultant Gynaecologist, Mr Anil Tailor, has compiled some of the most frequently asked questions around HRT and menopause and the answers.

What you’ll find in this article:

• What is HRT?
• How do I know if I’m going through menopause?
• Will I need hormone support?
• What hormones do I need when going through menopause?
• What menopause symptoms can HRT help with?
• What are bio-identical hormones?
• What are body-identical hormones?
• Does stress affect menopause?
• What are the benefits and risks of HRT?
• What are the advantages of attending a private clinic for HRT?
• What do Health & Aesthetics offer to patients?

What is HRT?

Hormone replacement therapy is used to supplement the dwindling supply of the body’s own hormones, as production decreases during and after menopause. The most common hormones supplemented with HRT are oestrogen and progesterone, though other hormones, including testosterone and DHEA, are also sometimes used in replacement form. Women who have their uterus intact take oestrogen and progesterone together, to protect against uterine cancer. Women who’ve undergone hysterectomy can take oestrogen alone.

How do I know if I’m going through menopause?

The term “menopause” refers to the final menstrual period. When doctors use the term “menopausal,” they really mean that someone is going through perimenopause, the process leading up to menopause, and which ends a year or so after the final menstrual period. Now, the final menstrual period is a retrospective diagnosis. You don’t know you’re done until one year has passed.

Will I need hormone support?

Hormones are a blessing for some women but just aren’t appropriate for others. Healthy women going through perimenopause may not require any additional hormone support. Menopause is, after all, a natural process. In fact, some women make all the hormones they need from their own adrenals and ovaries and fly through the process without any long-term issues.

However, many women enter perimenopause exhausted from chronic sleep deprivation, nutritional deficiencies and a range of other issues. This means that these women are running on empty and often their bodies lack the raw materials to produce enough hormones.

In addition, women who’ve had hysterectomies (with or without ovary removal) frequently require additional hormone support because surgery interferes with the blood flow to the ovaries. The result? Low hormone levels. And, in the case of ovary removal, instant menopause.

What hormones do I need?

Most people think that menopausal women only need replacement oestrogen. However, there are three sex hormones that can drop to low levels or become out of balance during this time:

• Oestrogen
• Progesterone
• Androgens (such as Testosterone)

Because all three hormones are produced by the ovaries, when a woman approaches menopause and stops ovulating, these hormone levels typically change.

Some women might be perfectly content with no supplemental hormones, some might need progesterone only, and some might need all three.

What symptoms can HRT help with?

Supplementation with any combination of oestrogen, progesterone and testosterone, or all three, can help ease many of the symptom’s women experience during perimenopause and menopause.  These symptoms include:

• Irritability.
• Sleeplessness.
• Anxiety.
• Premenstrual migraines. 
• Hot flashes and night sweats. 
• Chest Pain. 
• Reduced sex drive. 
• Vaginal dryness. 

What are bio-identical hormones?

Bio-identical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones. The hormones are packaged or formulated for individual patients by a regulated pharmacy and usually taken as creams or lozenges. These hormone treatments are not available on the NHS.

What are body-identical hormones?

Body-identical hormones includes oestrogen and progesterone (the main female sex hormones) developed in a conventional way by the pharmaceutical industry and authorised by the regulators such as the MHRA in the UK. These hormone treatments are available on the NHS.

Does stress affect menopause?

The stress hormones cortisol and epinephrine, which are produced by the adrenal glands, can wreak havoc on normal hormone metabolism. For example, if you are skipping ovulations, have progesterone levels that are very low, but oestrogen levels that are high (called oestrogen dominance,) your body will convert your oestrogen into substances that act like additional stress hormones.

Not only does stress affect hormone metabolism, but by following a diet high in processed foods and foods that elevate blood sugar (such as white bread, white potatoes, and white sugar products) also affects hormones.

What are the benefits and risks of HRT?

When considering whether hormone replacement is the right choice for you, both age and proximity to menopause are important factors to consider. Scientific evidence has demonstrated that women get the greatest benefits, with the lowest risks, when HRT is used in menopausal women under the age of 60 or within 10 years of menopause

There’s evidence that a longer duration of use may increase the risk of breast cancer. Women using replacement oestrogen alone may be able to stay on this treatment for a longer period, as the increased risk of breast cancer does not appear to be a factor in oestrogen-only HRT.

For women under the age of 60 and within 10 years of menopause, research shows oestrogen replacement may have a beneficial effect on cardiovascular health, bone health and may even reduce the risk of diabetes.

For women under 60 and within 10 years of menopause, risks associated with HRT may include an increased risk of blood clot in the legs and lungs. And the use of oestrogen and progesterone for longer than 5 years is linked to an increased risk of breast cancer.

HRT is not generally recommended in women who are older than 60, or who are more than 10 years beyond menopause, because of increased risks of cardiovascular disease as well as risks to cognitive health.

For women of all ages who are at elevated risk for blood clots, heart disease, stroke, and breast cancer, HRT may not be a suitable treatment for relief from menopause symptoms.

What are the advantages of attending a clinic?

By attending a specialist clinic, you will receive personalised advice on alleviating your menopausal symptoms with the utmost care taken regarding your future safety and with the risks expressed in context.

Your consultant will be able offer a range of therapies to suit you as we know that one size does not fit all. This includes:

• Conventional HRT
• Bio-identical hormones
• Body-identical hormones

What do Health & Aesthetics offer to patients?

At Health and Aesthetics, you will be asked about your general health; your menopause experience and we will also allow you time to explain your needs. You can ask questions and together we will plan to move forward. We can assess for suitability for HRT as well as a range of other alternative treatments. We are here to help you work out your best options.

If you are already on HRT and want a check-up, this is an opportunity to discuss any symptoms, side-effects or anxieties with our Consultant Gynaecologist. You can find out if you are still on the most appropriate therapy. If there is another therapy more suitable, we can discuss these alternatives, and how best to introduce them to your regime.

You will be monitored by Mr Anil Tailor closely, with regular check-ups and blood tests. You can discuss anything and everything, keeping the treatment tailored to your life and personal circumstances. If something isn’t working, then a new treatment could be suggested.

To learn more about our HRT and Menopause Clinic, click here, or click here to contact us for more information.