HRT is a safe and effective treatment option for most healthy women with symptoms, who are going through the menopause at the average age in the UK (about 51 years). The risks and benefits of HRT will vary according to your age and any other health problems you may have.
There are generalised and local genito-urinary symptoms of the menopause. Please download & complete the below symptom & risk checkers and submit them in advance of your remote / telephone appointment or bring them to your face to face appointment.
Top Tips for the Menopause
- Start downloading the Free menopause Balance App: balance – balance app (balance-menopause.com)
- Use a Vaginal moisturiser AND Vaginal Lubrication for sexual intercourse – such as the YES range: https://www.yesyesyes.org
- Please read this booklet https://balance-menopause.com/uploads/2021/10/Living-Well-through-your-perimenopause-and-menopause-March-22-update.pdf
- Please read this on HRT and Risks – https://balance-menopause.com/uploads/2021/10/Perimenopause-and-HRT-Feb-22.pdf
- Please read this about progesterone intolerance: https://www.newsonhealth.co.uk/wp-content/uploads/2021/07/Progesterone-Intolerance-March-22-update.pdf
- Please watch this How to apply the OestroGel https://www.youtube.com/watch?v=Y6DcKLtQ3tM
- Please watch this on how to apply HRT Patch https://www.youtube.com/watch?v=tXGIYWPqdpI
- Please watch this on how to use vaginal oestrogen – Vagifem https://www.youtube.com/watch?v=sWwdosL-I-0
What are the risks of HRT?
Side-effects with HRT are uncommon. They may include the following:
- In the first few weeks some women develop a slight feeling of sickness (nausea), some breast discomfort or leg cramps. These tend to go within a few months if you continue to use HRT.
- HRT skin patches and gels occasionally cause irritation of the skin.
- Some women have more headaches or migraines when they take HRT. This is usually reduced by using patches or gel rather than taking tablets.
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 help if you have side-effects.
There has been a lot of media attention to the risks of taking HRT. HRT can increase your risk of developing certain problems but this increase in risk is very small in most cases. These include:
Clots in the veins (venous thromboembolism)
This is a blood clot that can cause a deep vein thrombosis (DVT). In some cases the 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.
This increased risk of clots is not present for women who use patches or gel at standard doses rather than HRT tablets. Note: you should see a doctor urgently if you develop a red, swollen or painful leg, or have shortness of breath and/or sharp pains in your chest.
Breast cancer
The most recent research suggests that the risk of breast cancer is increased for all women taking HRT. However, this risk is much lower than previously thought.
The increased risk depends on the type of HRT you take and how long you take it for. For example, for women starting HRT at age 50 and taking it for five years, an extra one woman will be diagnosed with breast cancer between age 50 and 69 years for every:
- 50 women taking continuous combined HRT.
- 70 women taking combined monthly cyclical HRT.
- 200 women taking oestrogen-only HRT.
Women who have taken HRT are at some increased risk for at least 10 years after stopping. The risk of breast cancer is also increased in women in their 40s taking HRT, but in real terms this risk is lower because fewer women develop breast cancer at this age. Current guidance is to offer HRT to all women going through early menopause (before age 45) because HRT helps to protect against osteoporosis in this group.
Of note, oestrogen‑only HRT (ie without any progestogen) causes little or no change in the risk of breast cancer.
Cancer of the womb
There is an increased risk of womb (uterine) cancer due to the oestrogen part of HRT. However, by taking combined HRT containing oestrogen and progestogen, this risk reduces completely. You should always see your doctor if you have any abnormal vaginal bleeding which develops after starting HRT. For example, heavy bleeding, irregular bleeding, or bleeding after having sex.
Heart disease
There is no increased risk of heart disease when HRT is started in women under the age of 60. There may be a small increased risk of heart disease when HRT is started in older women (over 60) or those who already have some form of heart disease.
Stroke
HRT tablets (but not patches or gels) slightly increase the risk of stroke. However, it is important to remember that the risk of stroke in women under 60 is very low.
What are the benefits of HRT?
HRT is a safe and effective treatment option for most healthy women with symptoms, who are going through the menopause at the average age in the UK (about 51 years). The risks and benefits of HRT will vary according to your age and any other health problems you may have. Your doctor will be able to discuss any potential risks of HRT with you in detail.
Menopausal symptoms usually improve
This can make a big difference to quality of life in some women:
- HRT works to stop hot flushes (also known as ‘hot flashes’) and night sweats.
- HRT will reverse many of the changes around the vagina and vulva.
- This means that HRT can:
- Improve symptoms of vaginal dryness.
- Improve discomfort during sexual intercourse as a result of this vaginal dryness.
- Help to reduce recurrent urine infections.
- Improve any increased frequency of passing urine.
- There is some evidence that HRT itself improves your mood and your sleep.
- HRT may also help to improve joint aches and pains and it may improve muscle strength.
- HRT improves sexual function and libido in many women.
- Many women notice that the texture of their hair and skin improves when taking HRT.
Reduced risk of ‘thinning’ of the bones (osteoporosis)
Women who take HRT have a reduced risk of osteoporosis and their risk of having fractures due to osteoporosis is also reduced. Prevention of osteoporosis continues further the longer you take HRT.
References:
https://patient.info/womens-health/menopause/hormone-replacement-therapy-hrt#nav-5
