Hormone Replacement Therapy (HRT)
HRT is an available treatment to replace, or top-up, a woman’s levels of the hormone, oestrogen, which decrease during the menopause.
Oestrogen on its own provided no protection against the possibility of uterine cancer, so a synthetic hormone, progestegen, is added to the HRT preparation.
Assorted health scares have caused its popularity to rise and fall, and its effect is akin to a lottery.
If I prescribe HRT for five women, I find it causes unacceptable risks for two of them, makes no difference for two others, and is effective for one woman - Dr K. Anderson (Birmingham)
DID YOU KNOW?
- Will my doctor do any tests before prescribing it?
- What types of HRT are available?
- What are the benefits if I take HRT for menopausal symptoms?
- What about side-effects?
- How long can I use HRT for menopausal symptoms?
- I have heard that HRT causes breast cancer. Is that true?
- What about taking HRT post-menopausally?
A. Your doctor should examine you thoroughly before prescribing HRT, especially your breasts and pelvis, and check your blood pressure. If it is prescribed, then a first critical review should be arranged at the end of 12 weeks treatment.
It may not be suitable if you have a history of the following conditions :
- Endometriosis (unless it has been treated or has become quiescent post-menopausally)
- Breast cancer or cysts
- Cancer of the lining of the womb
- Liver disease
- High blood pressure, or if you have had a stroke
- A personal and/or family history of clotting of the deep leg veins or the lungs
- Any oestrogen-dependent malignancy
- Untreated vaginal bleeding
A. It is available as tablets, patches, hormone implants and nasal sprays as well as oestrogen vaginal creams and vaginal rings.
A. You are likely to find an improvement in the frequency and severity of hot flushes and night sweats, maybe within a week. This often has a ‘knock-on’ effect, in that your sleeping patterns will improve which in term will reduce any daytime irritability, mood swings etc.
I was started on HRT in the form of tablets. These produced high blood pressure and headaches so I was changed to patches. They changed my life - the night sweats and flushes disappeared, as did the pain in my vagina - Annette (Brunei)
I had awful night sweats and within days of going on HRT, I felt a different person. I had so much more energy.I hadn’t realised I was lacking it as I think it tends to build up gradually and you get used to it - Lynn (Wales)
A. HRT causes ‘start-up’ effects which usually recede, and you are highly likely to experience some, or all,of the following:
- Breast tenderness
- Nipple sensitivity
- Increase in appetite
- Calf muscle cramps
Infrequent or rare reactions include :
If you experience any of these, you should see your doctor and discuss the situation, rather than waiting for your first critical review.
A. This will depend on your symptom relief. Some women decide to take it for six months, then discontinue it for a few months and see what difference this makes to their well-being. The symptoms may return during this time, as HRT frequently ‘damps’ them down, especially if they are severe. So you might decide to :
- restart the therapy
- change your HRT preparation e.g from tablets to patches
- explore other solutions for your particular circumstances
A. It is certainly true that
- Breast cancer happens whether women are taking HRT or not taking HRT
- Breast tissue is influenced by changing levels of hormones
- Other factors that determine the development of cancers include heredity and alcohol consumption.
- Some types of breast cancer are fast-growing and quickly fatal.
- Others develop very slowly over 18-20 years or even longer
A. Some doctors are cautious, and believe that all HRT should be discontinued by 10 years after periods cease, mainly because of the risk of breast cancer in women from their 60s onwards.Certainly, its continuing use after the age of 50 should be be critically reviewed every 5 years. Having said that, it is not unknown for much older women to be taking it.