Hormone Replacement Therapy (HRT)
As women enter menopause, the ovaries produce less oestrogen. This can cause all kinds of complaints such as hot flashes, sweating, fatigue, mood swings and listlessness.
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Depending on the severity of the symptoms, hormonal medication can be prescribed to replace the oestrogen that your body stops making. This is called hormone replacement therapy (HRT). These hormones supplement oestrogen levels, which reduces or eliminates the symptoms. It is best to begin HRT as soon as you start experiencing menopausal symptoms. However, there are also some risks associated with HRT. For each individual a decision must be made based on their personal and medical history in order to determine whether the benefits of HRT outweigh the risks.
What is HRT?
Hormone replacement therapy (HRT) is a treatment that supplements women with hormones that are lost during the menopausal transition, with the aim of reducing symptoms associated with perimenopause and menopause.
What are the first signs of menopause?
Most women notice a change in their menstrual period sometime in their forties. This is usually a sign of progression toward menopause. Period changes that you can expect are less frequent periods, periods getting closer together, or heavier, clotty periods. Common symptoms that many women have during this stage are hot flashes, facial flushing, excessive sweating, and night sweats (periods of heavy sweating that occur at night, causing you to wake up from sleep). Other symptoms include headache and abdominal pain. You may also feel more emotional or have trouble concentrating. Some women get migraine headaches, dry skin or dry eyes. Urinary tract infections (UTIs) can occur more frequently. Vaginal issues caused by menopause include vaginal dryness, causing painful sex. Menopause can also affect your libido (sex drive).
When is HRT prescribed?
HRT is prescribed to women to treat moderate to severe symptoms of menopause. The menopausal transition typically begins between ages 45 and 55. The terms perimenopause and menopause are often used synonymously, but they are actually different stages of your life. Perimenopause is the time leading up to menopause. Menopause is when you have gone 12 consecutive months without a period. The transitional period before menopause lasts on average 7 to 10 years. During this period, the production of the main female sex hormones oestrogen and progesterone decreases, causing menstrual irregularity (less frequent periods or periods getting closer together), or heavier periods accompanied by blood clots. The symptoms, severity of the symptoms and how long it lasts will vary between women. The most common complaints are hot flashes, sweating and palpitations. Mood swings and fatigue may also happen.
Most symptoms are caused by changing levels of oestrogen. Hormone replacement therapy (HRT) offers an effective treatment that compensates for your body's diminished oestrogen levels.
What can I do to reduce menopause and perimenopause symptoms?
The menopausal transition is a normal and natural part of life. Just like when you started having periods as a girl, your body is now moving toward the end of your reproductive years. There is nothing you can do about this. However, there are things you can do to ease the symptoms.
- Maintain a healthy lifestyle, eat a healthy and varied diet with iron-rich foods, such as leafy vegetables and dried fruits.
- Get plenty of exercise (30 minutes a day) and plenty of rest, including keeping to regular sleep routines.
- Avoid or reduce potential hot flash triggers, such as caffeine, alcohol and spicy food.
- Wear light, preferably cotton, clothes or dress in layers so you can remove them when a hot flash strikes. Use cotton nightwear and cotton sheets to relieve night sweats.
- Use vaginal lubricants to ease vaginal dryness and increase foreplay. Talk to your partner about vaginal dryness. You can also discuss your insecurities with a close friend, sister, or a doctor.
Keep in mind that menopause is a natural transition that can cause different symptoms in each person and that it's normal to feel insecure.
What treatment options are there?
There are various medicines that a doctor can prescribe as part of hormone therapy for menopause, including:
- Oestrogen-only therapy (monotherapy): typically prescribed in women who have had a hysterectomy. These medicines contain oestradiol. They come in various forms: nasal spray, implant tablet, patch or vaginal tablet (which is inserted into the vagina with an applicator). There are also vaginal tablets containing the active ingredient oestriol. Both oestriol and oestradiol come in oral form too (to be taken by mouth).
- Combined oestrogen-progestogen therapy: typically prescribed in women who still have their uterus. Oestrogen can cause an overgrowth of cells in the lining of the uterus (endometrium), a condition that can lead to cancer. Progesterone reduces the risk of endometrial (uterine) cancer by making the endometrium thin.
- For women who want to use contraception, a combined oral contraceptive pill can be an option. Intrauterine devices (IUDs) can be combined with oestrogen-only therapy (monotherapy).
- Tibolone is a medicine that is effective for symptoms such as hot flashes and excessive sweating. It is associated with a decreased risk of endometrial and breast cancer. Therefore, it should be prescribed with caution.
There are alternative treatments for menopause symptoms. However, the core ingredient of all forms of HRT is oestrogen. There are plant-based compounds (phytoestrogens) that mimic oestrogen in the body, but they do not consistently help everyone.
A healthy lifestyle and regular routines are highly recommended while taking HRT. Get plenty of rest. Reduce your alcohol intake. Stop smoking. Eat a varied diet. Stay a healthy weight or lose excess weight. Exercise regularly.
Frequently asked questions
What is HRT?
Hormone replacement therapy (HRT) supplements female hormones during the menopause, with the aim of reducing the associated symptoms.
What types of HRT are available?
The hormones can be taken orally (by mouth) as tablets or capsules. Or they can be administered through the skin by a cream or plasters, or using pills you insert vaginally.