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  • Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy

When a woman enters menopause, the production of oestrogen in the ovaries decreases. This can lead to all kinds of complaints such as hot flushes, perspiration, fatigue, mood swings and listlessness. Depending on the severity of the symptoms, medication in the form of hormones may be prescribed, which is called hormone replacement therapy (HRT). These hormones supplement the content of oestrogen which reduces or eliminates the symptoms.

Treatment is best started at the beginning of menopause, but there are also some drawbacks to HRT, which is why the benefits and risks need to be carefully considered in order to make an informed choice that suits you best.

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    A doctor will review your medical questionnaire and send your prescription to an affiliated pharmacy.

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What is hormone replacement therapy?

Hormone replacement therapy (HRT) is the replenishment of hormones with the aim of reducing the symptoms associated with menopause.

What is the reason for hormone replacement therapy?

The reason for HRT is the complaints that women experience during menopause. The transition usually begins between the ages of 45 and 55. Transition and menopause are often used as synonyms, but menopause is the last menstruation, so this can only be identified afterwards. The average duration of the transition to menopause is seven-to-10 years.

During menopause, the production of the sex hormones oestrogen and progesterone decreases. As a result, menstruation follows more quickly, or is absent for longer, and clots are also common. This time can give rise to a number of symptoms that are worse in some women and/or are experienced to a greater extent than in others. The most common complaints are hot flushes, perspiration and heart palpitations. In addition, there may be mood swings and fatigue. The decline in oestrogen is the main cause of this, and to compensate for this decrease, HRT can be prescribed.

What forms of HRT treatment are there?

There are various forms of HRT treatment. The hormones can be taken orally (through the mouth) as tablets or capsules, through the skin with creams or plasters, or as pills that are inserted vaginally. There are also ovules for the vagina and a ring.

How can you recognise the transition?

When you are over 40 and your menstrual cycle changes, it is usually a sign that you are at the beginning of the menopause. The time between menstrual periods may be shorter or longer, your periods themselves may be shorter or longer, or more intense with blood clots. The most common complaints in this phase of your life are hot flushes and sudden heavy sweating and blushing, or waking up in the middle of the night bathed in sweat.

There may be other symptoms such as headaches and abdominal pain. You may feel more emotional or have trouble concentrating. You may experience migraines, dry skin and dry eyes. Bladder infections can also occur, while there may be vaginal complaints such as dryness, which can make intimacy painful. You may also feel less inclined to have sex.

All these symptoms can occur to a greater or lesser extent and you can suffer from them to a greater or lesser extent. This is different for every woman and each one experiences it differently, although there is often a lot of mutual recognition of the complaints.

What can I do about the transition?

The transition is a natural process. Just like the time you started menstruating, you are now entering a phase in which stopping menstruation is imminent. There is nothing you can do about the transition beginning, but you can do something about the complaints that come with it.

Ensure a healthy lifestyle, eat healthily and varied, with iron-rich foods such as red meat, leafy vegetables and dried fruits. Do plenty of exercise (at least half an hour a day) and get lots of sleep. Plan to have a regular rhythm to your life. Avoid coffee and alcohol or consume less during hot flushes, and do the same with spicy food. Adjust your clothes if you sweat a lot. Wear cotton clothing and choose layers, so you can take things off when you have a hot flush. It is also better to wear cotton clothing at night and use cotton sheets for your bed.

In the event of vaginal complaints, consider lubrication and longer foreplay, and discuss it with your partner. Discuss your insecurities with a good friend, sister or doctor. Keep in mind that the transition is a natural phase that can cause different symptoms for each person and that it is normal for you to feel insecure about this.

What are the forms of HRT treatment?

There are several medications that a doctor can prescribe you. These include:

  • Oestrogen hormones (mono-treatment):
    These are available for women who no longer have a uterus. They contain estradiol and come in the form of a nasal spray, an implantation tablet, patches, and pills to be inserted into the vagina with an applicator. There is also estriol for vaginal application, and an oral form of both estriol and estradiol (to be swallowed).
  • Oestrogen hormones in combination with progestogens:
    These are available for women who still have their uterus. The progestogens prevent excessive growth of the endometrium under the influence of the oestrogens.
  • A contraceptive pill with combination preparation:
    For women who want to use contraception (for example for a regular cycle). If you are using a hormone spiral, you can combine this with an oestrogen mono treatment.
  • Tibolon:
    This medicine only has a beneficial effect against hot flushes and sweat attacks. This medicine is not often prescribed because of an increased risk of uterine and breast cancer.

Alternative treatments

Alternative treatments exist for menopause, but there is no alternative HRT. Although there are plant substances that resemble oestrogens – called phyto-oestrogens – they do not work in everyone equally well.

Lifestyle changes

When you have HRT, it is advisable to have a healthy and regular lifestyle. Get enough rest, reduce your alcohol consumption, stop smoking, eat a varied diet, deal with excess weight, move and exercise.

Additional risks and side effects

There are risks and side effects of HRT, which are quite rare but can be very serious. It will therefore be necessary to weigh up whether the treatment of the complaints you have experienced outweighs these risks. The risks with HRT are blood clots in the legs and/or lungs, liver diseases and gallstones, breast cancer, heart attack and cerebral haemorrhage.

The possible side effects of HRT are:

  • Nausea, headaches, painful and/or sore breasts;
  • Breakthrough bleeding or more or less vaginal discharge;
  • Swollen ankles and feet due to retaining moisture;
  • Stomach ache;
  • Mood swings;
  • Less inclination to have sex.

In case of vaginal application:

  • Local complaints such as irritation and itching;
  • Hypersensitivity to the medicine
    This can be very serious. In the event of tightness and/or swelling in the face (thick lips, mouth, throat, tongue), you should go directly to hospital.

Due to the risks and side effects, it is advisable to stay under medical supervision. The aim is also to give HRT in the lowest possible effective dosage.


[Transition]. (z.j.). Consulted on 12/26/2018 at https://www.thuisarts.nl/overgang https://www.gezondheidsplein.nl/aandoeningen/overgang/item37779

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[Estradiol, (mono-treatment)] ; ] (z.j.). Consulted on 12/26/2018 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/e/estradiol oraal_ [Estradiol/drygesterone] . (z.j.). Consulted on 12/26/2018 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/e/estradiol_dydrogesteron

[Estradiol through the vagina]. (z.j.). Consulted on 12/26/2018 at https://www.apotheek.nl/medicijnen/estradiol-in-de-vagina? product=vagifem#mag-ik-zomaar-met-dit-medicijn-stoppen

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Bouma J, De Jonge, M., De Laat, E.A.T., Eekhof, H., Engel, H.F., Groeneveld, F.P.M.J., Stevens, N.T.J.M., Verduijn, M.M., Goudswaard, A.N., Opstelten, W. De Vries, C.J.H.. NHG Standard The transition (first revision). The standard and the scientific justification have been updated with respect to the previous version (General Practitioner Act 2001;44(10):436-45.) General Practitioner Act 2012;55(4):168-72.

[Overview of the main absolute risk increases for serious conditions in the use of hormone therapy]. (z.j.). Consulted on 12/26/2018 at https://www.nhg.org/standaarden/volledig/nhg-standaard-de-overgang#Medicamenteuzebehandeling

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