Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of menopause. It replaces the female hormones no longer produced after menopause.
The menopause, sometimes referred to as the “change of life”, is when a woman’s ovaries stop producing an egg every four weeks. This means that she will no longer have monthly periods or be able to have children. The menopause usually occurs when a woman is in her 50s (the average age is 52).
Oestrogen and progesterone are female hormones that play important roles in a woman’s body. When levels fall, it causes a range of physical and emotional symptoms, including hot flushes, mood swings and vaginal dryness.
HRT helps to restore female hormone levels, allowing the body to function normally again.
Oestrogen helps to release eggs from the ovaries. It also regulates a woman’s periods and helps her to conceive.
Oestrogen also plays a part in controlling other functions, including bone density, skin temperature and keeping the vagina moist. It is a reduction in oestrogen that causes most symptoms associated with menopause, including:
- hot flushes
- night sweats
- vaginal dryness
- loss of sex drive (libido)
- stress incontinence: leaking urine when you cough or sneeze
- thinning of the bones: this can lead to brittle bones (osteoporosis)
Most symptoms will pass within two-to-five years, although vaginal dryness is likely to get worse if not treated. Stress incontinence may also persist and the risk of osteoporosis will increase with age.
The main role of progesterone is to prepare the womb for pregnancy. It also helps to protect the lining of the womb, which is known as the endometrium.
A decrease in the level of progesterone does not affect your body in the same way as falling levels of oestrogen, but it does increase your risk of developing womb cancer (endometrial cancer).
Progesterone is therefore usually used in combination with oestrogen in HRT. However, if you have had a hysterectomy (an operation to remove your womb), you do not need progesterone and can take oestrogen-only HRT.
Who can use HRT?
You can start HRT as soon as you begin to experience menopausal symptoms. However, HRT may not be suitable if you are pregnant or have:
- a history of breast cancer, ovarian cancer or endometrial cancer
- a history of blood clots
- a history of heart disease or stroke
- untreated high blood pressure (your blood pressure will need to be controlled before you can start HRT)
- liver disease
If you are unable to have HRT, different medication may be prescribed to help control your menopausal symptoms.
Side effects of HRT
Hormones used in HRT can have associated side effects including:
- fluid retention
- breast tenderness or swelling