10 frequently asked questions about HRT for menopause symptoms

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of menopause. HRT replaces natural hormones that the body no longer produces in sufficient quantities (oestrogen and progesterone). By stabilising hormone levels and evening out fluctuations, symptoms such as hot flashes, mood swings and vaginal dryness will reduce.

How does HRT work? Is it suitable for everyone? And what should you know before starting HRT? In this in article, we discuss 10 frequently asked questions about HRT for managing symptoms of menopause.

1. When should I ask my doctor about HRT?

A healthy body allows you to do the things you enjoy, without uncomfortable symptoms or discomfort. Menopause can have a massive impact on both your physical and mental health and affect your quality of life. If a healthy diet and sufficient exercise are not enough to ease your symptoms, you could consider talking to a doctor about HRT.

Women who use HRT report that it helps them manage severe symptoms of menopause, such as sleep problems, hot flashes, vaginal dryness and muscle and joint pain, and that they feel happier and more energetic. For many women, HRT has made their journey through menopause a lot smoother.

2. What type of HRT should I use?

HRT medicines contain female sex hormones (usually oestrogen and progesterone). What type of HRT is right for you depends on your symptoms, medical history and what menopause stage you are in. HRT is available in various dosage forms:

Transdermal (via the skin), such as gels, ointments and patches.
Oral, such as tablets and capsules.
Vaginal, such as creams and vaginal suppositories.

Which form is best for you depends on your symptoms and personal preferences. Unlike oral HRT, transdermal HRT delivers hormones directly into the bloodstream through the skin, bypassing the liver. This method reduces the risk of side effects for some women. HRT patches and creams provide more stable hormone levels than gels, but absorption often varies between women. If one type of HRT does not work for you, you can always switch to another type.

3. What hormones do I need?

The two main hormones used in HRT are oestrogen and progesterone. Oestrogen (oestradiol) is used to relieve symptoms of menopause and progesterone (or a synthetic progestin) protects the lining of the uterus from the stimulating effects of oestrogen, reducing the risk of endometrial cancer.

Although some studies suggest that progesterone improves sleep and mood and supports bone health, it is not recommended if you have had your womb removed during a hysterectomy.

4. Are bioidentical hormones better than synthetic hormones?

Bioidentical hormones have the same molecular structure as hormones produced in the human body and they work in a similar way. They have similar effects as our natural hormones and are broken down in the same way. Synthetic hormones are artificial hormones that resemble our natural hormones but have a different biochemical structure.

HRT may cause side effects, such as headache and nausea. Whether or not you have side effects, and how severe they are, depends on the type of HRT you are taking, the dose, and your reaction to the treatment.

Most HRT treatments contain bioidentical oestrogen (oestradiol), and there are options with bioidentical progesterone or synthetic progestin. One is not necessarily ‘better' than the other. The choice of HRT depends on your needs, risk factors and preferences, so it is hard to predict what will work best for you.

5. Is HRT suitable for everyone?

No, not all women can use HRT. HRT is not recommended in women with a history of breast cancer or other hormone-related cancers, thrombosis, liver disease, stroke, heart disease or abnormal vaginal bleeding.

Age is also a factor. Women who begin hormone therapy at age 60 or older, or more than 10 years from the onset of menopause, have a higher risk of breast cancer and endometrial cancer, and a slightly increased risk of cardiovascular disease and stroke. So for women over 60, the risks of HRT may outweigh the benefits.

If HRT is not an option for you, you could try non-hormonal medication to manage your symptoms.

6. Does HRT help with mood swings?

Yes, HRT can be effective in reducing mood swings and symptoms such as irritability, restlessness and low mood.

Changes in mood may stem from hormonal factors. When oestrogen levels fluctuate and fall during menopause, levels of serotonin, the so-called happiness hormone, also fall. This can contribute to mood problems.

Progesterone has a calming effect. Low progesterone can trigger (sudden) feelings of restlessness, sadness or low mood.

HRT stabilises oestrogen and progesterone levels in the body. This can help alleviate mood swings, promoting a sense of calm. In some women, other treatments may also be needed, such as psychological treatments (therapy) or treatment with antidepressants.

7. Does HRT cause weight gain?

Menopausal weight gain is often attributed to hormonal changes. Up to 70 percent of women experience weight gain during menopause, on average one to two pounds per year between the ages of 50 and 60.

There is no evidence to suggest that taking HRT is a direct cause of weight gain. However, it is important to exercise and eat a balanced diet when you are on HRT. After all, a healthy lifestyle is the basis for good health.

Going through menopause and want to lose weight? Get weight management advice from a menopause specialist

8. Does HRT protect against cardiovascular disease?

Low oestrogen levels increase the risk of cardiovascular disease. HRT can reduce the risk of cardiovascular disease if started early in perimenopause or postmenopause. Initiated in women over 60 years of age, HRT can increase the risk of cardiovascular disease. Family history (i.e., having a parent of close relative with a heart or vascular condition) and some types of HRT can also increase your risk of cardiovascular disease.

9. Can HRT be stopped suddenly?

There are not guidelines on how to stop taking HRT. Whether you should taper off HRT gradually or can stop abruptly depends on your symptoms, side effects and preferences. However, it is generally recommended to reduce your dose gradually over the course of several months. Stopping abruptly may cause symptoms to return temporarily.

10. Does HRT increase the risk of cancer?

HRT has been a topic of discussion for decades and much research has been conducted into the risks of HRT. Conducted over 20 years ago, the Women’s Health Initiative study linked hormone therapy to a higher chance of negative health impacts, such as an increased risk of breast cancer.

Since then, the data have been re-evaluated and have shown HRT in a more positive light. New research proves that HRT is a safe and effective treatment for most women. The risks found in the 2002 WHI study apply mostly to women who start HRT more than 10 after menopause, when they are age 60 or older. If hormone therapy is started within 10 years of menopause, the benefits outweigh the risks. In other words, the risks of HRT depend on factors such as age and context (family history, general health and medical history).

Are you considering hormone therapy?

HRT is a godsend for many women going through menopause. By replacing the hormones the body no longer produces, HRT alleviates uncomfortable symptoms, improving quality of life. Are you ready to explore if HRT is right for you?

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