Hormone therapy: what can you expect?

The symptoms experienced during menopause occur because your ovaries cease producing oestrogen and progesterone. Consequently, the levels of these hormones decline, leading to various changes in your body. This is entirely normal, but there are ways to ease or lessen your symptoms. Hormone replacement therapy (HRT) helps to supplement the hormone deficiency.

There are two main forms of HRT:

1. Oestrogen-only therapy: This is for women who no longer have a uterus or as a local treatment for vaginal symptoms.   

2. Combined therapy (oestrogen + progesterone/progestogen): If you still have your uterus, the addition of a progestogen is necessary. This protects the uterine lining from excessive growth and reduces the risk of uterine cancer.

These hormones can be administered in various ways: orally (tablets), through the skin (patches, gel, or spray), or locally in the vagina.

The improvement of your symptoms often happens in stages. Not everything is resolved on the first day, but most women experience swift relief and observe the initial subtle effects within a few days. What can you expect to notice and when? 

• Hot flushes and night sweats: These are the most common reasons to begin hormone replacement therapy (HRT). With a standard dosage, you will typically experience a 75% to 80% reduction in the severity and frequency of these symptoms within four weeks.

• Vaginal dryness and urinary symptoms: Symptoms such as pain during intercourse or recurrent bladder infections typically improve within two to four weeks after commencing (local) hormone replacement therapy.

• Joint and muscle pain (sometimes resembling fibromyalgia) often improves significantly after approximately four weeks of hormone replacement therapy (HRT).

• Your sleep quality may improve, typically after four weeks; this is partly due to the cessation of night sweats, but the supplemented hormones also seem to have a directly beneficial effect on your sleep pattern.

• Oestrogen therapy can help counteract skin ageing within a few weeks by maintaining thickness, elasticity, and collagen levels.

• Hormone replacement therapy can reduce dizziness or vertigo within just four weeks and may help improve your balance.

• Concentration problems and brain fog may diminish within three weeks, once hormonal balance is restored and overall quality of life improves.

• Osteoporosis (bone loss): hormone replacement therapy (HRT) effectively protects against bone loss and reduces the risk of fractures by approximately one-third over the long term.

Hormone therapy is typically prescribed for an initial period of three months. During this time, your body will need to adapt to the new hormone levels. During this adjustment phase, you may encounter side effects that are generally temporary:

• Irregular bleeding or spotting: This occurs in approximately 40% of women during the first six months.

• Physical symptoms: Tender breasts, mild nausea, bloating, or headaches are common during the early stages. 

• Administration: Patches may occasionally cause mild skin irritation.

Most of these symptoms resolve within the first few months. If this does not happen, inform your doctor. An alternative dosage or method of administration may be more appropriate.

As with any medical treatment, there may be side effects or risks associated with hormone replacement therapy (HRT). It is important to understand that your personal risk largely depends on your age, particularly the age at which you begin hormone replacement therapy, your medical history, and the manner in which you use the hormones.

The 'window of opportunity'  

For healthy women who are younger (even if you begin while still experiencing (some) menstrual periods), under the age of 60, or less than 10 years into menopause, the benefits of hormone replacement therapy (HRT) generally outweigh the risks. This is often referred to as the 'window of opportunity.' However, if you start much later (in your 60s or 70s), the absolute risks of cardiovascular diseases and strokes increase.

Bio-identical or synthetic?

Hormone replacement therapy can be administered using various forms of oestrogen and progesterone.

• Bio-identical hormones are identical to the hormones your body naturally produces. They are also metabolised in the same way. This is favoured by many women and doctors.

• Synthetic hormones have the same effect but possess a different biochemical structure. They replicate the function of the body’s natural hormones.

Dosage forms

There are various forms of hormone replacement therapy. The most suitable form depends on your symptoms and personal circumstances.

• Oral administration: think of tablets and capsules. The hormones are metabolised in the liver, which slightly increases the risk of other conditions.

• Administration through the skin (transdermal): think of gels, ointments, and patches. As the hormones are absorbed through the skin, a lower dosage is often sufficient. The hormones also bypass the liver, reducing the risks of other conditions. 

• Vaginal hormone replacement therapy: such as creams and ovules. These deliver a low dose directly into the vagina. This can occasionally cause vaginal irritation, but it does not affect the rest of the body, as this type works locally. This method of administration is therefore only appropriate for addressing local symptoms (dryness, pain during intercourse, and sometimes recurrent urinary tract infections).

Administration through the skin or locally (vaginally) is preferred, as this carries the least risk.

No, there are situations where you need to exercise extra caution or should avoid using hormone replacement therapy (HRT). This applies, for instance, in cases of a history of breast cancer, unexplained vaginal bleeding, severe liver disease, gallbladder disorders, or a recent heart attack or stroke.

There is no definitive rule regarding when to discontinue hormone therapy. The treatment is tailored to the individual. It is important to regularly evaluate whether HRT remains advantageous. Many women undergo hormone replacement therapy (HRT) during the phase when their symptoms are most intense, typically for around five years. Women who experience early menopause (Premature Ovarian Insufficiency or POI, before the age of 40) require a longer duration of treatment.

Hormone replacement therapy can greatly enhance your quality of life during menopause. It is important not to endure this in silence. At SeeMe-nopause, you can access online menopause care. Following an initial consultation, an independent doctor will develop a personalised treatment plan tailored to your individual circumstances, medical history, and preferences. The doctor will select the most suitable and safest treatment for you. If hormone replacement therapy is the recommended option, the doctor will often choose bio-identical hormones administered through the skin or applied locally.