During menopausal hormone therapy, oestrogen and progesterone levels in your body fluctuate and decrease. The greater these fluctuations, the more symptoms you may experience, such as hot flushes or mood swings. For severe hormonal symptoms, menopausal hormone replacement therapy (HRT/HT) can help stabilise hormone levels, reducing or eliminating symptoms.
Hormone replacement (HRT/HT) therapy supplements the sex hormones (oestrogen and progesterone) in your body during the period when your hormone levels are fluctuating and decreasing. This stabilises hormone levels and reduces fluctuations, significantly alleviating or even completely eliminating hormonal symptoms.
Hormone medication supplements both female sex hormones: oestrogen (oestradiol) and progesterone. Oestrogen supplementation reduces the hormonal symptoms experienced during menopause. Progesterone, on the other hand, protects against the excessive build-up of uterine lining (caused by oestrogen supplementation). This is important because an excess can lead to heavy bleeding and increase the risk of uterine cancer. If you are postmenopausal or do not have a uterus, progesterone is not necessary.
Together with your doctor, you will determine the right hormone dosage to alleviate or reduce your symptoms. The dosage is gradually increased. It may take a few months to find the appropriate form and dose.
Hormone replacement therapy can quickly and safely relieve menopausal symptoms for many women.
Since the 1960s, hormone replacement therapy has been widely used to relieve menopausal symptoms. Various international organisations, such as the North American Menopause Society, recommend it as the first and most effective choice for (vasomotor) symptoms, such as hot flushes, during menopause. HRT can help with:
HRT is not the first choice for every woman. For mild symptoms, or when someone is not yet ready to pursue this option, other forms of support can be considered, such as lifestyle adjustments, dietary changes, or the use of non-hormonal medication or supplements.
Additionally, there are medical situations where hormone replacement therapy is not recommended, such as a history of hormone-sensitive cancer, thrombosis, or certain liver conditions. Personal preference also plays an important role. Therefore, hormone replacement therapy is always carefully and individually assessed.
Hormonal medication is available in various methods of administration (such as tablets, sprays, gels, creams, and ovules) and may contain either bio-identical or synthetic variants of oestrogen and/or progesterone.
The choice of administration method and the type of oestrogen and/or progesterone depends on various factors, such as the nature of your symptoms. Most treatments that are prescribed contain bio-identical oestrogen (estradiol). Bio-identical estradiol is identical to the estradiol that a woman naturally produces.
In addition, it often contains bioidentical progesterone or synthetic progestogens (such as levonorgestrel or dydrogesterone). The best option varies from woman to woman. Some respond better to bioidentical hormones, while others benefit more from synthetic ones or a combination of both. This is usually determined over time and adjusted based on how your body responds.
If you still have a uterus, hormone replacement therapy is usually given as a combination of oestrogen and progesterone. Oestrogen helps reduce menopausal symptoms, while progesterone is needed to protect the uterine lining from excessive build-up caused by oestrogen.
Hormone replacement therapy (HRT/HT), such as Femoston, Lenzetto and Utrogestan, aims to stabilise your hormone levels. The improvement of symptoms often occurs in stages. Most women notice the first slight relief after a few days. What you observe and when depends on the symptoms you are experiencing. Improvement is typically noticeable within a few weeks. Over time, many women find that they sleep better, experience fewer hot flushes, and notice a reduction in vaginal symptoms. Muscles and joints may also become less sensitive, and some women feel more energetic.
Hormone replacement therapy is often prescribed for three months. This is because your body requires time to adjust to the new hormone levels. During this period, you may experience side effects that are typically temporary, such as nausea, irregular bleeding or spotting, or headaches.
Hormone replacement therapy is generally not used indefinitely. Doctors often recommend reviewing after a few years whether the treatment can be gradually reduced and regularly assessing whether it should be continued, depending on whether the benefits still outweigh the risks.
Hormonal medication is considered by specialists to be the most effective treatment for menopausal symptoms, but it does come with some risks, as is the case with nearly all medications. The risks are primarily relevant for women who start treatment later in menopause, use it for an extended period (typically longer than five years), and depend on factors such as the product, method of administration, dosage, and medical history. Oral hormone therapy with oestrogen slightly increases the risk of thrombosis, stroke, and gallbladder issues. When applied through the skin, the risk of thrombosis is lower, although gallbladder issues may still occur. If you have a uterus, progesterone/progestogen is always required alongside oestrogen to prevent uterine cancer. Combined hormone therapy carries a rare but increased risk of breast cancer when used long-term. Hormone therapy applied vaginally is minimally absorbed and does not show an increased risk of these complications.
At the same time, recent studies show that women who start hormone therapy early (before age 60) and use it for several years during menopause tend to live longer and healthier lives on average. Hormone therapy appears to reduce the risk of cardiovascular disease, dementia, osteoporosis, and overall mortality. These positive effects are most commonly observed in women who begin treatment around the onset of menopause.
Hormone therapy is not recommended for women with (a history of) breast cancer, hormonal cancers, stroke, thrombosis, liver disease, or abnormal vaginal bleeding.
Side effects of hormone replacement therapy
As hormone levels increase and/or the correct hormone dosage is determined, some side effects may occur during the first months of treatment:
Headaches
Nausea
Breakthrough bleeding
Tender or sensitive breasts
Below is an overview of the main differences between hormone replacement therapy, hormone-free medication, supplements, and lifestyle and dietary changes. Not every woman wants or is able to use hormone replacement therapy. This comparison can help you determine which option best suits your symptoms, health, and personal preferences.
Many women experience symptoms during menopause. Fortunately, there are ways to manage them. A variety of treatments are available, depending on your preferences and medical history. For multiple symptoms, a combination of treatments is often the most effective approach. If hormone replacement therapy is not suitable or not your preferred choice, the following options can offer additional support.
Treatment per symptom, alternative to hormone replacement therapy
Natural and free from hormones
The foundation for a healthy body
Not sure which treatment is right for you? The intake process includes a medical questionnaire about your symptoms, medical history, and treatment preferences. Your answers provide the doctor with a complete picture of your situation and preferences. Within 48 hours, you will receive personalised treatment plan. A personalised treatment plan costs £49.95.
Why a treatment plan helps:
nams-2022-hormone-therapy-position-statement.pdf
New evidence for cardiac benefit of postmenopausal hormone therapy - PubMed
A pragmatic approach to the management of menopause | CMAJ
Menopausal hormone therapy and women’s health: An umbrella review | PLOS Medicine
Menopause: Study lists the benefits of hormone replacement therapy