During menopause, 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, hormone therapy (HT/HRT) can help stabilise hormone levels, reducing or eliminating symptoms.
Hormone 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 therapy can quickly and safely relieve menopausal symptoms for many women.
Since the 1960s, hormone 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 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 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 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. If you do not have a uterus or are postmenopausal, progesterone is not always necessary.
Hormone therapy aims to stabilise your hormone levels. Within a few days, the first menopausal symptoms may begin to subside. Over time, many women notice improved sleep, fewer hot flushes, and reduced vaginal symptoms. Muscles and joints may also become less sensitive, and some women feel more energetic.
The dosage is usually gradually increased. It may take several weeks to months to find the right form and dosage. The effect varies from person to person.
Hormone therapy is generally not used indefinitely. Doctors often recommend evaluating after a few years to see if the treatment can be tapered off, depending on your symptoms and situation.
Hormone medication is considered by specialists to be the most effective treatment for menopausal symptoms, but it does carry some risks. These risks primarily apply to women who start treatment later in menopause. These include:
The risk appears to be lowest with bioidentical hormones administered through the skin.
At the same time, recent studies show that women who start hormone therapy early and use it for several years during menopause tend to live longer and healthier lives. Hormone therapy appears to reduce the risk of cardiovascular disease, dementia, osteoporosis, and overall mortality. These positive effects are especially observed in women who start around the onset of menopause and are treated under medical supervision.
Hormone therapy is also not recommended for women with a history of breast cancer, hormonal cancer, stroke, thrombosis, liver disease, or abnormal vaginal bleeding.
Side effects of hormone therapy
As hormone levels increase and/or the correct hormone dosage is determined, some side effects may occur during the first months of treatment:
Below is an overview of the main differences between hormone therapy, hormone-free medication, supplements, and lifestyle and dietary changes. Not every woman wants or is able to use hormone 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 therapy is not suitable or not your preferred choice, the following options can offer additional support.
Treatment per symptom, alternative to hormone 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