Here are our straightforward answers to some of the most frequently asked questions we (and Google) get asked about HRT.
WHAT IS HRT?
Hormone Replacement Therapy is a treatment which comes in various forms to boost levels of oestrogen and/or progesterone which begin falling as you approach the menopause.
This boost can ease – and in some cases even completely halt – a whole raft of symptoms, including hot flushes, night sweats and mood swings.
Some hormones given as HRT are synthetic. The more natural ‘body-identical’ or ‘bio-identical’ types are a closer match to what our body produces, often meaning fewer side-effects and they appear to be safer in the long-term.
If you’re struggling with low libido, your doctor may also recommend testosterone too, as it’s this hormone that makes us feel fruity and energised.
WHO CAN TAKE HRT?
It’s safe for most of us to take HRT. If you have a uterus (i.e. you have not had a hysterectomy) you’ll be given a mix of both oestrogen and progesterone. This is because oestrogen alone can overstimulate the womb lining and cause abnormal bleeding – progesterone protects the womb from this. Oestrogen-only HRT can be used after hysterectomy unless you had endometriosis.
If you’re at a higher risk of breast, womb or ovarian cancer, have high blood pressure, a history of blood clots or liver disease, your doctor might refer you to a menopause specialist or offer an alternative. If you’ve had breast cancer in the past, your cancer care team should support you in managing symptoms related to menopause, rather than your GP, because this is one instance when HRT can be dangerous.
If you’re a transman with your female reproductive system still in-tact, you will go through the menopause. However if you take testosterone at normal male levels, you’ll probably find you experience very few or no symptoms.
If you’re considering HRT, when should you start taking it?
The NHS advises that you can start taking HRT as soon as you notice symptoms.
The problem for many of us is there’s not always a clear distinction between signs of the perimenopause and what’s just down to life’s stresses and strains.
Dr Annice Mukherjee, author of The Complete Guide to the Menopause, says you should start taking HRT if you recognise any of the below:
- ‘My life is very challenging right now; symptoms are getting on top of me and I need to be at the top of my game to manage everything and to be there for my loved ones.’
- ‘I’ve reached menopause early (before my 51st birthday) so HRT will protect my bones and blood vessels.’
- ‘I’m having drenching sweats day and night – I can’t live like this.’
- ‘I’m exhausted and simply can’t do all the things I need to do.’
- ‘I can’t sleep and it feels like torture going to bed every night.
- ‘My mood has crashed and there is no other trigger except my hormone changes.’
- ‘I can’t function at work because of brain fog and hot sweats.’
- ‘I’m so irritable, I’m driving my partner away.’
- ‘I have no sex drive, my vagina is dry and on fire, and it’s making me miserable.’
- ‘My muscle aches are so much worse than before, I don’t want to move.’
We recommend you download an app to track potential symptoms and, of course, read up on them so you know what to look out for.
HOW DO YOU TAKE IT?
Choices, choices! There are loads of different ways to take HRT and it all comes down to personal preference. There are one-a-day tablets of course, but you can also use creams, stick-on patches,
gels and there’s even a IUD coil version which doubles-up as contraception.
If you have a uterus you’ll be prescribed combined HRT. This is either given “cyclically” – where you take oestrogen continuously but progesterone for only part of each month. This is given in perimenopause when you’re still having periods or when your most recent one was within the last twelve months. Then there’s ‘continuous combined HRT’ – a dose of oestrogen and progesterone which stays the same every day, once you’ve gone 12 months without a natural bleed (so you’re post-menopausal).
Dr Annice Mukherjee adds: “If you’re experiencing heavy, erratic or painful bleeding or if the bleeding makes you anaemic, your doctor may recommend you have a progestogen hormone intrauterine device (IUD) coil.’
The coil can stop bleeding altogether during perimenopause, protect the womb lining and stop you getting pregnant. You’ll also be given oestrogen-only HRT in the form of gels, patches or tablets to treat your other perimenopausal symptoms (you’ll get progesterone through the coil.) Once you’ve gone a year without a natural period you can switch to a progesterone and oestrogen combined alternative. This might bring on some bleeding to begin with but will settle down.
If you’ve never had any bleeding on HRT but then suddenly start, ask your doctor to investigate. “It’s relatively common to get unscheduled bleeding on HRT and it’s usually nothing to worry about,” says Dr Annice, “but it must be checked out just in case it’s the start of something serious.”
What are the potential side effects of HRT?
Like pretty much every medicine on the planet, HRT can have side effects. This includes (but isn’t limited to): bloating, tender breasts, nausea, leg cramps, headaches and migraines, indigestion, weight gain and sometimes vaginal bleeding.
Your doctor will normally put you on a three-month course to see how your body reacts as most side effects will iron themselves out in this time. It can take a little while to find the right dose and treatment type, so be patient and go with what feels right to you – not anybody else.
HOW CAN YOU ACCESS IT?
If you’re in the UK, the most common way to start on HRT is through your GP. You don’t have to wait though – you can go private and the cost might not be as eye-wateringly expensive as you’d expect, with initial consultations often free.
Dr Louise Newson, The Menopause Doctor, has written a handy prescribing guide which you can download, print and share with your doctor. Simply search ‘easy’ on her website.
Check out our medical resource page for recommended clinics who can help you find the right treatment plan without delay.
WHAT’S THE DIFFERENCE BETWEEN BODY-IDENTICAL AND BIO-IDENTICAL HRT?
Okay, this is where it gets a bit complicated but we’ll try to keep it as simple as possible.
Body-identical hormones are structurally exact copies of the oestrogen and progesterone molecules made by your body.
“Licensed” bio-identical hormones are newer to the market, but are regulated by the authorities to ensure any adverse events are recorded. They are safety tested and safer than many of the old-fashioned synthetic HRT brands.
“Compounded” bioidentical hormones are also identical to what your body produces but are not regulated. Some private clinics offer these formulations but because they’re unregulated there’s no-one to report adverse effects to. Internationally, menopause societies all recommend against the “compounded” formulations and favour the “licensed” bioidentical forms of HRT.
There are a lot of tall tales and misinformation about HRT. Below are some of the most common and the truth behind them.
“HRT CAUSES CANCER AND BLOOD CLOTS.”
Over the last 15 years or so, there’s been a whole swathe of studies which have shone a spotlight on the risks of HRT. So much so, it’s put a lot of people off giving it a go and even doctors from
In fact, all the risks are fairly low, and often massively outweighed by the benefits.
In terms of breast cancer, the risk does increase the longer you’re on HRT, but will begin to reduce once you stop. If you’ve had breast cancer before, it’s not generally recommended that you take HRT but reach out to your treatment team (rather than your GP) for their specialist advice. Combined HRT almost eliminates the risk of womb cancer, and you’ll only be offered oestrogen-only HRT if you’ve had a hysterectomy. Finally, the link to ovarian cancer is thought to be minimal – one extra case per 1,000 who take it for five years.
Oestrogen in tablet form does increase your likelihood of getting a blood clot but again, the risk is very small (around two in every 1,000 women taking tablets for seven-and-a-half years, according to the NHS), and the creams and skin patches don’t bring any additional risk of clotting. Tablet progesterone does not appear to carry an increased risk of blood clots.
“IT WILL MAKE YOU FAT.”
As with any medication, HRT can have side effects – but weight gain isn’t one of them.
Unfortunately though, it is a symptom of the perimenopause and menopause.
There are plenty of simple ways you can ward off extra menopausal pounds which we should all be doing regardless of whether we’re taking HRT or not.
“YOU CAN ONLY TAKE IT
FOR FIVE YEARS.”
To put it bluntly, this is nonsense. You should be on HRT for however long you need to be. This will all come down to your symptoms, your genetics, your health and how you feel.
If you start taking it in your 40s while in the perimenopause, then your doctor will normally advise you keep taking it at least until the average age of menopause, which is 51 years in the UK.
It’s best to come off it gradually, and if symptoms flair back up don’t be afraid to go back on it.
“GOING NATURAL IS ALWAYS BETTER.”
Well, not if you're a hot mess, feeling pants about yourself or unable to live your life as normal.
It’s best to research your specific symptoms to find which might work best for you.
Of course there are plenty of natural remedies and supplements you can try (which come with warnings of their own) but that’s not to say you should dismiss HRT.
We don’t think women should be demonised for making the right choice for their body – and if that is HRT, we’re 100% behind you.
“HRT WILL SLOW DOWN YOUR MENOPAUSE.”
This isn’t true. HRT also doesn’t delay menopause. Most women experience symptoms for between two and eight years, and generally, they lessen gradually.
Turn that frown upside down though as HRT can help make the whole journey feel a whole lot smoother, and you might even jump for joy once you don’t have to deal with pesky periods anymore.
“TESTOSTERONE WILL MAKE YOU HAIRY.”
Technically this is true in higher doses. However, female bodies do naturally make testosterone. And if you’re struggling with a low sex drive, including this ‘male’ sex hormone in your HRT treatment can really help get your engine going, if you know what we mean.
Getting the dose right is important to avoid sprouting new hairs (among other symptoms), so this treatment will need to be guided by a doctor who regularly prescribes testosterone as part of HRT.