Hormone Replacement Therapy – what are the options?

For many women in the UK, menopause brings a range of physical and emotional symptoms that can significantly impact daily life. Hormone Replacement Therapy (HRT) is a common treatment option that helps alleviate these symptoms by replenishing hormones that naturally decline during menopause. If you’re considering HRT, it’s important to understand the available options, their benefits, and potential drawbacks.

Some of the most common symptoms of menopause are:

hot flushes
night sweats
vaginal dryness
low mood and/or feeling anxious
joint and muscle pain
loss of interest in having sex.

What are your options for menopausal symptoms?

HRT is the most common form of prescribed treatment for symptoms. HRT involves supplementing the body with oestrogen and, in some cases, progesterone to counteract the hormonal changes associated with menopause. The main goal of HRT is to relieve symptoms such as hot flushes, night sweats, mood swings, and vaginal dryness, while also offering longer-term benefits such as maintaining bone density.

Ways of taking HRT

HRT comes in several different forms. There are pros and cons for each and you may need to try different brands and methods of taking HRT to find the one that suits you. Talk it through with a GP first.

In the UK, women have several options to choose from, depending on their medical history, symptoms, and preferences:

1. Oestrogen-Only HRT

Oestrogen-only HRT is recommended for women who have had a hysterectomy, as they do not need progesterone to protect the womb lining. It is available in various forms, including tablets, skin patches, gels, and implants, allowing flexibility in administration. This type of HRT helps alleviate menopause symptoms such as hot flushes, night sweats, and vaginal dryness while also supporting bone health.

Suitable for women who have had a hysterectomy (removal of the womb).
Available as tablets, skin patches, gels, or implants.

2. Combined HRT (Oestrogen and Progesterone)

Most hormone replacement therapy is a combination of two female hormones, an ‘oestrogen’ and a ‘progestogen’. Oestrogens and progestogens are natural female hormones which are used to treat women’s health problems, including menopausal symptoms.

Recommended for women who still have their uterus, as progesterone helps protect the womb lining from excessive growth caused by oestrogen.
Can be taken as tablets, patches, gels, or intrauterine devices (IUDs).

3. Body-Identical and Bioidentical HRT

The safest and most regulated type of HRT – and that prescribed by the NHS – is body identical HRT. This includes oestrogen you take through your skin in a patch, gel or spray, and micronised progesterone, known as Utrogestan in the UK. Body identical HRT is derived from the yam plant and has the same molecular structure as the hormones you produce naturally from your ovaries.

Body-identical HRT contains hormones chemically identical to those produced by the human body.
Available on the NHS and considered a safer alternative to some synthetic versions.
Bioidentical HRT (often provided privately) is similar but less regulated.

4. Local (Vaginal) HRT

Low dose oestrogen is also available as a cream, gel, vaginal tablet, pessary or ring that you put inside your vagina. This can help with menopausal symptoms such as vaginal dryness, a burning sensation, or pain during sex.

Includes creams, vaginal rings, and pessaries containing low doses of oestrogen.
Used primarily to treat vaginal dryness and discomfort without affecting the whole body.

Benefits of HRT

Many women find HRT significantly improves their quality of life by addressing symptoms such as:

Relief from menopause symptoms: Reduces hot flushes, night sweats, and mood swings.
Bone health: Helps prevent osteoporosis and reduces fracture risk.
Heart health: Some studies suggest HRT may lower the risk of heart disease if started early.
Cognitive benefits: Some evidence suggests a potential role in reducing dementia risk.

Potential Risks and Disadvantages

While HRT is beneficial for many, it is important to be aware of potential risks:

Increased risk of blood clots and stroke: Especially with oral oestrogen.
Breast cancer risk: Long-term use of combined HRT has been associated with a small increased risk of breast cancer.
Side effects: Possible headaches, nausea, breast tenderness, and bloating.
Not suitable for everyone: Women with a history of certain cancers, liver disease, or cardiovascular issues may not be suitable candidates.

Making the Right Choice

If you are considering HRT, it’s essential to consult with your GP or a menopause specialist. They can help determine the best type and dose for you, considering your medical history and personal preferences. Regular reviews and adjustments may be needed to ensure optimal benefits while minimising risks.

HRT can be a life-changing treatment for many women navigating menopause. With various options available in the UK, understanding the benefits and potential risks can empower you to make an informed decision about your health. If you’re experiencing menopause symptoms and want to explore HRT, speaking with a healthcare professional is the best first step.

The NHS have an extensive list of benefits and disadvantages of all types of HRT options online Types of hormone replacement therapy (HRT) – NHS